Unit 8 Review Flashcards
what % of CO is received by the kidneys?
20-25%
the filtration of plasma per unit of time and is directly r/t the perfusion pressure of renal blood flow
glomerular filtration rate (GFR)
autoregulation of renal blood flow and sympathetic neural regulation of vasoconstriction is maintained by what
glomerular filtration rate
jobs of the kidneys
- regulate BP
- filter blood of toxins (filtration, reabsorption & secretion)
- concentrate urine
- maintain acid/base balance
- help control production of RBCs
the functional unit of the kidney
nephron
how many nephrons in each kidney
1.2 million
vascular components of the nephron
renal artery afferent arteriole multiple capillary tufts (in capsule of glomerulus) efferent arteriole peritubular capillaries and vasa recta interlobular veins renal veins
what is the first place in the kidney to receive diluted urine
Bowman’s capsule - coming from glomerulus
water, small molecules & ions filter thru the capillary walls into Bowman’s capsule. this fluid is called
nephritic filtrate - blood plasma minus most plasma proteins (interstitial fluid)
where does nephritic filtrate go from Bowman’s capsule
proximal tubule
what molecules and substances are reabsorbed in the proximal tubules by active transport?
glucose
amino acids
the active transport of Na+ out of the proximal tubule is controlled by what hormone?
Angiotensin II
active transport of phophate back into blood is regulated by….
parathyroid hormone and fibroblast growth factor
H2O follows the nephritic filtrate by what process
osmosis
H2O flows out of ( ) by osmosis because the interstitial fluid
is ( )
Loop of Henle
hypertonic
More reabsorption of Na+ and H2O happens in the…
distal tubules and collecting ducts
1st step in urine formation where permeable substances from blood are filtered
glomerular filtration
retains substances that are needed by the body, removes them and returns them to the blood
tubular reabsorption
excretes chemicals that are not needed by the body and adds material to the filtrate from the blood
tubular secretion
drugs that increase urine production
diuretics
what is the site of action for “loop” diuretics
ascending limb of the Loop of Henle
two important jobs of kidneys to maintain acid/base balance
- reabsorb bicarb from urine
2. excrete H+ ions into urine
which is slower to compensate for acid/base imbalances, kidneys or lungs
kidneys
in a state of ( ) the kidneys reabsorb more bicarb from the tubular fluid, and collecting ducts secrete more H+, generate more bicarb and increase formation of NH3 buffer
acidosis
in alkalosis the kidneys ( ) more bicarb and ( ) H+ ion secretion from the tubules, lowering ammonium excretion
excrete
decrease
the kidneys control the production of RBCs in bone marrow thru the production of
erythropoietan (EPO)
the kidneys play a central role in BP regulation through which system
RAAS
trace the RAAS system
Renin (kidneys) –> angiotensinogen–>angiotensin I –> angiotensin II c help from angiotensin converting enzyme (ACE) in the lungs –>converted to aldosterone –>reabosorption of Na+ and H2O in kidneys and preserves BP
possible causes of urinary tract obstruction
bladder/kidney stones, stricture BPH CA - bladder, colon, ureteral, prostate, cervical, uterine scar tissue/adhesions blood clot in ureter cystocele FB posterior urethral valves (birth defect) urethral diverticula rectal impaction c feces
condition in which your urine flow reverses direction
obstructive uropathy
what is the effect of complete obstruction of urinary tract upon kidneys structure and function
urine refluxes back to kidneys - obstructivve uropathy
causes swelling, damages kidneys possibly permanently (too much volume in kidneys)
three theories of kidney stone formation
- stones formed from renal plaque (Randall’s plaque)
ideopathic Ca++ oxalte stones - stones attached to plugs protruding from the ducts of Bellini
- stones formin in free solution in the renal collection system
stones in free solution in the renal collection system
cystinuria
stones protruding from ducts of Bellini - intraluminar plug formed
hyperoxaluria and distal tubular acidosis
abdominal pain caused by kidney stones
renal colic
pain beginning in abdomen and radiating to low anterior abdominal wall or groin, comes in waves or could be constant–worse than childbirth
renal colic
pain from kidney stones that distend the renal calices or the renal pelvis – dull and deep pain, flank or back, ranges from mild to severe, increases with drinking fluids
non-colicky renal pain
what organisms are responsible for UTIs
E. coli – most common
Staph – 2nd most
Klebsiella, proteus, pseudomonas, fungi, viruses, parasites, etc.
fungal infections are rare (Candidas)
many physiologic mechanisms protect us from UTIs… Name some
bacteria washed out during micturation (peeing)
low pH and high osmolality of urine
proteins to kill bacteria (Tamm-Horsfall)
secretions from uroepithelium - bacteriacidal
ureterovesical junction closes preventing reflux of urine
urethral sphincter is a mechanical barrier
immune system
secretions from female glands and male prostate trap bacteria before it can invade
what factors predispose sexually active women to UTIs
frequency of sex “honeymoon cystitis”
what factors predispose elderly women to UTIs
pH is higher,
immune system weaker
incontinence increases chances of bacteria invading
hospital stay or long term living care
bladder drops (cystocele), bladder can’t empty completely (stagnant urine)
lack of estrogen allows bacteria to grow more easily - loss of protective vaginal flora
DM, lack of activity, poor hygiene,
polypharmacy
what factors predispose pregnant women to UTIs
hormone changes cause changes in urinary tract
growing uterus pressing on bladder prevents complete emptying of bladder (stagnant urine)
UTIs are often ( ) or ________ __________ which is costly in terms of future kidney disease and increased health care costs
under-treated or improperly treated
The most commonly recognized form of acute glomerulonephritis follows infxns caused by strains of
strep (in children)
staph (in adults)
Nephritic syndrome is caused by disorders that increase the permiability of the glomerular capillary membrane causing massive loss of ( ) in the urine
blood (hematurea)
don’t confuse with NEPHROTIC SYNDROME which where the patient loses PROTEIN (albumin) in urine
form of nephritis affecting the interstitium of the kidneys surrounding the tubules–eventually ends in kidney failure
tubulointerstitial kidney disease
pathogenesis of pyelonephritis
bacterial infection in the urethra which travels to the bladder and from there to the kidneys
untreated pyelonephritis can _______ the kidneys and lead to renal _____________ or complete renal _______, due directly to _________-__________ damage to kidney and secondary damage from inadequate _________ _____ to kidneys if sepsis occurs
damage insufficiency failure infection-related blood flow
kidneys filter chemicals, substances, and toxins in the blood which puts them at risk for __________ kidney _________
acute (kidney) injury
formerly called acute renal failure
Some medications/drugs that can cause kidney injury:
Abx, ACE inhibitors, ARBS, chemotherapy, contrast dye, illegal drugs (heroin & meth), protease inhibitors, NSAIDS, cimitidine
difference between acute and chronic renal failure
acute - sudden decline, decrease in GFR, and accumulation of nitrogenous waste products in blood
cause is usually prerenal insult, i.e…
hypovolemia, sepsis, PE, stenosis of renal artery, MI,
chronic - progressive loss of renal fxn associated with systemic diseases like HTN, DM, SLE or intrinsic kidney disease including stones,or previous injury, CA….
what are two clinical manifestations of chronic renal failure?
axotemia - increased serum urea, increased BUN and creat
uremia - proinflammatory state with many systemic effects - accumulation of urea and other nitrogenous compounds and toxins
chronic __________ is the most profound hematologic alteration that accompanies renal failure
anemia
what is cause of anemia r/t renal failure
inadequate production of erythropoietin, decreases RBC production
chronic inflammation, iron deficiency and decreased half-life of eythrocytes
a decline in what is r/t normal aging?
GFR
declining GFR means older persons are more susceptible to the detrimental effects of _____________ ________
nephrotoxic drugs (and other things that compromise renal function)
treatable causes of incontinence in elderly
DIAPPERS pneumonic...
D elirium
I nfection--urinary (symptomatic)
A trophic urethritis and vaginitis
P harmaceuticals
P sychologic disorders, especially depression
E xcessive urine output (eg, from heart failure or hyperglycemia)
R estricted mobility
S tool impactionneural lesion that interrupts innervation of the bladder
neurogenic bladder
