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DTC 330: Medical Nutrition Therapy > Renal System > Flashcards

Renal System Flashcards

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USMLE® Step 1 flashcards
1
Q

Function of Kidneys

A

Eliminates waste products of metabolism
Acid-base balance: exreting H+ when there is excess acid
Regulation of arterial blood pressure: by adjusting Na excretion
Regulates plasma volume and osmolality: osmotic pressure by excreting osmotically dilute or concentrated urine
Regulate concentrations of several ions in blood plasma; including all electrolytes.
Eliminates many drugs
Hormone production: EPO
Vitamin D activation
Enzyme: renin production for BP control

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2
Q

Nephron?

A

functional unit of kidney -1.2 million in each kidney Each nephron has 2 parts; glomerulus and tubules

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3
Q

Glomerulus

A

cluster of branching capillaries
Cup shaped membrane at the head of each nephron forms the bowman’s capsule
Filters waste products from blood

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4
Q

Tubules

A

Proximal tubule
loop of Henle
Distal tubule
Collecting tubule

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5
Q

Nephron blood supply?

A

Blood flows to the glomerulus by afferent arterioles
Leaves glomerulus by efferent arterioles
Follows nephrons in peritubular capillaries

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6
Q

What is the main function of the glomeruli

A

Ultrafiltration

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7
Q

How is filtration based on size and charge?

A

Small solutes cross readily
larger substances are generally restricted
Negatively charged molecules are restricted
99% water reabsorbed- 1-1.5L urine excreted

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8
Q

Regulation of h20 homeostasis

A

The large concentration gradient between the inner medulla and outer cortex allows the kidney to excrete urine

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9
Q

Solute load?

A

Represents the end waste products of normal metabolism

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10
Q

GFR

A

Glomerular filtration rate: the rate at which substances are cleared from plasma.
Urine albumin: first signs of renal insufficiency

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11
Q

Calculate GFR

A

amount of filtrate formed per minute based on total surface area available for filtration (# of functioning glomeruli)
Can be calculated from serum creatinine using standard eq
Can be determined also by using injected isotop (inulin) measurement in 24 hr urine collection

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12
Q

Normal GFR

A

> 60mL/min/1.73m2

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13
Q

Daily fixed load:

A

600 mOsm

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14
Q

Minimum Urine volume capable of eliminating daily fixed 600mOsm

A

500mL

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15
Q

Oliguria

A

<500 mL/d

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16
Q

Two key markers for CKD?

A

Urine albumin

eGFR

17
Q

Current accepted “normal” level of albumin in urine

A

<30 mg/g

18
Q

Nephrone functions to maintain balance:

A

Filtration
Reabsorption
Secretion

19
Q

BUN

A

Normal level 8-20 mg/dL

20
Q

Common Kidney Diseases

A 
Edema
HTN
Metabolic acidosis
Hyperkalemia
Microcytic anemia and iron def
Uremia
Azotemia (nitrogenous waste product acumulation)
Oliguria
Hyperphosphatemia
21
Q

CKD

A

Chronic Kidney Disease
syndrome of progressive and irreversible loss of functions secondary to kidney damage
Excretory, endocrine, metabolic

22
Q

Most common CKD:

A 
Diabetic nerphorpathy
High BP
PKD Polycystic kidney disease
Acute Renal Failure
Chronic Renal Failure
End Stage Renal Disease
23
Q

Nephrotic Syndrome

A

Alterations of the glomerular basement membrane allows persistant loss of large amounts of protein in the urine.
Marked by def of albumin in blood and excretion of albumin in urine
Assoc w/ DM, etc

24
Q

NS Pathophysiology

A

Proteinuria >3.5g per 1.73m2 of body surface per day
Hyperlipidemia: Possible reasons altered lipid metabolism High serum chol, TG, LDL, Normal or Low HDL, Reduced levels of lipoprotein lipase
Diseases that can result in NS:
DM nephropathy
infection/drug toxicitiy
autoimmune disease

25
Q

Clinical manifestations of NS?

A

Frothy urine
Anorexia, malaise, puffy eyelids, ab pain, muscle wasting
Anascarca (generalized edema) with ascites
Altered BP
Oliguria d/t hypovolemia
Loss of minerals. Iron bound to protein lost

26
Q

NS Treatment

A 
Treat underlying cause
Reduce chole
Control BP- fluid retention
Reduce protein in urine-protein controlled diet
ACE inhibitors and ARBs
Check K levels
27
Q

Nephritic syndome

A 
Acute glomerulonephritis (inflammation of glomerulus) Sudden onset often after strep infections
Symptoms include hematuria, hypertension, usually resolve on their won or advance to nephrotic syndrome or ESRD
28
Q

Acute Renal Failure (ARF)

A

when kidneys suddenly stop functioning and abrupt cessation over 24-48 hrs leading to reduction in GFR and accumulation of nitrogenous wastes

29
Q

How does it happen?

A

Rapid, often reversible,
GFR declines over hours to days
Most commonly occurs during hospitalization
Assoc with major in hospital morbidity
Ischemic injury d/t loss of blood supply to kidneys
Nephrotoxic injury: medications, contract medium chemotherapy, poision
Multiorgan system failure
Sepsis
Obstructive uropathy
Acute glomerular nephritis

30
Q

Phases of ARF

A

Prodromal phase: duration variable UO normal
Oliguric: 10-14 days- Output low
Postoliguric: average 10 days UP returns to normal
Recovery 1 month to one year

31
Q

Hemodialysis (HD)

A

blood is circulated through a dialyzer (artificial kidney), where it is bathed by dialysate, a solution that selectively removes fluid and wastes

32
Q

Peritoneal dialysis (PD)

A

dialysate is infused into a person’s peritoneal cavity, and blood is filtered by the peritoneum (the membrane that surrounds the abdominal cavity) – after several hours, the dialysate is drained, removing unneeded fluid and wastes

33
Q

Internal arteriovenous (AV) fistula

A

A connection between two organs or vessels that normally do not connect. •An artery and vein are surgically connected

Access site

34
Q

Continuous cyclic peritoneal dialysis (CCPD)

A

The machine automatically fills and drains the dialysate from the abdomen.
Schedule involves three to five exchanges during the night while the person sleeps.
During the day, the person performs one exchange

35
Q

Cyclosporine

A

Cyclosporine is used to prevent organ rejection after a kidney, heart, or liver transplant
Grapefruit and grapefruit juice may interact with cyclosporine and lead to unwanted side effects. Avoid the use of grapefruit products while taking cyclosporine.

36
Q

Prednisone

A

Prednisone is a corticosteroid. It prevents the release of substances in the body that cause inflammation. It also suppresses the immune system.

37
Q

Spironolactone

A

Spironolactone is a potassium-sparing diuretic (water pill) that prevents your body from absorbing too much sodium and keeps your potassium levels from getting too low.
Drinking alcohol can increase certain side effects of spironolactone.

Do not use salt substitutes or low-sodium milk products that contain potassium. These products could cause your potassium levels to get too high while you are taking spironolactone.

Avoid a high-salt diet. Too much salt will cause your body to retain water, which may reduce the effectiveness of this medicine.

38
Q

Neomycin

A

Neomycin is an antibiotic that fights bacteria in the body.

Neomycin is used to reduce the risk of infection during surgery of your intestines. Neomycin is also used to reduce the symptoms of hepatic coma.

If you are being treated for hepatic coma, avoid eating foods that are high in protein

39
Q

Epoetin alfa

A

It is used to treat anemia.

It is used to help avoid the need for blood transfusions.

DTC 330: Medical Nutrition Therapy (5 decks)

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