Unit 10 Chapters 32-34 Flashcards
how many mL of filtrate is formed each minute
125mL
what is GFR
glomerular filtration rate
GFR is what
amount of filtrate formed in each minute
only ___mL of the 125mL formed each minute is excreted in urine
1mL
what happens to the rest of the 124mL
reabsorbed in tubules
what is the average urine output
60mL/hr
what is the bare minimum of urine output
30mL/hr
what percent of all reabsorptive and secretory processed occur in the proximal tubule
65%
renal threshold
plasma level at which the substance appears in urine
sometimes the renal threshold exceeds the ___________ ____________
transport mechanism
an example of renal threshold exceeding transport mechanism is in diabetics when _____mg/minute spills into urine
320
where do loop diuretics work
loop of Henle
ADH maintains _____________ volume by returning water to vascular compartment
extracellular
ADH is associated with what system
RAA
_________________ in hypothalamus sense increase in osmolality of extracellular fluids and stimulates the release of _____ from the posterior pituitary
osmoreceptors, ADH
where are osmoreceptors located at
hypothalamus
ADH is also known as
vasopressin
without ADH _________ channels are closed, tubular cells lose water permeability and dilute urine is formed
water
what innervates renal
SNS
if you are in hypovolemic shock will there be any flow to the kidneys
no
what 3 substances produce vasoconstriction of renal vessels
Angiotensin II, ADH, endothelins
what 3 substances dilate renal vessels
dopamine, nitric oxide, prostaglandins
_______________ __________ represents feedback control system linking GFR with renal blood flow
juxtaglomerular complex
juxtaglomerular complex controls the release of
renin
what does the juxtaglomerular complex link
GFR with renal blood flow
what are three values that measures kidneys function
GFR, creatine, BUN
creatinine is a product of
creatine metabolism in muscles
is the release of creatinine constant or not
constant
creatinine is freely filtered in glomeruli and is it or is it not reabsorbed from tubules
not reabsorbed from tubules
creatinine serum levels depend closely on
GFR
creatinine is used as a measure of
renal function
regulation of NA and K
- aldosterone
- atrial natriuretic peptide
- ADH
atrial natriuretic peptide
synthesized in the muscle cells of atria and released with atria are stretched; vasodilatation of arterioles, inhibits NA reabsorption
regulation of pH in kidney conserves and eliminates what
conserves HCO3
eliminates H+
kidney uric acid elimination. what drug competes and what drugs affect
ASA competes, diuretics affect
urea elimination is a product of ____________ metabolism
protein
normal urea production by an adult
25-30 G/day
urea qualities rises with increased intake, tissue breakdown and
GI bleeding
RAA: renin is released in response to
- decrease in renal blood flow
- change in composition of distal tubular fluid
- SNS stimulation
erythropoietin is what kind of hormone
polypeptide
what does erythropoietin regulate
differentiation of RBC in bone marrow
where is erythropoietin majority produced
kidney (89-95%)
WHAT IS THE STIMULUS FOR PRODUCTION OF ERYTHROPOEITIN
TISSUE HYPOXIA
why is tissue hypoxia the stimulus for production
to produce more red blood cells in the chance to get more oxygen
if your kidney is not functioning will it still produce erythropoietin
NO
where does the activation of Vitamin D occur
in kidney
vitamin D is needed to increase ______ absorption from GI tract
Ca
does vitamin D need to be activated before it is used
yes
what is the preferred type of urine sample
first voided and fresh
Casts
molds of distal nephron lumen
specific gravity valuable index of
hydration status and functional status of kidney
use of urine and what else is used to calculate GFR
blood
serum creatinine level
0.6-1.2
BUN normal level
8-20 mg
what does BUN stand for
blood urea nitrogen
BUN is influenced by
- protein intake
- GI bleeidng
- hydration status
normal BUN to creatinine ratio
10:1
what ratio do we start to get suspected of pre renal conditions such as CHF or GI bleed
15:1
casts are formed when
cells are packed together in the tubule lumen
Dysgenesis
failure of an organ to develop normally
agenesis
complete failure of an organ to develop
hypoplasia
failure of an organ to reach normal size
Potters syndrome is what type of failure of organ development
agenesis
when you see the prefix A what does that mean
without
Pottersyndrome is characteristic facial features of newborns with _________ agenesis
renal
renal agenesis name
Potter Syndrome
Polycystic kidney disease can be what autosomal
both (dominant and recessive)
if you have cysts in kidney you may also have them where
liver, pancreas
cysts of kidney may also present with mitral valve
prolapse
cysts of the kidney may have a 10-30% chance of ___________ aneurysm
cerebral
cysts of the kidney may also have chronic colonic ___________
diverticula
cysts of the kidney will present with
pain, hematuria, infection, hypertension
is the process of cysts in the kidney fast or slow
slow
hematuria
blood in urine
causes of urinary tract obstruction
developmental defects
pregnancy
benign prostatic hyperplasia
scar tissue
inflammation
tumors
neurological disorders
stasis of urine predisposing to
infection and stone formation
development of back pressure interfere with
renal blood flow and destroys kidney tissue
what is back pressure in renal system
urine from bladder pushes on ureter and kidney
manifestations of urinary obstruction depend on
site of obstruction
the cause
the rapidity with which the condition developed
common symptoms of urinary obstruction
pain
signs and symptoms of UTI
manifestations of renal dysfunction
hydronephrosis
refers to urine filled dilation of renal pelvis and chalices with accompanying atrophy of renal tissues caused by obstruction of urine flow
hydronephrosis causes
congenital, stones, tumors, inflammatory
kidney stones definition
crystalline structures that form from components of the urine
kidney stones are also alled
renal calculi
kidney stones happen when the filtrate is extremely saturated or unsaturated
saturated
what is the prevention of kidney stones/renal calculi
FLUID INTAKE PLUS CORRECTING CAUSE WITH DIET/MEDS
you have a patient who is frequently having kidney stones what is one preventative measure you can tell them to further prevent kidney stones
increased fluid intake
why would you want to increase fluid intake if you have kidney stones
makes the filtrate less saturated
why are women more at risk for UTI
shorter urethra
lower UTIs are just your basic
cystitis
lower UTI is the normal or abnormal UTI
normal
what is infected with lower UTI
bladder and urethra
how would someone present with a lower UTI/cystitis
urgency, pain, frequent bathroom
a women comes in a claims she was sexually active a few days ago and after that encounter she has had pain with urination and has to use the bathroom frequently. what does she have
lower UTI, cystitis
in an upper UTI what is infected
kidneys
upper UTI may lead to
sepsis, renal abscess, chronic pyelonephritis, chronic renal failure
pyelonephritis
kidney infection
how would someone present with a upper UTI
head ache, fever, chills, pain over kidneys
what UTI is more systemic
upper
a patient comes in and claims she was just in the hospital and had a catheter in, she claims she now has a fever and chills and she is having back pain, what does she have
upper UTI
why would someone with an upper UTI have back pain
kidneys are retroperitoneal so they are closest organ to the back
what is the most common bacteria to cause UTI
e. coli
what makes you more at risk for UTI
prior UTI, urinary obstruction/reflux, neurogenic bladder, sexually active women, disease of prostate, elderly, instrumentation, changes in vaginal flora, static urine flow
what is neurogenic bladder
loss of control of bladder
an elderly patient just had a catheter in for a week, they are now not hungry (when they normally are) and are also acting confused, what could they have
UTI
characteristics of acute episode of cystitis
frequency of urination
lower abdominal or back discomfort
burning and pain on urination
cloudy and foul smelling urine on occasion
elderly with UTI may present with
vague symptoms such as anorexia, fatigue, CONFUSION
glomerulonephritis
inflammatory process involving the globular structures
what is the second leading cause of kidney failure
glomerulonephritis
glomerulonephritis can either be
primary or secondary
primary glomerulonephritis
condition in which glomerular abnormality is the only disease present
secondary glomerulonephritis
secondary condition such as DM or SLE
triggers for glomerulonephritis
immunologic, nonimmunologic (hypertension, drugs, chemicals, DM) and hereditary
glomerulonephritis injury results from __________ reacting with fixed glomerular antigens
OR
circulation _________-__________ __________ trapped in glomerular membrane
anitbodies, antigen-anitbody complexes
glomerulonephritis causes
disease that provoke proliferative inflammatory response
inflammatory process of glomerulonephritis
damages the capillary wall
permits red blood cells to escape into the urine
produces hemodynamic changes that decrease the GFR
glomerulonephritis presents with hematuria with
red cell casts
glomerulonephritis may present with coke color urine, why?
the longer the blood is there the darker it gets and since it is coming from the kidneys it will be dark
glomerulonephritis will have normal or diminished GFR
diminished
glomerulonephritis will present with azotemia which is?
presence of nitrogenous wastes in blood
why would a patient with glomerulonephritis have azotemia
because the GFR is decreased which means the kidney is not filtering out nitrogen so it stays in the blood
glomerulonephritis will present with oliguria which is?
less urine
glomerulonephritis will present with hyper or hypo tension
hypertesion
glomerulonephritis is a disorder of
glomerular function
types of glomerular disease
acute nephritic syndrome
nephrotic syndrome
is acute nephritic syndrome a disease or not
yes it is a disease
acute nephritic syndrome, what type of inflammation
acute proliferative inflammation
acute nephritic syndrome will have an onset of oliguria why?
GFR is decreased
will acute nephritic syndrome have casts, hematuria, and proteinuria
yes
since acute nephritic syndrome has a decreased GFR this will lead to
hypertension and edma
since acute nephritic syndrome has a decreased GFR this will lead to
hypertension and edema
acute nephritic syndrome could develop how long after someone has pharyngitis (strep) or impetigo
7-12 days
what may be the first sign of acute nephritic syndrome
cola colored urine due to RBC breakdown
is nephrotic syndrome a disease
NO NOT A SPECIFIC DISEASE
what is nephrotic syndrome
constellation of clinical findings that results from increased glomerular permeability to plasma proteins
nephrotic syndrome is either a primary or a secondary disorder, a secondary disorder is changes of systemic diseases such as DM or
systemic lupus erythematosus
nephrotic syndrome presents like
massive amounts of proteinuria, lipiduria, hypoalbuminemia, generalized edema and hyperlipidemia
nephrotic syndrome could present with edema of the
face
why might a person with nephrotic syndrome have generalized edema
since they have hypoalbuminemia they have decreased colloidal osmotic pressure and the fluid is not being kept in intravascular space
since nephrotic syndrome have hypoproteinemia they will have decreased plasma oncotic pressure which leads to
fluid escaping into tissues and causing edema
nephrotic syndrome hypoproteinemia will be compensated by the liver in synthesizing ____________ and will also lead to hyper____________
proteins, lipidemia
diseases associated with glomerular lesions associated with systemic disease
systemic lupus erythematosus
diabetic glomerulosclerosis
hypertensive glomerular disease
what type does diabetic glomerulosclerosis occur in
type 1 and 2
diabetic glomerulosclerosis is a widespread thickening of the glomerular capillary ____________ ___________
basement membrane
can diabetic glomerulosclerosis occur without proteinuria
yes
hypertensive glomerular disease: mild to moderate hypertension causes __________ changes in renal arterioles in 15%
sclerotic
what race is majority affected by hypertensive glomerular disease
african americans
Tubulointerstital disorders are damage to the ________, ______, or ______ portion of the nephron could be caused by
proximal, loop, distal
Tubulointerstital disorders
actue tubular necrosis
renal tubular acidosis
pyelonephritis
drugs and toxins
if an individual with a low GFR has pain and is requesting pain medication what type would you give them and why would you not give them the one you did not chose
you would give they Tylenol, NOT ibprophen. You would not want to give them ibprophen because it is nephrotoxic
pyelonephritis
inflammation of parenchyma and pelvis
what type of infection is acute pyelonephritis
bacterial
acute pyelonephritis
bacterial infection of upper urinary tract
the source of infection for acute pyelonephritis is
lower urinary tract, blood stream
is the infection of acute pyelonephritis systemic or not
systemic
signs of acute pyelonephritis
shaking chills, fever, headache, pain over costovertebral angle
would you have CVA tenderness with acute pyelonephritis
yes
where do you tap to asses for CVA tenderness
back
chronic pyelonephritis is progressive with _________ and _____________ of the renal chalices and pelvis
scarring, deformation
what are some examples of drugs that cause decrease in renal blood flow
diuretics, contrast, NSAID, immunosuppressive drugs
what do NSAIDS do to the kidney
decrease renal blood flow
what drugs obstruct urine flow
vit c and sulfonamides
renal neoplasm disease
Wilms tumor, renal cell carcinoma
Wilms tumor is a mass in any part of the kidney, is it solid or soft mass
solid
what is the median age diagnosis for a Wilms tumor
3
Wilms tumor presents
asymptomatic abdominal mass
hypertension
microscopic and gross hematuria
gross hematuria
visible blood
renal cell carcinoma is a silent disorder so if you have symptoms this may denote
advanced disease
renal cell carcinoma cause
unclear, smoking, obesity, occupational, asbestos
renal cell carcinoma age
55-84
why might in renal cell carcinoma the BUN and creatine be normal
because remaining kidney works well to compensate
renal failure definition
condition in which the kidney fail to remove metabolic end product from the blood and regulate the fluid, electrolyte, and pH balance of the extracellular fluids
renal failure underlying causes
renal disease
systemic disease
urologic defects of non renal origin
acute and chronic kidney injury is a rapid decline in renal function sufficient to increase _______ and impair _______ and electrolyte _________
wastes, fluid, imbalance
kidney injury threatens ____ patient
ICU
prerenal
leading up to kidney
intrinsic
within kidney
post renal
after kidney
where does majority of renal failure occur
pre renal
is contrast nephrotoxic
yes
if someone who has decrease GFR and we use contrast we might have to go to
dialysis
pre renal causes of acute renal failure
hypovolemia
decreased vascular filling
heart failure and cariogenic shock
decreased renal perfusion due to sepsis, vasoactive mediators, drugs, diagnostic agents
hypovolemia cause pre renal failure
not enough fluid going to kidneys
prerenal failure will have a decrease or increase in urine called
olyuriga
prerenal failure disproportionate elevation of _____ in relation serum ____________
BUN, creatinine
is prerenal failure reversible with treatment
yes
intrinsic
- prolonged renal ischemia
- exposure to nephrotoxic drugs
- intratubular obstruction
- acute renal disease
sepsis produces ischemia by provoking
- systemic vasodilatation
- infrarenal hypo perfusion
- generation of toxins that sensitize tubules to ischemia
postrenal
- results from obstruction of urine outflow
- ureter
- bladder
- urethra
post renal ureter
calculi and strictures
post renal bladder
tumors or neurogenic bladder
post renal urethra
BPH
hypovolemic is prerenal, postrenal or intrinsic
prerenal
decreased vascular filling prerenal, postrenal or intrinsic
prerenal
prolonged exposure to renal ischemia prerenal, postrenal or intrinsic
intrinsic
obstruction of urine outflow prerenal, postrenal or intrinsic
post renal
neurogenic bladder prerenal, postrenal or intrinsic
post
benign prostatic hyperplasia prerenal, postrenal or intrinsic
postrenal
sepsis prerenal, postrenal or intrinsic
prerenal
acute renal disease (glomerulonephritis) prerenal, postrenal or intrinsic
intrinsic
heart failure prerenal, postrenal or intrinsic
prerenal
why would congestive heart failure be a prerenal cause of renal failure
low blood flow to kidneys
which type of acute renal failure would be most likely to accompany benign prostatic hypertrophy
postrenal
trauma would cause renal failure why
crush injuries release creatinine and myoglobin
Rhabdomyolysis
renal failure caused by tissue damage
SCENARIO
a man developed acute renal failure after emergency surgery for a severed left leg…
he came in with a serum creatinine of 1.2 but it is now 5.6 mg/dL
his BUN is 86 mg/dL
why would leg damage cause renal failure
Rhabdomyolysis
- muscle breakdown from trauma would cause increase in creatinine going to the kidneys and it is too much for the kidneys to handle
rhabdo myelysis presents with what abnormal test used to determine GFR
creatinine
onset or initiating phase
lasts hours or days from onset of precipitating event until tubular injury occurs
maintenance phase
marked decrease in GFR, sudden retention of urea, K, and creatinine
low urine output, edema, pulmonary congestion
may be non oliguric
recovery or convalescent phase
renal tissue repair occurs, diuresis may begin before renal function has fully returned to normal
BUN and creatinine begin to return to normal
in chronic kidney disease as kidney structures are destroyed the remaining nephrons undergo
structural and functional hypertrophy, each increasing function as a means of compensation
regardless of cause of chronic kidney failure results in progressive deterioration of
glomerular filtration
tubular reabsorption capacity
endocrine function
what are the 3 most common causes of chronic renal disease
hypertension
diabetes mellitus
polycystic kidney disease
what are the stages of the progression of chronic renal failure
diminished renal reserve
renal insufficiency
renal failure
end stage renal disease
why would a manifestation of chronic renal failure be accumulation of nitrogenous wastes (early)
kidney is not filtering out of the blood so it will stay in the blood
why would a manifestation of chronic renal failure be anemia
kidney is not making erythropoietin
what are the electrolyte imbalances associated with chronic renal failure
Metabolic acidosis, hyperkalemia, decrease calcium, increase phosphorus
stage 1 chronic kidney disease
kidney damage with normal or increased GFR (GFR >90)
stage 2 chronic kidney disease
kidney damage with mild decrease in GFR (GFR 60-89)
stage 3 chronic kidney disease
moderate decrease in GFR (GFR 30-59)
stage 4 chronic kidney disease
severe decrease in GFR (GFR 15-29)
stage 5 chronic kidney disease
kidney failure (GFR <15 or dialysis)
GFR below 60 represents a loss of
one half or more of normal adult kidney
which of the following renal disorders is characterized by an increase BUN and creatinine levels
- ARF
-CRF
-uremia
ALL OF THE ABOVE
SCENARIO
a man has chronic renal failure
he has high creatinine and BUN, hyperkalemia, acidosis with normal pCO2, and severe anemia
his blood glucose has reached 340 mg/dL one hour after his hospital meal
he complains of having broken two toes in the last few weeks, even though he eats a lot of daily products for calcium
why does he have hyperkalemia
kidney not able to eliminate potassium
SCENARIO
a man has chronic renal failure
he has high creatinine and BUN, hyperkalemia, acidosis with normal pCO2, and severe anemia
his blood glucose has reached 340 mg/dL one hour after his hospital meal
he complains of having broken two toes in the last few weeks, even though he eats a lot of daily products for calcium
why is he acidosis
kidney cannot hold onto bicarb and eliminate H+
SCENARIO
a man has chronic renal failure
he has high creatinine and BUN, hyperkalemia, acidosis with normal pCO2, and severe anemia
his blood glucose has reached 340 mg/dL one hour after his hospital meal
he complains of having broken two toes in the last few weeks, even though he eats a lot of daily products for calcium
why does he have severe anemia
kidney cannot produce erythropoietin
SCENARIO
a man has chronic renal failure
he has high creatinine and BUN, hyperkalemia, acidosis with normal pCO2, and severe anemia
his blood glucose has reached 340 mg/dL one hour after his hospital meal
he complains of having broken two toes in the last few weeks, even though he eats a lot of daily products for calcium
what does his blood glucose tell you? what other disease is this patient suffering from
diabetes
SCENARIO
a man has chronic renal failure
he has high creatinine and BUN, hyperkalemia, acidosis with normal pCO2, and severe anemia
his blood glucose has reached 340 mg/dL one hour after his hospital meal
he complains of having broken two toes in the last few weeks, even though he eats a lot of daily products for calcium
why is he breaking toes despite the high calcium
he does not have kidneys to convert vit d which helps aid in the process of calcium absorption so the body is using osteoclasts to breakdown bones for calcium which causes fragile bones
uremia
urine in the blood
what is the first clinical manifestations of end stage renal disease
BUN may rise as high as 800mg/dL; with creatinine levels of 10 mg or more it is assumed that 90% of renal function is loss
what clinical manifestations may present later with end stage renal disease
disorders of water, electrolyte and acid base balance
mineral metabolism and skeletal disorders
hematologic disorders
with end stage renal disease patients will be chronic anemia due to
erythropoietin deficiency
with end stage renal disease what might be common
pruritus
what is the long term treatment for renal failure
dialysis
as renal failure progresses and the GFR falls below 50 mL/min which change occurs
- metabolic acidosis
- hypokalemia
- hypercalcemia
- hypophosphatemia
metabolic acidosis (HYPERkalemia, HYPOcalcemia, HYPERphosphatemia)
T/F: hypercalcemia is the most life threatening of the fluid and electrolyte changes that occur in patients with renal disturbances
FALSE, HYPERPOTASSIUM
