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Advanced Pathology > Renal System and Disorders- Notes from Slideshow (quiz 3) PART 1 > Flashcards

Renal System and Disorders- Notes from Slideshow (quiz 3) PART 1 Flashcards

1
Q

Recommended to review slide on fluid and electrolytes acid base. Important and book does not cover them.

A

Recommended to review slide on fluid and electrolytes acid base. Important and book does not cover them.

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2
Q

The main function of the nephron

A

To maintain balance/homeostasis of

blood volume
blood pressure
plasma osmolarity

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3
Q

What mechanisms are used by the nephron to maintain balance?

A
  1. Filtration
  2. Reabsorption
  3. Secretion
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4
Q

Glomeruli generate ultrafiltrate of the plasma

A

Nephron function: Filtration

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5
Q

Tubules selectively reabsorb substances from the ultrafiltrate

A

Nephron function: Reabsorption

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6
Q

Tubules secrete substances into the urine

A

Nephron function: Secretion

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7
Q

Components of the Nephron

Know how to find on diagram

A
  1. Afferent arteriole
  2. Efferent arteriole
  3. Bowman’s capsule
  4. glomerulus
  5. Renal Vein
  6. Loop of Henle with capillary network
  7. Tubule
  8. Collecting duct

(Know how to find on diagram)

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8
Q
  1. Afferent arteriole
  2. Efferent arteriole
  3. Bowman’s capsule
  4. glomerulus
  5. Renal Vein
  6. Loop of Henle with capillary network
  7. Tubule
  8. Collecting duct

(Know how to find on diagram)

A

Parts of the Nephron

Know how to find on diagram

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9
Q

Components of the Urinary System

Know how to find on diagram

A
  1. Main vein to the heart
  2. Main artery from the heart
  3. Kidneys (R/L)
  4. Ureters (R/L)
  5. Bladder
  6. Bladder Nerves (open/close)
  7. Bladder Muscle
  8. Urethra

(Know how to find on diagram)

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10
Q
  1. Main vein to the heart
  2. Main artery from the heart
  3. Kidneys (R/L)
  4. Ureters (R/L)
  5. Bladder
  6. Bladder Nerves (open/close)
  7. Bladder Muscle
  8. Urethra

(Know how to find on diagram)

A

Components of the Urinary System

Know how to find on diagram

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11
Q

Urinary System: Function of the Main vein to the heart

A

Carries cleaned blood to the heart

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12
Q

Urinary System: Function of the Main artery from the heart

A

Bring blood with with wastes from the heart

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13
Q

Urinary System: Function of the Ureters

A

Carry urine

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14
Q

Urinary System: Function of the Bladder

A

Collects urine

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15
Q

Urinary System: Function of the Bladder Nerves

A
  1. one nerve tells the brain the bladder is full

2. second nerve tells the bladder to open

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16
Q

Urinary System: Function of the bladder muscle

A

To keep bladder closed

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17
Q

How do kidneys work?

A
  1. Blood enters kidney through renal artery to nephrons
  2. Inside each nephron is a vessel (glomerulus)
  3. Glomerulus strains out extra fluid/wastes and lets blood cells/other substances in
  4. Wastes produce urine which travels to the ureter then bladder
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18
Q
  1. Blood enters kidney through renal artery to nephrons
  2. Inside each nephron is a vessel (glomerulus)
  3. Glomerulus strains out extra fluid/wastes and lets blood cells/other substances in
  4. Wastes produce urine which travels to the ureter then bladder
A

How do kidneys work?

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19
Q

A hormone system within the body that is essential for the regulation of blood pressure and fluid balance

A

RAAS

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20
Q

What 3 hormones comprise RAAS?

A
  • renin
  • angiotensin II
  • aldosterone
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21
Q

What system regulates RAAS?

A

Renal blood flow

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22
Q

What simulates RAAS?

A

Hypotension

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23
Q

What senses hypotension to stimulate RAAS?

A

Kidneys

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24
Q

What is stimulated in order to activate RAAS?

A

Kidneys and blood vessels

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25
Q

What supplies the kidneys with blood? How much blood?

A
  1. The renal arteries

2. 20-25% of cardiac output

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26
Q

What is included in the kidney anatomy that is important to RAAS?

A
  1. Afferent arterioles
  2. glomerulus
  3. juxtaglomular cells
  4. Efferent arterioles
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27
Q

What do to juxtaglomular cells do in RAAS?

A

They produce prorenin

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28
Q

What does prorenin do in RAAS?

A

When BP is low prorenin is converted to renin

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29
Q

What does renin do in RAAS?

A

It converts Angiotensinogen to angiotensin 1

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30
Q

Where is Angiotensinogen made?

A

In the liver

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31
Q

What is ACE and where is it found?

A
  1. Angiotensin converting enzyme

2. found in lungs

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32
Q

What does ACE do for RAAS?

A

It converts angiotensin 1 to angiotensin 2

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33
Q

What is angiotensin 2?

A
  1. a vasoconstrictor

2. RAAS mediator

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34
Q

What does angiotensin 2 effect in RAAS?

A
  1. blood vessels
  2. Kidneys directly
  3. Kidneys indirectly
  4. Pituitary gland
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35
Q

How does angiotensin 2 effect the blood vessels in RAAS?

A

It constricts the arteries AND veins

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36
Q

What does the constriction of arteries AND veins by RAAS do?

A

Higher BP

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37
Q

How fast does the constriction of arteries AND veins by RAAS occur?

A

within mins

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38
Q

How does angiotensin 2 effect the Kidneys directly in RAAS?

A

constricts afferent vessels to glomeruli

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39
Q

How does the constriction of afferent vessels to glomeruli effect RAAS?

A

It decreases blood flow to kidneys

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40
Q

How does decreased blood flow to kidneys effect RAAS?

A

lowers GFR

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41
Q

What is the effect of a lower GFR?

A

Lowers urine output

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42
Q

How does angiotensin 2 effect the kidneys indirectly in RAAS?

A

acts on adrenal gland to release aldosterone

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43
Q

What does aldosterone do in RAAS?

A

increases sodium and water reabsorption

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44
Q

In RAAS what does decreased urine output, increased water reabsorption and increased sodium reabsorption lead to?

A
  1. Increased Extracellular fluid (EFC)
  2. Increased capillary pressure
  3. Long term increase in arterial pressure
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45
Q

What tests are evaluated to determine renal function?

A
  1. Renal concentration test (specific gravity and osmolarity of urine)
  2. Creatinine clearance
  3. Serum creatinine
  4. Serum urea nitrogen (blood urea nitrogen BUN)
  5. Protein
  6. Microalbumin/creatinine ratio
  7. Urine casts
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46
Q

The ratio of the mass of a solution compared to the mass of an equal volume of water

A

specific gravity

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47
Q

What is specific gravity of urine testing?

A

The density of urine

48
Q

What is normal specific gravity of urine?

A

1.005 to 1.030

49
Q

If specific gravity of urine is increased what does it indicate?

A

dehydration

50
Q

If specific gravity of urine is decreased what does it indicate?

A

overhydrated

51
Q

How else can you tell if urine is concentrated?

A

Just by looking- yellow is concentrated and clear is not concentrated

52
Q

What is creatinine?

A

waste product filtered from the blood by the kidneys into the urine

53
Q

What does creatinine clearance measure

A

The amount of blood cleaned of creatinine by your kidneys

54
Q

What is normal creatinine clearance for women?

A

95 mL/min

55
Q

What is normal creatinine clearance for men?

A

120 mL/min

56
Q

What does high/low creatinine clearance indicate?

A

kidneys are not filtering as they should

57
Q

What does serum creatinine measure?

A

level of creatinine in your blood

58
Q

What is normal serum creatinine for women?

A

0.6 to 1.1 mg/dL

59
Q

What is normal serum creatinine for men?

A

0.9 to 1.3 mg/dL

60
Q

What is another name for serum urea nitrogen

A

Blood urea nitrogen

61
Q

What does BUN measure?

A

the amount of nitrogen in your blood

62
Q

What is does nitrogen levels in a BUN test indicate?

A

Urea is a waste product that produces nitrogen

63
Q

What is a normal BUN level?

A

6 to 20 mg/dL

64
Q

What does high BUN indicate?

A

The kidneys aren’t filtering properly

65
Q

Proteins test

A

Done to see if there is protein in urine

66
Q

What does it mean if there is protein in urine?

A

It means the kidneys are filtering out important blood components. The body needs and uses proteins

67
Q

What does a microalbumin creatinine ratio measure?

A

compares the amount of albumin to the amount of creatinine in your urine

68
Q

What is a normal microalbumin creatinine ratio?

A

less than 30

69
Q

Why do we compare albumin and creatinine in urine?

A

Albumin in urine can carry throughout the day but creatinine is released at a steady rate.

70
Q

What is albumin?

A

A protein found in blood

71
Q

What does high albumin indicate?

A

The kidneys aren’t working properly and are filtering products (like albumin) needed by the body.

72
Q

Urinary casts

A

Particles found when urine is examined under the microscope during a urinalysis.

73
Q

What is a normal cast range?

A

There should be NO casts in urine

74
Q

What are the different types of abnormal casts?

A
  1. Fatty
  2. Granular
  3. Waxy
  4. RBC
  5. WBC
  6. Renal tubular epithelial cell
75
Q

What does a test with fatty casts indicate?

A
  1. lipids in urine

2. nephrotic syndrome

76
Q

What does a test with Granular casts indicate?

A

many types of kidney diseases

77
Q

What does a test with RBC casts indicate?

A

microscopic amount of bleeding from the kidney

78
Q

What does a test with Renal tubular epithelial cell casts indicate?

A

damage to tubule cells in the kidney

79
Q

What does a test with Waxy casts indicate?

A
  • advanced kidney disease

- long-term (chronic) kidney failure.

80
Q

What does a test with WBC casts indicate?

A

acute kidney infections and interstitial nephritis

81
Q

Hgb and Hct test

A

test for levels of RBC

82
Q

How does a hgb and hct indicate kidney malfunction?

A

Pts with kidney disease are anemic

83
Q

Why are kidney disease pts anemic?

A

they are not producing erythropoietin EPO (made in kidney)

84
Q

Why test for potassium in kidney disease pts?

A

Potassium would be high because they retain urine and therefore potassium

85
Q

Clinical urine test for examination of urine for certain physical properties, solutes, cells, casts, crystals, organisms, or particulate matter, and mainly serves for medical diagnosis.

A

Urinalysis

86
Q

Urine culture vs Urinalysis

A

Culture takes days and analysis is faster

87
Q

Urinalysis with a positive result may indicate what?: Leukocytes

A

UTI

88
Q

Urinalysis with a positive result may indicate what?: Nitrate

A

UTI

89
Q

Urinalysis with a positive result may indicate what?: Urobilinogen

A

Liver disease (hepatitis of cirrhosis)

90
Q

Urinalysis with a positive result may indicate what?: Protein

A

infection or kidney damage

91
Q

Urinalysis with a positive result may indicate what?: pH

A

high- UTI or kidney damage

low- kidney stones

92
Q

Urinalysis with a positive result may indicate what?: Blood

A

kidney damage, liver disease

93
Q

Urinalysis with a positive result may indicate what?: Specific Gravity

A

UTI or kidney dysfunction

94
Q

Urinalysis with a positive result may indicate what?: Ketone

A

diabetic or ketogenic diet

95
Q

Urinalysis with a positive result may indicate what?: Bilirubin

A

liver damage

96
Q

Urinalysis with a positive result may indicate what?: Glucose

A

diabetes

97
Q

Normal Urinalysis: Glucose

A

negative

98
Q

Normal Urinalysis: Bilirubin

A

negative

99
Q

Normal Urinalysis : ketones

A

negative

100
Q

Normal Urinalysis: proteins

A

negative

101
Q

Normal Urinalysis Levels: blood

A

negative

102
Q

Normal Urinalysis Levels: nitrate

A

negative

103
Q

Normal Urinalysis Levels: specific gravity

A

1.015-1.025

104
Q

Normal Urinalysis Levels: urobilinogen

A

0-2

105
Q

Normal Urinalysis Levels: leukocyte esterase

A

negative

106
Q

Normal Urinalysis Levels: RBCs

A

0-2

107
Q

Normal Urinalysis Levels: WBCs

A

0-5

108
Q

If urinalysis indicates infection what should an APRN do?

A

Order antibiotics for the pt prophylactical

109
Q

Etiology for hematuria

A
  1. Nephritic syndrome
  2. Pyelonephritis
  3. UTI
  4. Kidney stones
  5. Enlarged prostate
  6. Medication their taking
  7. Someone who strenuously exercises such as a long distance runner
  8. Family- inherited disorders
110
Q

Narrowing of one or more arteries that carry blood to your kidneys

A

Atherosclerotic renal artery stenosis (RAS)

111
Q

Symptoms of RAS

A
  1. HTN before 30yrs
  2. Sig. HTN after 55
  3. Abdominal bruit
  4. Accelerated HTN
  5. HTN that was easy to control but now resistant
  6. Recurrent flash pulmonary edema
  7. Multivessel CAD
  8. PAD
  9. Unexplained CHF
  10. Refectory angina
  11. Renal failure of certain etiology
  12. Renal failure involving RAAS treatment
112
Q

Teachers example of RAS

A

When the teacher worked in cardiology she knew a pt that was a thin young man with HTN and he was on two HTN medications. His mother was a nurse. Meds could not control his HTN. Mom talked to cardiology friends and got referred to a specialist. He had RAS

113
Q

What main symptom should prompt the APRN to send their pt to a specialist?

A

Pt with HTN who is refractory to medication management

114
Q

Why is it important to identify pt that may have RAS?

A

If pt is not treated they could have a stroke

115
Q

What is a treatment for RAS?

A

Stenting

Advanced Pathology (27 decks)

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