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Pathophysiology > Unit 10 Chapters 32-34 > Flashcards

Unit 10 Chapters 32-34 Flashcards

1
Q

how many mL of filtrate is formed each minute

A

125mL

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2
Q

what is GFR

A

glomerular filtration rate

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3
Q

GFR is what

A

amount of filtrate formed in each minute

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4
Q

only ___mL of the 125mL formed each minute is excreted in urine

A

1mL

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5
Q

what happens to the rest of the 124mL

A

reabsorbed in tubules

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6
Q

what is the average urine output

A

60mL/hr

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7
Q

what is the bare minimum of urine output

A

30mL/hr

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8
Q

what percent of all reabsorptive and secretory processed occur in the proximal tubule

A

65%

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9
Q

renal threshold

A

plasma level at which the substance appears in urine

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10
Q

sometimes the renal threshold exceeds the ___________ ____________

A

transport mechanism

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11
Q

an example of renal threshold exceeding transport mechanism is in diabetics when _____mg/minute spills into urine

A

320

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12
Q

where do loop diuretics work

A

loop of Henle

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13
Q

ADH maintains _____________ volume by returning water to vascular compartment

A

extracellular

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14
Q

ADH is associated with what system

A

RAA

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15
Q

_________________ in hypothalamus sense increase in osmolality of extracellular fluids and stimulates the release of _____ from the posterior pituitary

A

osmoreceptors, ADH

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16
Q

where are osmoreceptors located at

A

hypothalamus

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17
Q

ADH is also known as

A

vasopressin

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18
Q

without ADH _________ channels are closed, tubular cells lose water permeability and dilute urine is formed

A

water

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19
Q

what innervates renal

A

SNS

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20
Q

if you are in hypovolemic shock will there be any flow to the kidneys

A

no

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21
Q

what 3 substances produce vasoconstriction of renal vessels

A

Angiotensin II, ADH, endothelins

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22
Q

what 3 substances dilate renal vessels

A

dopamine, nitric oxide, prostaglandins

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23
Q

_______________ __________ represents feedback control system linking GFR with renal blood flow

A

juxtaglomerular complex

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24
Q

juxtaglomerular complex controls the release of

A

renin

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25
Q

what does the juxtaglomerular complex link

A

GFR with renal blood flow

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26
Q

what are three values that measures kidneys function

A

GFR, creatine, BUN

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27
Q

creatinine is a product of

A

creatine metabolism in muscles

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28
Q

is the release of creatinine constant or not

A

constant

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29
Q

creatinine is freely filtered in glomeruli and is it or is it not reabsorbed from tubules

A

not reabsorbed from tubules

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30
Q

creatinine serum levels depend closely on

A

GFR

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31
Q

creatinine is used as a measure of

A

renal function

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32
Q

regulation of NA and K

A
  • aldosterone
  • atrial natriuretic peptide
  • ADH
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33
Q

atrial natriuretic peptide

A

synthesized in the muscle cells of atria and released with atria are stretched; vasodilatation of arterioles, inhibits NA reabsorption

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34
Q

regulation of pH in kidney conserves and eliminates what

A

conserves HCO3
eliminates H+

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35
Q

kidney uric acid elimination. what drug competes and what drugs affect

A

ASA competes, diuretics affect

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36
Q

urea elimination is a product of ____________ metabolism

A

protein

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37
Q

normal urea production by an adult

A

25-30 G/day

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38
Q

urea qualities rises with increased intake, tissue breakdown and

A

GI bleeding

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39
Q

RAA: renin is released in response to

A
  • decrease in renal blood flow
  • change in composition of distal tubular fluid
  • SNS stimulation
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40
Q

erythropoietin is what kind of hormone

A

polypeptide

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41
Q

what does erythropoietin regulate

A

differentiation of RBC in bone marrow

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42
Q

where is erythropoietin majority produced

A

kidney (89-95%)

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43
Q

WHAT IS THE STIMULUS FOR PRODUCTION OF ERYTHROPOEITIN

A

TISSUE HYPOXIA

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44
Q

why is tissue hypoxia the stimulus for production

A

to produce more red blood cells in the chance to get more oxygen

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45
Q

if your kidney is not functioning will it still produce erythropoietin

A

NO

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46
Q

where does the activation of Vitamin D occur

A

in kidney

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47
Q

vitamin D is needed to increase ______ absorption from GI tract

A

Ca

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48
Q

does vitamin D need to be activated before it is used

A

yes

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49
Q

what is the preferred type of urine sample

A

first voided and fresh

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50
Q

Casts

A

molds of distal nephron lumen

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51
Q

specific gravity valuable index of

A

hydration status and functional status of kidney

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52
Q

use of urine and what else is used to calculate GFR

A

blood

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53
Q

serum creatinine level

A

0.6-1.2

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54
Q

BUN normal level

A

8-20 mg

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55
Q

what does BUN stand for

A

blood urea nitrogen

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56
Q

BUN is influenced by

A
  • protein intake
  • GI bleeidng
  • hydration status
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57
Q

normal BUN to creatinine ratio

A

10:1

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58
Q

what ratio do we start to get suspected of pre renal conditions such as CHF or GI bleed

A

15:1

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59
Q

casts are formed when

A

cells are packed together in the tubule lumen

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60
Q

Dysgenesis

A

failure of an organ to develop normally

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61
Q

agenesis

A

complete failure of an organ to develop

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62
Q

hypoplasia

A

failure of an organ to reach normal size

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63
Q

Potters syndrome is what type of failure of organ development

A

agenesis

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64
Q

when you see the prefix A what does that mean

A

without

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65
Q

Pottersyndrome is characteristic facial features of newborns with _________ agenesis

A

renal

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66
Q

renal agenesis name

A

Potter Syndrome

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67
Q

Polycystic kidney disease can be what autosomal

A

both (dominant and recessive)

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68
Q

if you have cysts in kidney you may also have them where

A

liver, pancreas

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69
Q

cysts of kidney may also present with mitral valve

A

prolapse

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70
Q

cysts of the kidney may have a 10-30% chance of ___________ aneurysm

A

cerebral

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71
Q

cysts of the kidney may also have chronic colonic ___________

A

diverticula

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72
Q

cysts of the kidney will present with

A

pain, hematuria, infection, hypertension

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73
Q

is the process of cysts in the kidney fast or slow

A

slow

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74
Q

hematuria

A

blood in urine

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75
Q

causes of urinary tract obstruction

A

developmental defects
pregnancy
benign prostatic hyperplasia
scar tissue
inflammation
tumors
neurological disorders

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76
Q

stasis of urine predisposing to

A

infection and stone formation

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77
Q

development of back pressure interfere with

A

renal blood flow and destroys kidney tissue

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78
Q

what is back pressure in renal system

A

urine from bladder pushes on ureter and kidney

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79
Q

manifestations of urinary obstruction depend on

A

site of obstruction
the cause
the rapidity with which the condition developed

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80
Q

common symptoms of urinary obstruction

A

pain
signs and symptoms of UTI
manifestations of renal dysfunction

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81
Q

hydronephrosis

A

refers to urine filled dilation of renal pelvis and chalices with accompanying atrophy of renal tissues caused by obstruction of urine flow

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82
Q

hydronephrosis causes

A

congenital, stones, tumors, inflammatory

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83
Q

kidney stones definition

A

crystalline structures that form from components of the urine

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84
Q

kidney stones are also alled

A

renal calculi

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85
Q

kidney stones happen when the filtrate is extremely saturated or unsaturated

A

saturated

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86
Q

what is the prevention of kidney stones/renal calculi

A

FLUID INTAKE PLUS CORRECTING CAUSE WITH DIET/MEDS

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87
Q

you have a patient who is frequently having kidney stones what is one preventative measure you can tell them to further prevent kidney stones

A

increased fluid intake

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88
Q

why would you want to increase fluid intake if you have kidney stones

A

makes the filtrate less saturated

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89
Q

why are women more at risk for UTI

A

shorter urethra

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90
Q

lower UTIs are just your basic

A

cystitis

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91
Q

lower UTI is the normal or abnormal UTI

A

normal

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92
Q

what is infected with lower UTI

A

bladder and urethra

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93
Q

how would someone present with a lower UTI/cystitis

A

urgency, pain, frequent bathroom

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94
Q

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

A

lower UTI, cystitis

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95
Q

in an upper UTI what is infected

A

kidneys

96
Q

upper UTI may lead to

A

sepsis, renal abscess, chronic pyelonephritis, chronic renal failure

97
Q

pyelonephritis

A

kidney infection

98
Q

how would someone present with a upper UTI

A

head ache, fever, chills, pain over kidneys

99
Q

what UTI is more systemic

A

upper

100
Q

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

A

upper UTI

101
Q

why would someone with an upper UTI have back pain

A

kidneys are retroperitoneal so they are closest organ to the back

102
Q

what is the most common bacteria to cause UTI

A

e. coli

103
Q

what makes you more at risk for UTI

A

prior UTI, urinary obstruction/reflux, neurogenic bladder, sexually active women, disease of prostate, elderly, instrumentation, changes in vaginal flora, static urine flow

104
Q

what is neurogenic bladder

A

loss of control of bladder

105
Q

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

A

UTI

106
Q

characteristics of acute episode of cystitis

A

frequency of urination
lower abdominal or back discomfort
burning and pain on urination
cloudy and foul smelling urine on occasion

107
Q

elderly with UTI may present with

A

vague symptoms such as anorexia, fatigue, CONFUSION

108
Q

glomerulonephritis

A

inflammatory process involving the globular structures

109
Q

what is the second leading cause of kidney failure

A

glomerulonephritis

110
Q

glomerulonephritis can either be

A

primary or secondary

111
Q

primary glomerulonephritis

A

condition in which glomerular abnormality is the only disease present

112
Q

secondary glomerulonephritis

A

secondary condition such as DM or SLE

113
Q

triggers for glomerulonephritis

A

immunologic, nonimmunologic (hypertension, drugs, chemicals, DM) and hereditary

114
Q

glomerulonephritis injury results from __________ reacting with fixed glomerular antigens
OR
circulation _________-__________ __________ trapped in glomerular membrane

A

anitbodies, antigen-anitbody complexes

115
Q

glomerulonephritis causes

A

disease that provoke proliferative inflammatory response

116
Q

inflammatory process of glomerulonephritis

A

damages the capillary wall
permits red blood cells to escape into the urine
produces hemodynamic changes that decrease the GFR

117
Q

glomerulonephritis presents with hematuria with

A

red cell casts

118
Q

glomerulonephritis may present with coke color urine, why?

A

the longer the blood is there the darker it gets and since it is coming from the kidneys it will be dark

119
Q

glomerulonephritis will have normal or diminished GFR

A

diminished

120
Q

glomerulonephritis will present with azotemia which is?

A

presence of nitrogenous wastes in blood

121
Q

why would a patient with glomerulonephritis have azotemia

A

because the GFR is decreased which means the kidney is not filtering out nitrogen so it stays in the blood

122
Q

glomerulonephritis will present with oliguria which is?

A

less urine

123
Q

glomerulonephritis will present with hyper or hypo tension

A

hypertesion

124
Q

glomerulonephritis is a disorder of

A

glomerular function

125
Q

types of glomerular disease

A

acute nephritic syndrome
nephrotic syndrome

126
Q

is acute nephritic syndrome a disease or not

A

yes it is a disease

127
Q

acute nephritic syndrome, what type of inflammation

A

acute proliferative inflammation

128
Q

acute nephritic syndrome will have an onset of oliguria why?

A

GFR is decreased

129
Q

will acute nephritic syndrome have casts, hematuria, and proteinuria

A

yes

130
Q

since acute nephritic syndrome has a decreased GFR this will lead to

A

hypertension and edma

131
Q

since acute nephritic syndrome has a decreased GFR this will lead to

A

hypertension and edema

132
Q

acute nephritic syndrome could develop how long after someone has pharyngitis (strep) or impetigo

A

7-12 days

133
Q

what may be the first sign of acute nephritic syndrome

A

cola colored urine due to RBC breakdown

134
Q

is nephrotic syndrome a disease

A

NO NOT A SPECIFIC DISEASE

135
Q

what is nephrotic syndrome

A

constellation of clinical findings that results from increased glomerular permeability to plasma proteins

136
Q

nephrotic syndrome is either a primary or a secondary disorder, a secondary disorder is changes of systemic diseases such as DM or

A

systemic lupus erythematosus

137
Q

nephrotic syndrome presents like

A

massive amounts of proteinuria, lipiduria, hypoalbuminemia, generalized edema and hyperlipidemia

138
Q

nephrotic syndrome could present with edema of the

A

face

139
Q

why might a person with nephrotic syndrome have generalized edema

A

since they have hypoalbuminemia they have decreased colloidal osmotic pressure and the fluid is not being kept in intravascular space

140
Q

since nephrotic syndrome have hypoproteinemia they will have decreased plasma oncotic pressure which leads to

A

fluid escaping into tissues and causing edema

141
Q

nephrotic syndrome hypoproteinemia will be compensated by the liver in synthesizing ____________ and will also lead to hyper____________

A

proteins, lipidemia

142
Q

diseases associated with glomerular lesions associated with systemic disease

A

systemic lupus erythematosus
diabetic glomerulosclerosis
hypertensive glomerular disease

143
Q

what type does diabetic glomerulosclerosis occur in

A

type 1 and 2

144
Q

diabetic glomerulosclerosis is a widespread thickening of the glomerular capillary ____________ ___________

A

basement membrane

145
Q

can diabetic glomerulosclerosis occur without proteinuria

A

yes

146
Q

hypertensive glomerular disease: mild to moderate hypertension causes __________ changes in renal arterioles in 15%

A

sclerotic

147
Q

what race is majority affected by hypertensive glomerular disease

A

african americans

148
Q

Tubulointerstital disorders are damage to the ________, ______, or ______ portion of the nephron could be caused by

A

proximal, loop, distal

149
Q

Tubulointerstital disorders

A

actue tubular necrosis
renal tubular acidosis
pyelonephritis
drugs and toxins

150
Q

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

A

you would give they Tylenol, NOT ibprophen. You would not want to give them ibprophen because it is nephrotoxic

151
Q

pyelonephritis

A

inflammation of parenchyma and pelvis

152
Q

what type of infection is acute pyelonephritis

A

bacterial

153
Q

acute pyelonephritis

A

bacterial infection of upper urinary tract

154
Q

the source of infection for acute pyelonephritis is

A

lower urinary tract, blood stream

155
Q

is the infection of acute pyelonephritis systemic or not

A

systemic

156
Q

signs of acute pyelonephritis

A

shaking chills, fever, headache, pain over costovertebral angle

157
Q

would you have CVA tenderness with acute pyelonephritis

A

yes

158
Q

where do you tap to asses for CVA tenderness

A

back

159
Q

chronic pyelonephritis is progressive with _________ and _____________ of the renal chalices and pelvis

A

scarring, deformation

160
Q

what are some examples of drugs that cause decrease in renal blood flow

A

diuretics, contrast, NSAID, immunosuppressive drugs

161
Q

what do NSAIDS do to the kidney

A

decrease renal blood flow

162
Q

what drugs obstruct urine flow

A

vit c and sulfonamides

163
Q

renal neoplasm disease

A

Wilms tumor, renal cell carcinoma

164
Q

Wilms tumor is a mass in any part of the kidney, is it solid or soft mass

A

solid

165
Q

what is the median age diagnosis for a Wilms tumor

A

3

166
Q

Wilms tumor presents

A

asymptomatic abdominal mass
hypertension
microscopic and gross hematuria

167
Q

gross hematuria

A

visible blood

168
Q

renal cell carcinoma is a silent disorder so if you have symptoms this may denote

A

advanced disease

169
Q

renal cell carcinoma cause

A

unclear, smoking, obesity, occupational, asbestos

170
Q

renal cell carcinoma age

A

55-84

171
Q

why might in renal cell carcinoma the BUN and creatine be normal

A

because remaining kidney works well to compensate

172
Q

renal failure definition

A

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

173
Q

renal failure underlying causes

A

renal disease
systemic disease
urologic defects of non renal origin

174
Q

acute and chronic kidney injury is a rapid decline in renal function sufficient to increase _______ and impair _______ and electrolyte _________

A

wastes, fluid, imbalance

175
Q

kidney injury threatens ____ patient

A

ICU

176
Q

prerenal

A

leading up to kidney

177
Q

intrinsic

A

within kidney

178
Q

post renal

A

after kidney

179
Q

where does majority of renal failure occur

A

pre renal

180
Q

is contrast nephrotoxic

A

yes

181
Q

if someone who has decrease GFR and we use contrast we might have to go to

A

dialysis

182
Q

pre renal causes of acute renal failure

A

hypovolemia
decreased vascular filling
heart failure and cariogenic shock
decreased renal perfusion due to sepsis, vasoactive mediators, drugs, diagnostic agents

183
Q

hypovolemia cause pre renal failure

A

not enough fluid going to kidneys

184
Q

prerenal failure will have a decrease or increase in urine called

A

olyuriga

185
Q

prerenal failure disproportionate elevation of _____ in relation serum ____________

A

BUN, creatinine

186
Q

is prerenal failure reversible with treatment

A

yes

187
Q

intrinsic

A
  • prolonged renal ischemia
  • exposure to nephrotoxic drugs
  • intratubular obstruction
  • acute renal disease
188
Q

sepsis produces ischemia by provoking

A
  • systemic vasodilatation
  • infrarenal hypo perfusion
  • generation of toxins that sensitize tubules to ischemia
189
Q

postrenal

A
  • results from obstruction of urine outflow
  • ureter
  • bladder
  • urethra
190
Q

post renal ureter

A

calculi and strictures

191
Q

post renal bladder

A

tumors or neurogenic bladder

192
Q

post renal urethra

A

BPH

193
Q

hypovolemic is prerenal, postrenal or intrinsic

A

prerenal

194
Q

decreased vascular filling prerenal, postrenal or intrinsic

A

prerenal

195
Q

prolonged exposure to renal ischemia prerenal, postrenal or intrinsic

A

intrinsic

196
Q

obstruction of urine outflow prerenal, postrenal or intrinsic

A

post renal

197
Q

neurogenic bladder prerenal, postrenal or intrinsic

A

post

198
Q

benign prostatic hyperplasia prerenal, postrenal or intrinsic

A

postrenal

199
Q

sepsis prerenal, postrenal or intrinsic

A

prerenal

200
Q

acute renal disease (glomerulonephritis) prerenal, postrenal or intrinsic

A

intrinsic

201
Q

heart failure prerenal, postrenal or intrinsic

A

prerenal

202
Q

why would congestive heart failure be a prerenal cause of renal failure

A

low blood flow to kidneys

203
Q

which type of acute renal failure would be most likely to accompany benign prostatic hypertrophy

A

postrenal

204
Q

trauma would cause renal failure why

A

crush injuries release creatinine and myoglobin

205
Q

Rhabdomyolysis

A

renal failure caused by tissue damage

206
Q

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

A

Rhabdomyolysis
- muscle breakdown from trauma would cause increase in creatinine going to the kidneys and it is too much for the kidneys to handle

207
Q

rhabdo myelysis presents with what abnormal test used to determine GFR

A

creatinine

208
Q

onset or initiating phase

A

lasts hours or days from onset of precipitating event until tubular injury occurs

209
Q

maintenance phase

A

marked decrease in GFR, sudden retention of urea, K, and creatinine
low urine output, edema, pulmonary congestion
may be non oliguric

210
Q

recovery or convalescent phase

A

renal tissue repair occurs, diuresis may begin before renal function has fully returned to normal
BUN and creatinine begin to return to normal

211
Q

in chronic kidney disease as kidney structures are destroyed the remaining nephrons undergo

A

structural and functional hypertrophy, each increasing function as a means of compensation

212
Q

regardless of cause of chronic kidney failure results in progressive deterioration of

A

glomerular filtration
tubular reabsorption capacity
endocrine function

213
Q

what are the 3 most common causes of chronic renal disease

A

hypertension
diabetes mellitus
polycystic kidney disease

214
Q

what are the stages of the progression of chronic renal failure

A

diminished renal reserve
renal insufficiency
renal failure
end stage renal disease

215
Q

why would a manifestation of chronic renal failure be accumulation of nitrogenous wastes (early)

A

kidney is not filtering out of the blood so it will stay in the blood

216
Q

why would a manifestation of chronic renal failure be anemia

A

kidney is not making erythropoietin

217
Q

what are the electrolyte imbalances associated with chronic renal failure

A

Metabolic acidosis, hyperkalemia, decrease calcium, increase phosphorus

218
Q

stage 1 chronic kidney disease

A

kidney damage with normal or increased GFR (GFR >90)

219
Q

stage 2 chronic kidney disease

A

kidney damage with mild decrease in GFR (GFR 60-89)

220
Q

stage 3 chronic kidney disease

A

moderate decrease in GFR (GFR 30-59)

221
Q

stage 4 chronic kidney disease

A

severe decrease in GFR (GFR 15-29)

222
Q

stage 5 chronic kidney disease

A

kidney failure (GFR <15 or dialysis)

223
Q

GFR below 60 represents a loss of

A

one half or more of normal adult kidney

224
Q

which of the following renal disorders is characterized by an increase BUN and creatinine levels
- ARF
-CRF
-uremia

A

ALL OF THE ABOVE

225
Q

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

A

kidney not able to eliminate potassium

226
Q

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

A

kidney cannot hold onto bicarb and eliminate H+

227
Q

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

A

kidney cannot produce erythropoietin

228
Q

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

A

diabetes

229
Q

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

A

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

230
Q

uremia

A

urine in the blood

231
Q

what is the first clinical manifestations of end stage renal disease

A

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

232
Q

what clinical manifestations may present later with end stage renal disease

A

disorders of water, electrolyte and acid base balance
mineral metabolism and skeletal disorders
hematologic disorders

233
Q

with end stage renal disease patients will be chronic anemia due to

A

erythropoietin deficiency

234
Q

with end stage renal disease what might be common

A

pruritus

235
Q

what is the long term treatment for renal failure

A

dialysis

236
Q

as renal failure progresses and the GFR falls below 50 mL/min which change occurs
- metabolic acidosis
- hypokalemia
- hypercalcemia
- hypophosphatemia

A

metabolic acidosis (HYPERkalemia, HYPOcalcemia, HYPERphosphatemia)

237
Q

T/F: hypercalcemia is the most life threatening of the fluid and electrolyte changes that occur in patients with renal disturbances

A

FALSE, HYPERPOTASSIUM

Pathophysiology (44 decks)

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