Unit 3 Module 3: Urinary/Renal Flashcards by Chris Letts

Up or down in CKD? calcium

down (inverse to phosphorus, so when the phosphorus can’t be excreted, it goes up)

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If only one ureter is blocked, will that cause acute renal failure?

No, can still excrete through the other ureter. But bilateral ureter blockages or blockages further down will cause ARF.

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Four symptoms related to fluid and electrolyte imbalance in ARF

hypertension
hypervolemia
heart failure
edema
hyperkalemia (stage 5)

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ARF Phase 3:

name, symptoms, duration

Diuretic phase
Symptoms:
- increased urine output
- electrolyte imbalance
- dehydration
days to weeks

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Can AKI patients have permanent kidney dysfunction?

Yes

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Why does poor activation of vitamin D cause osteodystrophies?

it causes hypocalcemia (which then also triggers hyperparathyroidism)

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Most patients are in which stage of CKD?

3 (GFR 30-59)

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up or down in kidney failure: phosphorus

up (excreted by kidney)

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What are causes of low blood flow to the kidneys which would cause pre-renal failure?

Hypovolemia, shock, sepsis, drugs like NSAIDs, low cardiac output

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Why does acid-base imbalance lead to osteodystrophies?

skeletal buffering – the kidneys leave the blood too acidic, so the bones try to compensate

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Which stage CKD patients need dialysis?

5 (GFR <15)

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What are the three types of ARF?

pre-renal
intrarenal
postrenal

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Why do patients urinate a lot in phase 3 ARF?

In the diuretic phase, the kidney is healing but doesn’t concentrate urine very well.

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Stage 5 GFR

<15

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ARF Phase 1:

name, symptoms, duration

onset phase
asymptomatic
hours to days (typically <48 hours)

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What is the most common type of intrarenal failure?

ATN: acute tubular necrosis

they’re easily damaged because they’re sensitive to ischemia and toxins

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Why does low blood flow cause pre-renal failure? (Hypovolemia, shock, sepsis, drugs like NSAIDs, low cardiac output)

There isn’t a pressure gradient to filter waste.

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What are the four functions of the kidneys?

eliminate waste
fluid/electrolyte
regulate blood pH
regulate blood pressure

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If we give a patient fluids and their status improves, which type of AKI is it?

prerenal – it improves because there’s more bloodflow in the kidneys

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Up or down in CKD? GFR

down

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Normal BUN

10-20 mg/dL

ARF: elevated

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CKD GI problems

anorexia, nausea (early morning), metallic taste

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ARF GFR is elevated or decreased?

Decreased

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Which organ systems are affected by poor elimination of nitrogenous wastes?

cardiovascular (pericarditis, bleeding)
immune
integumentary (itching from high levels of phosphate)
GI (nausea)
neurologic (peripheral neuropathy)
sexual

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ARF BUN/creatinine is elevated or decreased?

Elevated (15-20:1 ratio)

Do patients recover from CKD?

No. They need kidney transplants ultimately.

CKD patients have progressively higher albumin in their urine. That makes sense with which systemic symptom?

Edema. Remember, albumin draws fluid out of the 3rd space into the vasculature. If it's getting peed out: edema.

As the nephron number goes down, [hyper/hypo]filtration occurs

hyperfiltration at the glomerulus occurs

Normal creatinine

0.6-1.2 mg/dL | ARF: elevated

Normal GFR

120-130 mL/min | ARF: Decreased

Up or down in CKD? BUN

What are causes of ischemia leading to intrarenal failure?

infection, inflammation, nephrotoxic drugs

CKD sexual dysfunction

decreased sex hormones -> decreased libido

up or down in kidney failure: pH

down (metabolic acidosis)

Why does CKD cause anemia?

Kidneys produce erythropoetin which drives red blood cell production

Up or down in CKD? creatinine

Stage 3 GFR

30-59

Under what conditions is AKI reversible?

``` We identify it early We identify (and treat) the cause ```

Why does poor phosphate elimination cause osteodystrophies?

Phosphate and calcium have an inverse relationship, so it causes hypocalcemia (which then also triggers hyperparathyroidism)

What portion of the cardiac output goes to the kidneys?

20-25% | They're greedy!

ARF BUN/creatinine ratio

15-20:1

What's the relationship between aging and CKD?

- Natural decrease in kidney function with age (usually doesn't need dialysis) - more comorbidities

Normal relationship between BUN and creatinine

10:1 BUN:creatinine (direct)

CKD cardiovascular symptoms

Coagulopathies, pericarditis

Up or down in CKD? Hemoglobin/hematocrit/RBC

down: lack of erythropoeitin (+ chronic blood loss, iron deficiencies, hemolysis)

ARF Phase 4: | name, symptoms, duration

Recovery phase | 3-12 months

CKD integumentary symptoms

skin disorders: discoloring - sallow, dry, pruritis (itching), uremic crystals on skin (stage 5 pre-dialysis)

Stage 1 GFR

=>90

Underlying disease process of CKD

Non-functioning nephrons replaced by scar tissue

What are the top two causes of CKD?

1. Diabetes (due to vascular damage) | 2. HTN (sustained pressure causes damage to the glomerulus)

CKD neuro symptoms

peripheral neuropathy

What is the etiology of intrarenal failure?

ischemia

What does oliguric mean?

Decreased urine output, from oli (scanty) + uric (urine). Oliguric is phase 2 of ARF, sometimes called anuric

What are the two key characteristics of AKI (compared to chronic)

``` reversible abrupt onset (<48 hours) ```

ARF Phase 2: | name, symptoms, duration

``` *this is the big one where patients usually present* Oliguric/anuric phase Extremely symptomatic: - Low urine output - fluid volume overload - fluid/electrolyte imbalance - acid/base imbalance (metabolic acidosis) - azotemia -> uremia 1-2 weeks ```

Stage 4 GFR

15-30

Stage 2 GFR

60-90

Is azotemia or uremia worse?

Uremia (in A-Z order, AZotemia is first and Uremia is last). Uremia, from Greek for urine + in the blood -- not in the toilet where it belongs.

What is the etiology of postrenal failure?

obstruction that blocks urine excretion (so urine backs up and the toxins that should be excreted cause internal damage)

Up or down in CKD? Potassium

up (excreted by kidney)

up or down in kidney failure: albumin

down (glomeruli allow protein to pass through and get excreted)

CKD immune symptoms

impaired immune function, increased risk of infection d/t dialysis

Azotemia vs. uremia: which has symptoms or signs of renal failure?

Uremia -- azotemia just has elevated BUN and creatinine

What are the four phases of ARF

onset oliguric/anuric ( from scanty or no + urine) diuretic (from through + urine) recovery

As glomerular permeability and RAAS go up, what process occurs?

Nephrotoxic inflammation and remodeling -> fibrosis in the kidneys