Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Fall 2020 Advanced Patho > Renal Pathophysiology > Flashcards

Renal Pathophysiology Flashcards

1
Q

Renal Function

The kidneys perform several functions

  • Filters the metabolic wastes (especially _____ waste) from the blood plasma and excretes it from the body. Such as (3). Is the primary route of elimination for ____
  • Participates in the maintenance of constant extracellular environment, required for proper ___ functioning (ECF: v____, os____, p__, etc)
  • Excretes ____ and ____ to match water intake and endogenous production. Regulates excretion of water and solutes by changing tubular reabsorption or excretion. (maintains essential electrolyte balance, ___, ___, etc)
A
  • nitrogenous, (urea, creatinine, uric acid), drugs
  • cell (volume, osmolarity, pH)
  • water and electrolytes (Na, K)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Renal Function Part 2

  • Secretes _____ that participate in systemic and renal ______ regulation (r____, pr_____, br_____), ___ blood cell production (_____), as well as c_____, ph_____ and b____ metabolism (vitamin __)
  • Perform other functions such as catabolism of peptide hormones and synthesis of glucose (______) when fasting
A
  • hromones, hemodynamic (renin, prostoglandin, bradykinin), red (erythropoietin), calcium, phosphorus, bone (D)
  • glyconeogenesis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Assessing Renal Function: Basic Steps in Urine Formation

(3)

  • Renal Clearance Rate: the rate at which a substance is _____ from the blood over _____
    • Assuming substance X is freely filtered: __% filtered out at glomerulus -> then goes through TR, TS, elimination
    • Tubular reabsorption _____ the clearance rate
    • Tubular secretion _____ the clearance rate
A

Glomerular Filtration

Tubular Reabsorption

Tubular Secretion

  • 20%
  • decreases
  • increases
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clearance and Measurements of Renal Function

  • Plasma clearance is the ____ of plasma cleared of a particular ____ per ____
  • Useful tool for evaluating renal ____: How effective the kidneys are at removing various substances from the internal environment

Clearance rate (ml/min) = ____ for substance (quantity/ml urine) x Urine ____ / ____ for substance (quantity/ml plasma)

  • usually assessed through (1)
A
  • volume, substance, minute
  • function
  • urine x flow rate / plasma
    • 24 hour urine collection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Patterns of Renal Handling

  1. Freely filtered -> __ reabsorption -> __ secretion
  2. Freely filtered -> __ reabsorption -> __ secretion
  3. Freely filtered -> __ reabsorption -> __ secretion

  • Fastest rate of secretion #__
  • Slowest rate of secretion #__

Conclusion, hard to find a substance that accurately will reflect true ___

A
  1. NO reabsorption, ALOT of secretion
  2. Modest reabsorption, NO secretion
  3. Full reabsorption, NO secretion
  • 1
  • 3

GFR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

GFR

Measures?

____ ml plasma/min

We use the clearance rate of certain _____ to estimate GFR

So how must a substance be handled if its going to effect GFR

  1. Must be ____ filtered (not ___ to plasma proteins)
  2. Can’t undergo any ____ or ____ (rate of filtration = rate of excretion)
  3. ____ plasma concentration
  4. Can’t effect GFR like _____
A

Healthy Nephron Mass

125 ml plasma/min

substance

  1. freely (not bound)
  2. no reabsorption or excretion
  3. stable
  4. hormones
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Clearance and GFR

(1): perfect substance that is not endogenous, the only thing that’s missing is? bc not endogenous so would have to sit there with a gtt

(1): substance we actually use, is a byproduct of?

  • Has all aspects except there is a tiny bit of?

CrCL = slight ______ of GFR (bust still best bet and what we use)

A

Inulin (missing stable plasma concentration)

Creatinine (byproduct of muscle metabolism - creatinine phosphate powers the first few sec of muscle conttraction so constantly being producted)

  • Tiny bit of secretion

Overestimation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Blood Tests

  • Plasma _____ (Pcr) (as indicator of GFR)

A long term decline in GFR over weeks or months is reflected in the plasma Creatinine concentration

  • Normal value ___-___

Stability of Pcr is dependent on stable GFR values

  • When GFR declines = Pcr ______ proportionately (____ proportionate)
  • Is useful for monitoring the progress of _____ rather than acute renal disease because it takes __-__ days for plasma Creatinine to stabilize when GFR declines
A
  • Plasma Creatinine
  • 0.7-1.2
  • increases (inversely proportionate)
  • chronic disease, 7-10
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Inverse Relationship btwn GFR and Plasma Creatinine

  • Long term decline in GFR -> _____ of plasma Cr
    • Ex) ____ with open faucet, open drain, if drain is closed/backed up (GFR), water lvl (Plasma Cr) rises
  • Normal GFR ~125, normal plasma Cr __-__ -> CrCl is a good ____ of overall ____ of GFR
A
  • elevation
    • bathtub
  • 0.7-1.2, snapshot of overall stability of GFR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Limitations with Serum Creatinine Values

  1. Compensatory _____
  2. Variation in Creatinine ______
  3. Variations in Creatinine ______
  4. Presence of certain _____
  5. ____ Creatinine Excretion
A
  1. Compensatory Hypertrophy
  2. Variations in Cr Production
  3. Variations in Cr Secretion
  4. Presence of certain Drugs
  5. Extrarenal Creatinine Excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Limitations with Serum Creatinine Values (Notes)

  1. Compensatory Hypertrophy = response to early? so can filter faster to compensate -_____ kidney disease
  2. Variations in Creatinine Production unrelated to GFR (d___, muscle ___, recent ___ meal, muscle w____, limp ____, rh____)
  3. Variations in Creatinine Secretion (increased proximal tubular creatinine secretion with (1))
  4. Presence of Certain Drugs may ____ the lvl of serum Cr by decreasing Cr secretion ex) T_____, S______…both are?
  5. Extrarenal Creatinine Excretion: increased creatinine metabolism by ____ in the GI tract with advanced kidney disease
A
  1. nephron loss, ex) 30% nephron loss dt kidney disease bc other 70% is working overtime -> which means inflammation, injury, burn out - Masks kidney disease
  2. diet, muscle mass, meaet, wasting, amputation, rhabdo
  3. early renal disase
  4. increase Cr, Trimethoprim, Sulfamethoxazole…both antibiotics
  5. bacteria in GI tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Plasma Cycstatin C (as an Estimate of GFR)

  • A low molecular weight protein that is a member of the cystatin superfamily of cysteine protease inhibitors filtered at the glomerulus and NOT ______ but is ______ in the tubules, which ____use of cystatin C to _____ measure clearance.
  • Cystatin C is produced by all nucleated _____: its rate of production has been through to be relatively _____ and thought to be unaffected by g____ or ____ mass
A
  • NOT reabsorbed, metabolized in tubules, prevents use of cystatin C to directly measure clearance
  • cells, constant, gender, muscle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Blood Urea Nitrogen (BUN)

The concentration of urea nitrogen in the blood reflects glomerular filtration and urine concentrating capacity

  • Urea is ____ filtered so as GFR goes down BUN ____
  • Urea is also ______ by the tubule - BUN ____ in states of dehydration and acute and chronic renal failure (also varies as a result of altered protein intake and protein catabolism)
  • Comparisons of BUN to ___ can be useful
A
  • freely, GFR down, BUN increases
  • reabsorbed, decreases
  • Pcr
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

BUN (Notes)

Urea = waste product of ____ metabolism, can also get recycled and the nitrogen in urea can be used to make new (2)

  • Handling of urea by kidneys: ____ filtered, __% reabsorbed, __ secretion
  • Reabsorption of urea entirely dependent on reabsorption of ____ (more water reabsorbed = more urea reabsorbed)

GFR ____/_____ (water conservation) -> BUN increases

Similar to Creatinine is a helpful indicator of what’s happening in the kidneys in terms of GFR

Normal Bun: Cr Ratio =

  • ​Increase in both #s w same ratio =
  • Increase in both and ratio goes up =
A

waste produce of protein metabolism -> amino acids, protein

  • freely filtered, 50% reabsorbed , no secretion
  • water

GFR decreases/Dehydration

20:1

  • decrease in GFR
  • decrease in GFR AND water reabsorption has happened
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Urinalysis

=

Changes in c____, cl____, p__, presence of ____, o___

A

Oldest, cheapest way in assessing renal function

color, clarity (cloudy), pH, cells, odor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Urine Dipstick Tests

=

Assesses presence of (7)

A

Assesses presence of

  • Nitrates
  • Protein (common in HTN/CV disease)
  • pH (Diabetic Ketoacidosis, Alkaline urine in UTIs)
  • Blood
  • Specific Gravity (comparison of density of urine vs. distilled water) - easy way to estimate osmolarity (higher osmolarity -> higher specific gravity (dehydration))
  • Ketones, Glucose (diabetes)
  • Bilirubin (liver disease)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Urine Sediment Analysis

=

What you’ll be able to see

  • _____ (more under certain pH lvls)
  • C____ crystals
  • ____ acid
  • Cells (2)
  • H__, I____
  • (1): strips of cells that are interior epithelim of tubule named (1)
A

Centrifuge -> solid particles pushed to bottom -> pour out liquid and visualize sediment on plate through microscope

  • crystals
  • Calcium
  • uric
  • (bacteria, wbcs)
  • Hgb, Iron
  • Casts - acute tubular injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Disorders or Alterations in Renal and Urinary Function

*Most common source of reduced renal function =

  1. Changes in Renal Function with _____
  2. Intrarenal Disorders
    1. ​C_____ Disorders
    2. In_____ Disorders
    3. O____ Disorders
    4. G_____ Abnormalities
  3. Disorders of _____ Function and Micturition
  4. Renal _____
A

​AGING

  1. Aging
  2. Intrarenal
    1. ​Congenital
    2. Infectious
    3. Obstructive
    4. Glomerular
  3. Bladder
  4. Failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

The Aging Process

With aging there is a __-__% decrease in n____, s___, w____, and f____ of the ______

  1. Decreased renal ____ flow
  2. Decreased size and weight of ____
  3. Decreased bladder _____
  4. Decreased bladder ____
  5. Increased urinary _____ weakness
  6. Change in ____ of female urethra
  7. Loss of ____ excretion pattern
A

30-50%, number, size, weight, function of nephron

  1. blood
  2. nephron
  3. innervation
  4. capacity
  5. muscle
  6. structure
  7. diurnal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

The Aging Process Effects

Main Takeaway:

Main Consequence:

  • Decreased GFR, resorptive capacity, excretion -> decreased excretion of d___, m_____ -> need to ____ dose of drugs bc excretion is slower
  • Decreased excretion of H+ -> more vulnerable to _____
  • Decreased ability to concentrate urine -> more vulnerable to _____
  • Increased in renal threshold for glucose -> decrease in likelihood of glucose ____ -> more glucose in ____
  • Loss of diurnal excretion -> usually kidneys know when ur flat and asleep so rena blood flow tends to slow down, if this is not present -> ______
  • Urinary i_____
A

30-50% decrease in #, size, weight, and functional nephrons

Decreased rate of urinary excretion -> drugs, contrast, metabolites

  • drugs, metabolites -> lower
  • acidosis
  • dehydration
  • urea -> in blood
  • nocturia
  • incontinence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Obstructive Disorders

Upper Urinary Tract Obstruction:

Lower Urinary Tract Obstruction:

Common Causes of Obstructions

  1. _______ kidney disease (right kidney in pic)
  2. D_____ of ureter
  3. ________: dilation upstream of obstruction
  4. Fibrous _____
  5. S_____/narrowing
  6. ______ Hypertrophy
A

obstruction above bladder

obstruction below bladder

  1. Polycystic
  2. Dysplasia
  3. Hydronephrosis
  4. Fibrous bands
  5. Stenosis
  6. Prostate
22
Q

Most Common Cause of Obstruction (Upper, Lower)

=

A

Kidney Stones (Renal Calculi, Nephrolithiasis)

Prostate Hypertrophy

23
Q

Kidney Stone

Solid mass that consists of a collection of tiny ______

  • One or ____ stones present at the same time in the ____ or ____
  • Caused by super_____ of the urine by stone forming constituents, including (3) - overwhelming majority of renal calculi contain (1)
  • Which gender has a higher incidence? why?
  • Tx (1), Rx (1)
  • Causes
    • (1): increase calcium in urine - usually RT set close to normal blood concentration so normally would get removed easily. Elevated calcium causes: ___ mineralization, o_____, c_____, over_____
    • Low ___: usually interferes with stone formation
    • Low ____ intake
A

Crystals

  • more, kidney, ureter (parenchyma of kidneys and travel into renal pelvis)
  • supesaturation - Calcium, Oxalate, Uric Acid - Calcium
  • Men dt higher GFR (higher filtration rate)/longer urinary tract
  • Naturally passing the stone but V painful “worse than childbirth”, Ca channel blocker may help ureters to relax to pass stone
    • Hypercalcuria: bone mineralization, osteoporosis, corticosteroids, overconsumption
    • Low Mg
    • Low Fluid Intake
24
Q

Benign Prostatic Hyperplasia

=

  • Prostate Enlargement: can be caused by (3)
  • A _____ problem affecting the QOL for approximately 1/3 of men older than ___ yrs. Histologic evidence of BPH occurs in up to 90% of men by age 80 yrs.
  • Common Symptoms
    • Urinary _____
    • Urinary _____
    • Urinary _____
    • Incomplete bladder ______ (straining)
A

Noncancerous enlargement of prostate gland that may restrict flow of urine from bladder

  • acute inflammation, BPH, Prostate cancer
  • common problem, >50y
    • Frequency
    • Urgency
    • Hesitancy
    • Incomplete bladder emptying

Acute inflammation dt microorganisms that commonly cause prostatitis -> tx with abx

BPH most common cause: enlargement dt testosterone lvls decrease with aging

25
Q

Functions of the Prostate Gland

  1. Produces (1) that constitutes 70% of volume of _____ -> function to?
  2. Clamps down on urethra to prevent what during ejaculation?

  • Is the size of a walnut and surrounds _____
  • What about the prostate’s anatomy is the reason why it can narrow the urethra when enlarged?
A
  1. Alkaline fluid, semen, protect sperm from acidic vaginal environment
  2. Retrograde movement of semen into bladder
  • Urethra
  • Outside covering is inelastic (doesn’t stretch)
26
Q

Prostate Cancer

Is the ____ most common cancer except for non-melanoma skin cancer

  • The clinical behavior of prostate cancer ranges from microscopic, well-_____ tumor of little clinical importance, to an ______ cancer with substantial invasive and _____ potential
  • (1) Testing has improved detection (+ DRE and biopsy)

Treatment options:

  • Active ______ (wait and see)
  • R_____ Therapy
  • Prostate-____
  • Androgen _____ Therapy (palliative option with several common adverse effects)
    • S_____ Dysfunction
    • O_____ and bone _____
    • V_____ symptoms
    • Gyno____
A

2nd most common

  • well differentiated -> aggressive, metastatic
  • PSA: protein found on prostate cells -lvls correlate w prostate mass (higher in CA then same size prostate in BPH)
  • Surveillance (if biopsy done and cells low grade)
  • Radiation
  • Prostatectomy (better now but risk of damaging penile nerves -> ED, incontinence)
  • Deprivation (bc cancer cells were originally prostate cells, will grow when exposed to male hormones, block to limit growth)
    • Sexual Dysfunction
    • Osteoporosis, bone fractures
    • Vasomotor
    • Gynomastia
27
Q

DRE

Assesses for

  1. _______
  2. ______ more likely in CA vs. symmetrical enlargement in BPH
  3. S_____, B____ (consistent with inflammation-prostatitis)
A
  1. Enlargement
  2. Nodules
  3. Spongey, Boggy
28
Q

What is this picture an example of?

A

Nodular Prostate Cancer

29
Q

2 Major Complications of Tract Obstructions

A

Hydronephrosis and Hydroureter

Pyelonephritis and UTI

30
Q

Hydronephrosis and Hydroureter

  • Hydronephrosis is defined as a _____ of the renal pelvis and calyces
  • Rise in ureteral ____ leads to decline in renal blood flow and glomerular filtration.
  • What can occur if left untreated?
  • Gross changes within urinary tract depends on d_____, degree, and l____ of obstruction
  • May lead to Renovascular _______ (dt reduced renal blood flow)
A
  • Dilation
  • pressure
  • Ischemia and nephron loss
  • duration, degree, level of obstruction
  • Hypertension
31
Q

Pyelonephritis and UTI

  • Almost all UTI’s are ______ in origin
  • Contributing factors include
    • Urinary ______
    • _____ changes like hyerglycemia -> diabetics more vulnerable
    • _____ kill normal flora in lower urinary tract -> less competition for pathogenic organism
  • ​Most Common Organism?
  • Higher incidence in what gender?
A
  • Ascending
    • Stasis
    • Metabolic Changes
    • Antibiotics
  • E.COLI from fecal matter
  • Female > Men bc women have shorter lower UTI (less distance for bacteria to travel)
32
Q

UTI and Pyelonephritis Risk Factors

  1. Structural Abnormalities AKA? - C_____, infected c____, renal/bladder ab____, certain forms of pyelonephritis, ___ ___ injury, c_____
  2. Metabolic/Hormonal abnormalities - ______, _____
  3. Impaired host _____: _____ receipients, pts with ____
  4. Unusual pathogens: _____ etc
  5. Disturbance of non-harmful urethral _____ : broad spectrum _____
A
  1. Urinary Stasis - Calculi, cysts, abscesses, SCI, catheter (stasis from not needing to contract muscles to pee + introduces bacteria, req sterile technique)
  2. Diabetes, Pregnancy (reduces bladder muscle tone)
  3. response: transplant, AIDS
  4. yeast
  5. Flora: antibiotics

+ poor hygiene

33
Q

Acute Renal Failure

=

Defined as pre____ and significant (>__%) decrease in (1)) over a period of ____ to ____, with an accompanying accumulation of (1) in the body

A

precipitous, >50% decrease in GFR, hours to days, accumulation of nitrogenous wastes

34
Q

Acute Renal Failure

Three Main Mechanisms

  1. ​(1): GFR is depressed by compromised renal perfusion
  2. (1): includes diseases of glomerulus or tubule, which are associated with release of renal afferent vasoconstrictors
  3. (1): initially causes an increase in tubular pressure, decreasing the filtration driving force
A
  1. Prerenal blood flow (prob with renal blood flow)
  2. Intrinsic renal (Intrarenal) failure (damage to structure)
  3. Postobstructive renal failure (impedence of urinary outflow causes pressure and shuts down GFR)
35
Q

Prerenal Causes of Acute Renal Failure

  1. Hypovolemia
    1. H____
    2. De_____
    3. Excessive loss of _____ fluids
    4. Excessive loss of fluid dt ____ injury
  2. Decreased vascular filling
    1. Anaphylactic, Septic _____
  3. Heart ____ and C____ shock
  4. Decreased renal perfusion due to vasoactive mediators, d____, d____ agents
A
  1. Hypovolemia
    1. Hemorrhage
    2. Dehydration
    3. GI
    4. burn
  2. Decreased vascular filling
    1. Shock
  3. Heart Failure, Cardiogenic Shock
  4. drugs (vasoconstrictors that reduce blood flow), diagnostic agents
36
Q

Intrinsic or Intrarenal Causes of Acute Renal Failure

  1. Most Common (1): injured tubule cells die and cause shedding of sheets (casts)
    1. ​(1) ie pt with heart attack -> drop in CO -> pre renal failure -> ischemia -> necrosis -> intrarenal failure
    2. (1) drugs, contrast, heavy metals, organic solvents
A
  1. Acute Tubular Necrosis
    1. ​Ischemia
    2. Exposure to Nephrotoxic Substances
37
Q

Postrenal Causes of Acute Renal Failure

  • _____ _____ obstruction
  • _____ outlet obstruction
A
  • Bilateral Ureteral Obstruction
  • Bladder Outlet Obstruction
38
Q

Acute Tubular Necrosis

How does Acute Tubular Necrosis reduce glomerular filtration?

A

Tubular cells dying and getting shed and cause obstructions in nephron -> increased pressure in bowman’s capsule -> blocks GFR

Can potentially see tubular cells in the urine

39
Q

Three Distinct Phases w Tx of Renal Failure

  1. Oliguric Phase (____ urine output)
    • BUN and Creatinine lvls ____
    • _____ can occur causing edema, weight gain, and high BP
  2. Diuretic Phase (_____ urine output)
    • Urine output can range from __-__L/day to __-__L/day
    • _____ ability to _____ water and sodium
    • Osmotic ____ produced by high ___ lvls
  3. Recovery Phase (GFR _____)
    • When (3) lvls normalize
A
  1. decreased UO
    • rise (MI, hemorrhage, in shock -> want to make sure they’re forming urine, check blood for BUN/Cr)
    • Hypervolemia
  2. increased UO
    • 1-2L - 4-5L
    • decreased, conserve
    • diuresis, BUN (dt getting rid of excess urea)
  3. normalizes
    • BUN, Creatinine, Output

No matter waht the cause of acute renal failure -> progresses in these stereotypical phases

40
Q

Chronic Renal Failure

Is the progressive loss of renal ____ over ___-____. Advancement of the disease can be _____ but the loss of function is ______ and terminates in (1)? ​

A

loss of renal function over months-years. can be slowed but loss of function is irreversible, terminates in end stage renal disease (ESRD)

41
Q

Terms used to describe decreasing renal function

(1): decline of about 15% of normal GFR and elevated serum creatinine and urea

(1): significant loss in renal function (when less than 10% left - end stage renal failure)

(1): increased serum urea lvls and frequently increased creatinine lvls - renal insufficency and failure cause this

(1): a syndrome of renal failure that includes elevated blood urea and creatinine lvls accompanied by fatigue, anorexia, N/V, pruritis, and neuro changes

A

Renal Insufficiency

Renal Failure

Azotemia

Uremia

Renal insufficiency can be seen in ex) older pts with underlying problem such as diabetes and HTN

Uremia: urine in the blood when pts are in renal failure - lose ability to make urine so nitrogenous waste accumulates in blood

42
Q

Causes of Chronic Renal Failure

  1. ______ Acute renal failure
  2. Developmental/______ conditions
  3. C_____ disorders
    • ​P______ kidney disease
    • ______ cystic disease
  4. N_______
    • ​_____/_____ tumors of the kidney
  5. I_______
    • ​Recurrent P______
    • Post______ Glomerulonephritis
  6. ______ Conditions
    • ​D______ mellitus/insipidus (diabetic nephropathy)
    • H______
    • G_____
    • Sc_____
    • Systemic ______ erythematous
A
  1. Unresolved Acute renal failure
  2. Congenital conditions
  3. ​​Cystic Disorders
    • ​​Polycystic kidney disease
    • Medullary cystic disease
  4. Neoplasm
    • ​​Benign/Malignant tumors
  5. Infection
    • ​​Recurrent Pyelonephritis
    • Poststreptococcal Glomerulonephritis
  6. Systemic Conditions
    • ​​Diabetes
    • HTN
    • Gout
    • Scleroderma
    • Lupus
43
Q

4 Stages of Chronic Renal Failure

(4)

A
  1. Reduced Renal Reserve
  2. Renal Insufficiency
  3. Renal Failure
  4. End-Stage Renal Disease
44
Q

Reduced Renal Reserve

  • GFR (Nephron Mass) drops to __% of normal rate
  • Usually __ symptoms of impaired renal function
  • Increased risk for a_____ and susceptibility to _____ drugs
A
  • 50%
  • no symptoms
  • azotemia, nephrotoxic drugs

GFR hasn’t dropped yet - what’s dropping is your nephron mass -> pure reserve (not needed to maintain normal function) has declined -> no sx, compensatory hypertrophy begins and progresses into renal insufficiency

45
Q

Renal Insufficiency

  • GFR is __-__% normal
  • (1) and Hyperfiltration leading to injury, fibrosis, loss
  • Maintenance of normal function until about __% of nephron loss
  • Symptoms begin to arise including: A____, a____, and h______
A
  • 20-50%
  • Compensatory Hypertrophy
  • 75%
  • Azotemia, anemia, hypertension

remaining nephron mass has shrunk below reserve, hypertrophied, hyperfiltrating, under constant stress and injury -> start to see symptoms

46
Q

Renal Failure

  • GFR is less than ___% of normal
  • Kidneys fail to regulate v____ and s_____ composition
  • E_____, metabolic ______, and hyper_____ develops
  • Overt _____ with n_____, gastrointestinal, and CV manifestations
A
  • <20%
  • volume, solute
  • edema, acidosis, hypertension
  • uremia, neuro
47
Q

End Stage Renal Disease

  • GFR is less than ___% of normal
  • The overall ____ of kidneys is reduced
  • Treatment with _____ or _____ necessary for survival
A
  • <5%
  • mass
  • dialysis, transplantation
48
Q

Impaired Functions in Chronic Renal Failure

(1): increased vascular volume bc can’t make urine -> increased workload on heart/HTN, edema. Even with expanded volume kidneys continue to pump out renin -> ang/aldosterone so thats going to add to HTN

(1): hyperkalemia -> arrhythmias

(1): uremia -> effects everything -> skin disorders (itchiness), GI dysfunction, neurotoxic, sexual dysfunction, coagulopathies (bleeding problems)

(1): can’t secrete H+ so you become acidotic -> start buffering acid by demineralizing bone but acidic blood starts to trap calcium so free calcium goes down

A

Sodium and Water balance

Potassium balance

Elimination of Nitrogenous Waste

Acid Base Balance

49
Q

Impaired Functions in Chronic Renal Failure (Continued)

(1): goes down so you can’t absorb enough calcium in GI tract

(1): not eliminated so this substance grabs the free calcium too

(1): due to (3) things

  • (1): as a result - pumps out PTH to increase calcium but does this by breaking down bone in order to liberate calcium - but that calcium just gets sucked up again by above 3 things -> bone _____
A
  • Activation of Vitamin D
  • No elimination of Phosphate
  • Hypocalcemia ​
    1. ​Acidosis
    2. Vitamin D disorder so can’t absorb calcium in GI tract
    3. Phosphate binds to calcium
    • Hyperparathyroidism, bone wasting
50
Q

Hemodialysis

=

What is filtered out of the blood? (3)

What is filtered into the blood? (2)

  • Major thing is trying to get rid of enourmous amount of _____ -> osmolarity of dialysate fluid there is VERY _____ bc trying to pull fluid out
  • __-__hrs/__-__ times per week, Dialysis itself creates unstable ___ -> chronic HMD pts are very ill and ____ impairment for reasons we don’t fully understand
A

Removal of blood through filter that has semi-permeable membrane -> creating concentration and osmotic gradient

Fluid, Potassium, Phosphate OUT

Bicarb, Calcium IN

  • volume, osmolarity of dialysate VERY HIGH
  • 3-4hr/2-4x/week, unstable rbc, brain impairment
51
Q

Peritoneal Dialysis

_____ Invasive method that utilizes peritoneal _____ ____ as the semipermeable membrane instead of using a membrane outside of the body

  • Dialysate fluid pumped into peritoneal cavity so blood can _____ with dialysate fluid which is then pulled out
  • Does not require moving person’s blood outside of the body so benefit of (1), however con of (1)
A

Less invase, peritoneal seous membrane

equilibrate

Fewer negative effects but NOT AS ROBUST as hemodialysis

Fall 2020 Advanced Patho (15 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions