Brainscape's Knowledge GenomeTM

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


See full index

BHSC 2203 - Patho > Unit 12 - Renal Disorders > Flashcards

Unit 12 - Renal Disorders Flashcards

1
Q

True or False:

Filtration occurs in the medulla of the kidney

A

False

  • filtration occurs in the cortex (renal corpuscles)
  • reabsorption occurs in the medulla (and concentration of urine)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where is the glomerulus located in the kidney?

A

In the cortex

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

Where is the Loop of Henle located in the kidney?

A

In the medulla

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

What is ATM (acute tubular necrosis)?

A

Death of cells along the tubules in the Loop of Henle

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

Why are UTIs usually ascending (4)?

A
  1. Catheterization
  2. Instrumentation
  3. Accidental occurence
  4. Obstruction - ureters are not flushed regularly(ex. pregnancy or stone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are three examples of descending infections of the renal system?

A
  1. Sepsis = infection of the blood, distributed to every organ
  2. Septic emboli = infected chunk of tissue breaking into the bloodstream
  3. Strep throat = can lead to inflammation of the urinary tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the vesicoureteric reflux?

A

Backward flow of urine from the bladder to the kidneys

- bacteria ascend up the ureters from the bladder to the kidneys

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

True or False:

Anything that affects the emptying of the bladder can trigger infection (or increase the risk of infection)

A

True

- and it’s typically an ascending infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Define cystitis

A

Inflammatory condition of the urinary bladder and ureters

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is cystitis characterized by (4)?

A
  1. Urgency
  2. Pain
  3. Frequency
  4. Hematuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most common cause of cystitis?

A

Stagnation of urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Why does a patient experience urgency during cystitis?

A

B/c of exudation of fluid (edema)

  • adds to the volume of fluid in the bladder
  • causes the bladder to stretch more
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Why is hematuria a common symptom of cystitis?

A

There is inflammation in the bladder

  • inflammation = more blood flow to the surface
  • breakdown of tissue in the wall of the bladder - RBCs can escape
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

True or False:

During acute cystitis, there are areas of hyperemia of the mucosa

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Define ureteritis cystica

A

Inflammation that results in ureteral mucosal cysts

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

In ureteritis cystica, where are the lesions most commonly found?

A

In the bladder!

- surprisingly, not in the ureters (as the name suggests)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do the cysts form in ureteritis cystica?

A

Epithelial cells undergo metaplaisa

- form thing sacs (cysts)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a clinical manifestation of ureteritis cystica?

A

BURNING pain upon urination

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How do you treat ureteritis cystica?

A

Antibiotics

- broad spectrum

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

Define pyelonephritis

A

Infection of the renal pelvis and parenchyma (tissue of the kidneys)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is ACUTE pyelonephritis usually the result of?

A

Infection

  • that ascends from the lower urinary tract
  • E. coli in females
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is pyelonephritis characterized by (5)?

A
  1. Pain in flanks
  2. Fever
  3. Chills
  4. Nausea
  5. Urinary frequency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What happens in ACUTE pyelonephritis with WBCs and the renal tubules?

A

WBCs (neutrophils) rush to the area of inflammation

  • infiltrate tubules
  • block tubules
  • cause damage to epithelial cells of tubules = acute tubular necrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When does CHRONIC pyelonephritis develop?

A

After bacterial infection of the kidneys

- and the bacteria have some resistance to treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is a common risk factor of CHRONIC pyelonephritis?

A

Urinary tract obstruction

  • stones
  • catheter
  • pregnancy
  • tumor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is a characteristic of CHRONIC pyelonephritis?

A

Presence of plasma cells (lymphocytes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

True or False:

Chronic pyelonephritis occurs for the same reasons as acute pyelonephritis

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

In pyelonephritis, when are lymphyoctes and neutrophils seen?

A 
Acute = neutrophils (polynorphonuclear)
Chronic = lymphocytes (plasma)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How can a renal abscess form (2)?

A
  1. Ascending up the urinary tract

2. Descending (hematogenous spread with sepsis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

If a kidney has an abscess, what will the area look like?

A

Necrotic area surrounded by inflamed tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What could happen to the kidneys if there is a large area of inflammation (aka: abscess) (4)?

A
  1. Prevent draining
  2. Urine will build up
  3. Kidney become enlarged
  4. Hydronephrosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What type of phylonephritis is most typical for hematogenous dissemination of infection?

A

Micro-abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are characteristics of micro-abscesses on kidneys?

A
  • yellow centers

- prominent hyperemic borders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

True or False:

Micro-abscesses on kidneys MUST occur from infections of the blood (cannot occur from ascending infection)

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Why is it important to know if the infection to the kidneys is ascending or descending?

A

Affects how we treat it

  • if descending = needs to be systemic treatment
  • if ascending = needs to be focused on urinary system
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

True or False:

Acute tubular necrosis can be intrarenal, postrenal, or prerenal

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What are the four things or values associated with ATN (acute tubular necrosis)

A
  1. Lower urine osmolality ( < 350 mOsm)
  2. Elevated urine sodium ( > 40 mEq/L)
  3. Fractional sodium excretion > 1.5%
  4. Tubular cell casts and protein in urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Describe the process of PRERENAL acute tubular necrosis

A
  1. Blood flow to kidney is decreased
  2. Low oxygen = cells will die
  3. Cell die and fall into tubule
  4. Fallen cells cause an obstruction
  5. FUNCTIONAL ROLE of cells is also lost!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What are some factors that could decrease the blood flow to the kidneys and result in ATN?

A
  1. Hemorrhage
  2. Shock
  3. Atherosclerosis
  4. Obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Describe the process of POSTRENAL acute tubular necrosis

A
  1. Obstruction
  2. Increased pressure above obstruction will injure cells
  3. Cells will die and fall off
  4. Fallen cells cause FURTHER obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the cause of INTRARENAL acute tubular necrosis?

A

Nephrotoxin

- poison that kills or compromises the function of the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is the function of the epithetial cells of the basement membrane in the tubules?

A

Reabsorb sodium and water (back into the blood)

= aka: water reuptake

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Why will the urine have a lower osmolality ( < 350 mOsm) during ATN?

A

More water is being excreted

- b/c it is not being reabsorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Why will the urine have a higher level of sodium ( > 40 mEq/L) during ATN?

A

Cells that reabsorb sodium into the blood are lost

- more sodium will be lost in urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Why will tubular cell casts and proteins be found in urine during ATN?

A

Because the pressure above the obstruction (fallen tubular cells) eventually pushes the obstruction out of the kidneys

  • and then the cells end up in the urine
  • same reason for protein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

When are tubular cell casts formed?

A

When cells are packed together in the tubule lumen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What happens to net filtration is there is a tubular cell cast formed in the tubule (obstruction)?

A

Capsular pressure increases

- therefore, net filtration will DECREASE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What are the two causes for glomerulonephritis?

A
  1. Kidneys (glomeruli) get attacked by the immune system - hereditary
  2. Infection (from streptoccal) - very common!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the clinical manifestations of glomerulonephritis (2)?

A
  1. Decreased GFR

2. Leaky basement membrane (increased GFR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

The presence of what structure in the blood vessels of the glomerulus allow for filtration?

A

Pores in the blood capillaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

The presence of what structure in the bowman’s capsule allows for filtration?

A

Podocytes

- have slits in them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What structure prevents large things from crossing the blood to podocytes in the kidneys?

A

Basement membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the principal barrier to filtration in the kidneys?

A

Basement membrane

54
Q

What happens if antibodies attack protein IN the basement membrane in the glomerulus?

A
  • Leads to disorganization of the basement membrane

- Basement membrane becomes leaky (to PROTEINS, NOT TO RBCs)

55
Q

What happens if there are streptoccal in the circulation that attack the glomerulus?

A
  • Body produces antigen-antibody complexes to fight off the bacteria
  • Blood vessel wall gets damaged
  • Results in RBCs in the urine
  • End up clogging the filtration slits in the capsule
56
Q

Where are mesangial cells found?

A

In the glomerulus

57
Q

What is the role of mesangial cells?

A

They contract like smooth muscle cells

- more contraction = smaller amount of filtration

58
Q

What happens to mesangial cells when the glomerulus is inflamed (acute glomerulonephritis)?

A

Increase in the number of mesangial cells

59
Q

What is the overall result of acute glomerulonephritis on net filtration?

A

Decreased!

60
Q

What are the reasons for decreased filtration in acute glomerulonephritis (3)?

A
  1. Increase in mesangial cells
  2. WBCs present in blood capillaries
  3. Blocked slits (in podocytes)
61
Q

What are the two types of nephron dysfunction?

A
  1. Nephritic syndrome

2. Nephrotic syndrome

62
Q

What happens during nephritic syndrome?

A

Proliferation inflammatory response
= increase in mesangial cells
= RBCs found in urine

63
Q

What happens during nephrotic syndrome?

A

Increase permeability of glomerulus
= basement membrane is attacked
= increase leakiness to proteins

64
Q

What system is activated in nephritic syndrome?

A

Renin-angiotensin-aldosterone pathway

65
Q

Why does the renin-angiotensin-aldosterone pathway get activated in nephritic syndrome?

A
  1. Mesangial cells are going to squeeze outside of afferent arteriole
  2. Juxtaglomerular cells will sense that pressure is high
  3. Amount of blood going to glomerulus is decreased
  4. There will be less filtration
  5. Macular densa cells will respond to decreased filtration (b/c there will be decreased sodium)
  6. Will interpret that as a decrease in blood pressure
  7. Angiotensin is activated = blood pressure goes UP
66
Q

What is a common clinical manifestation of nephritic syndrome?

A

Hypertension

67
Q

Define azotemia

A

Presence of nitrogenous wastes in the blood

68
Q

Explain why hematuria is a clinical feature of nephritic syndrome

A

Blood vessel walls are damaged = blood in urine

69
Q

Explain why oliguria is a clinical feature of nephritic syndrome

A

Decreased GFR

- b/c of blockage of slits and mesangial cells are contracting

70
Q

Explain why proteinuria is a clinical feature of nephritic syndrome

A

Blood vessel walls are damaged = allows proteins to escape

71
Q

Explain why hypoalbuminemia is a clinical feature of nephritic syndrome

A

The more protein that you lose in urine (b.c of damaged blood vessel walls) = less protein in blood

72
Q

Explain why generalized edema is a clinical feature of nephritic syndrome

A

The less blood proteins that you have, the less water is able to stay in blood vessels
= generalized edema

73
Q

Explain why hypertension is a clinical feature of nephritic syndrome

A

Nephron senses low blood flow through kidneys (b/c of mesangial contraction)
- increases blood pressure to increase filtration

74
Q

Describe the pathophysiology of nephrotic syndrome

A

Basement membrane gets attacked by auto-antibodies

  • damages basement membrane
  • increase in leakiness
  • proteins in urine
75
Q

Why will there be generalized edema in nephrotic syndrome?

A

B/c proteins are being lost in the urine

  • less protein in blood
  • results in edema
76
Q

Why will there be hyperlipidemia in nephrotic syndrom?

A

Liver responds to low protein in the blood

  • protein synthesis is a complex process (takes too long)
  • liver makes lipids instead (faster and easier)
77
Q

Explain why proteinuria is present in nephrotic syndrome

A

Basement membrane is damaged

  • cannot hold them in
  • lost in urine
78
Q

Explain why hypoalbuminemia is present in nephrotic syndrome

A

B/c basement membrane is damaged

- proteins are escaping into urine

79
Q

Explain why lipiduria is present in nephrotic syndrome

A

B/c lipids are high in circulation

- some will also escape into the urine

80
Q

When do benign cysts form on the kidneys?

A

Because tubules get blocked

  • tubules will “blow out” above the obstruction
  • when the obstruction is close to the cortex, they can easily be seen from the surface of the kidney
81
Q

How can a large renal cyst be distinguished from a neoplasm on a radiographic imaging procedure?

A

By its uniform fluid density and thin wall

82
Q

True or False:

Simple cysts are unlikely to compromise renal function

A

True

83
Q

True or False:

Since there are millions of tubules, there is a high chance that everyone has kidney cysts

A

True

84
Q

What is the name of the disease that is inherited with an autosomal dominant pattern?

A

Adult Dominat Polycystic Kidney Disease

you can ignore the “adult” part though

85
Q

What is the recurrence risk in the family for dominant polycystic kidney disease?

A

50%

86
Q

Describe the disease progression of dominant polycystic kidney disease

A

Onset: Middle age

  • cysts develop slowly over time
  • APKD leads to kidney failure
87
Q

What is the result of having adult dominant polycystic kidney disease?

A
  • Cortex is gone
  • Medulla is gone
  • Filtration and concentration of urine functions are SEVERELY compromised
  • usually happens bilaterally
88
Q

True or False:

Adult dominant polycystic kidney disease decreases the size of the kidney by 25x

A

False

  • INCREASES the size by 25x
  • patient will feel A LOT of discomfort and pain
89
Q

What are the results of failing kidneys (3)?

A
  1. Less waste is removed
  2. More waste remains in the blood
  3. Nitrogenous compounds build up in the blood
90
Q

How do we determine that the kidneys are failing (2)?

A
  1. BUN tests (blood urea nitrogen)
  2. Creatinine tests
    - if they are elevated, patient is deemed to have kidney failure
91
Q

What are the two classifications of renal failure?

A
  1. Acute renal failure

2. Chronic renal failure

92
Q

True or False:

Acute renal failure has a 50% mortality rate

A

True

93
Q

Why does acute renal failure have such a high mortality rate?

A

B/c there is a sudden decrease in renal function

- can happen in hours or days

94
Q

How long does chronic renal failure take to progress?

A

Years

95
Q

What are the three classifications for acute renal failure?

A
  1. Prerenal
  2. Intrarenal
  3. Postrenal
96
Q

What is the cause of prerenal acute renal failure?

A

Decreased blood supply

- from shock, hemorrhage, obstruction, dehydration, sepsis, trauma

97
Q

What is the cause of intrarenal acute renal failure?

A

Nephrotoxin or renal ischemia

  • something that damages the kidneys
  • causes death of tubular cells
98
Q

What is the cause of postrenal acute renal failure?

A

Obstruction (like benign prostatic hypertrophy or stones)

- of ureters or calyces

99
Q

What is a staghorn calculus?

A

Kidney stone of the ENTIRE calyces
- can block entire kidney
= kidney cannot filter anything

100
Q

Why is oliguria seen in the prerenal acute renal failure? What does it result in?

A

Decrease blood flow to the kidneys = less urine will be produced
- results in increase in nitrogenous wastes in the blood

101
Q

What are the 3 stages of acute renal failure?

A
  1. Oliguric
  2. Diuretic
  3. Recovery
102
Q

What happens in the oliguric phase of acute renal failure?

A

Net filtration is decrease b/c of high capsular pressure (due to blockage from ATN)

  • lasts for 2 - 10 days
  • until ATN is cleared
103
Q

Why does the diuretic phase happen next?

A

Obstruction is cleared

  • functional cells are lost in the tubules
  • no way to reabsorb!
104
Q

How long can the diuretic phase last?

A

Months to 2 years

105
Q

What happens in the recovery phase of acute renal failure?

A

Person gets better

  • tubular cells are healed
  • urine output becomes normal again
106
Q

What are the two clinical manifestations of chronic renal failure?

A
  1. Hypertrophy

2. Hyperperfusion

107
Q

True or False:

We need only need 1 kidney to live

A

False (technically)

- we only need 1/2 a kidney to live

108
Q

Why does the kidney experience hypertrophy and hyperperfusion during chronic renal failure?

A

Nephrons become larger and require more blood in compensation for the nephrons that are being lost

109
Q

What is a clue that a patient has chronic renal failure?

A

Steady rise in BUN and creatinine levels

110
Q

What is a common symptom of chronic renal failure?

A

Hypertension

  • b/c the kidneys are not functioning properly
  • hypertension only makes problem worse (damages kidneys even more)
111
Q

True or False:

Some patients reach end stage chronic renal failure without significant S/S

A

True

- approx 33 - 50% don’t show signs or symptoms

112
Q

In chronic renal failure, what accumulates in the renal sinus?

A

Fatty accumulation

113
Q

Who is at risk for developing chronic renal failure?

A

Diabetes patients
- changes in blood vessels
= poor filtration of blood

114
Q

What are the stages of chronic renal failure (3)?

A
  1. 75% nephron loss - no s/s; BUN and creatinine are normal
  2. 75 - 90% nephron loss - polyuria, nocturia, slight increase in BUN and creatinine
  3. > 90% loss = uremia
115
Q

Is it possible to have chronic renal failure if one kidney is normal?

A

NO!

  • b/c 1 kidney is sufficient for the body’s functions
  • will NOT see a rise in BUN or creatinine
116
Q

What happens in chronic renal failure (generally)?

A

Nephrons cannot keep up

  • no longer keep blood composition normal
  • no longer regulate urine density
117
Q

True or False:

In end-stage renal diease, the kidneys are small bilaterally

A

True

118
Q

Define uremia

A

Urine in the blood

119
Q

What happens in end-stage renal failure?

A
  1. Renal filtering function decreases (altered electrolytes)
  2. Wastes build up in the blood (BUN and creatinine)
  3. Kidney metabolic functions decrease (EPO and vitamin D activation)
120
Q

Why is osteodystrophy seen in Chronic Renal Failure?

A

Kidneys cannot activate vitamin D

- leads to abnormal bone composition

121
Q

Why is anemia seen in Chronic Renal Failure?

A

Decrease in EPO production

- less RBC are stimulated to be formed

122
Q

Why is tachycardia seen in Chronic Renal Failure?

A

There is a decreased viscosity of blood (b/c of anemia) - decreases blood pressure
- heart compensates by INCREASING

123
Q

Why is hypertension seen in Chronic Renal Failure?

A

Renin-aldosterone system

124
Q

Why is heart failure seen in Chronic Renal Failure?

A

Kidneys aren’t filtering out fluid

- too much fluid for the heart to handle

125
Q

Why is edema seen in Chronic Renal Failure?

A

Too much fluid on board b/c the kidneys cannot filter it out

126
Q

True or False:

Neoplasms of the urinary tract are more often benign than malignant

A

FALSE

- more often malignant

127
Q

What can urinary tract tumors cause?

A

Obstruction!

128
Q

What does the patient report if there is a urinary tract tumor?

A

Back pain

129
Q

True or False:

BUN and creatinine levels can be normal if there is a cancer of the kidney?

A

True!

- if it only affects 1 kidney

130
Q

What will the patient experience if there is a tumor of the bladder?

A
  • urgency

- frequency

131
Q

What happens in urothelia carcinoma in the calyces?

A

Fluid will be stuck in the renal papilla

- it has no where to drain to

132
Q

Define hydronephrosis

A

Kidneys swell b/c the fluid has no where to drain to

BHSC 2203 - Patho (13 decks)

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