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Patho Units 7-10 > Unit 8 Review > Flashcards

Unit 8 Review Flashcards

1
Q

what % of CO is received by the kidneys?

A

20-25%

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2
Q

the filtration of plasma per unit of time and is directly r/t the perfusion pressure of renal blood flow

A

glomerular filtration rate (GFR)

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3
Q

autoregulation of renal blood flow and sympathetic neural regulation of vasoconstriction is maintained by what

A

glomerular filtration rate

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4
Q

jobs of the kidneys

A
  1. regulate BP
  2. filter blood of toxins (filtration, reabsorption & secretion)
  3. concentrate urine
  4. maintain acid/base balance
  5. help control production of RBCs
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5
Q

the functional unit of the kidney

A

nephron

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6
Q

how many nephrons in each kidney

A

1.2 million

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7
Q

vascular components of the nephron

A 
renal artery
afferent arteriole
multiple capillary tufts (in capsule of glomerulus)
efferent arteriole
peritubular capillaries and vasa recta
interlobular veins
renal veins
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8
Q

what is the first place in the kidney to receive diluted urine

A

Bowman’s capsule - coming from glomerulus

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9
Q

water, small molecules & ions filter thru the capillary walls into Bowman’s capsule. this fluid is called

A

nephritic filtrate - blood plasma minus most plasma proteins (interstitial fluid)

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10
Q

where does nephritic filtrate go from Bowman’s capsule

A

proximal tubule

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11
Q

what molecules and substances are reabsorbed in the proximal tubules by active transport?

A

glucose

amino acids

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12
Q

the active transport of Na+ out of the proximal tubule is controlled by what hormone?

A

Angiotensin II

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13
Q

active transport of phophate back into blood is regulated by….

A

parathyroid hormone and fibroblast growth factor

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14
Q

H2O follows the nephritic filtrate by what process

A

osmosis

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15
Q

H2O flows out of ( ) by osmosis because the interstitial fluid
is ( )

A

Loop of Henle

hypertonic

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16
Q

More reabsorption of Na+ and H2O happens in the…

A

distal tubules and collecting ducts

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17
Q

1st step in urine formation where permeable substances from blood are filtered

A

glomerular filtration

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18
Q

retains substances that are needed by the body, removes them and returns them to the blood

A

tubular reabsorption

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19
Q

excretes chemicals that are not needed by the body and adds material to the filtrate from the blood

A

tubular secretion

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20
Q

drugs that increase urine production

A

diuretics

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21
Q

what is the site of action for “loop” diuretics

A

ascending limb of the Loop of Henle

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22
Q

two important jobs of kidneys to maintain acid/base balance

A
  1. reabsorb bicarb from urine

2. excrete H+ ions into urine

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23
Q

which is slower to compensate for acid/base imbalances, kidneys or lungs

A

kidneys

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24
Q

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

A

acidosis

25
Q

in alkalosis the kidneys ( ) more bicarb and ( ) H+ ion secretion from the tubules, lowering ammonium excretion

A

excrete

decrease

26
Q

the kidneys control the production of RBCs in bone marrow thru the production of

A

erythropoietan (EPO)

27
Q

the kidneys play a central role in BP regulation through which system

A

RAAS

28
Q

trace the RAAS system

A

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

29
Q

possible causes of urinary tract obstruction

A 
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
30
Q

condition in which your urine flow reverses direction

A

obstructive uropathy

31
Q

what is the effect of complete obstruction of urinary tract upon kidneys structure and function

A

urine refluxes back to kidneys - obstructivve uropathy

causes swelling, damages kidneys possibly permanently (too much volume in kidneys)

32
Q

three theories of kidney stone formation

A
  1. stones formed from renal plaque (Randall’s plaque)
    ideopathic Ca++ oxalte stones
  2. stones attached to plugs protruding from the ducts of Bellini
  3. stones formin in free solution in the renal collection system
33
Q

stones in free solution in the renal collection system

A

cystinuria

34
Q

stones protruding from ducts of Bellini - intraluminar plug formed

A

hyperoxaluria and distal tubular acidosis

35
Q

abdominal pain caused by kidney stones

A

renal colic

36
Q

pain beginning in abdomen and radiating to low anterior abdominal wall or groin, comes in waves or could be constant–worse than childbirth

A

renal colic

37
Q

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

A

non-colicky renal pain

38
Q

what organisms are responsible for UTIs

A

E. coli – most common
Staph – 2nd most
Klebsiella, proteus, pseudomonas, fungi, viruses, parasites, etc.
fungal infections are rare (Candidas)

39
Q

many physiologic mechanisms protect us from UTIs… Name some

A

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

40
Q

what factors predispose sexually active women to UTIs

A

frequency of sex “honeymoon cystitis”

41
Q

what factors predispose elderly women to UTIs

A

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

42
Q

what factors predispose pregnant women to UTIs

A

hormone changes cause changes in urinary tract

growing uterus pressing on bladder prevents complete emptying of bladder (stagnant urine)

43
Q

UTIs are often ( ) or ________ __________ which is costly in terms of future kidney disease and increased health care costs

A

under-treated or improperly treated

44
Q

The most commonly recognized form of acute glomerulonephritis follows infxns caused by strains of

A

strep (in children)

staph (in adults)

45
Q

Nephritic syndrome is caused by disorders that increase the permiability of the glomerular capillary membrane causing massive loss of ( ) in the urine

A

blood (hematurea)

don’t confuse with NEPHROTIC SYNDROME which where the patient loses PROTEIN (albumin) in urine

46
Q

form of nephritis affecting the interstitium of the kidneys surrounding the tubules–eventually ends in kidney failure

A

tubulointerstitial kidney disease

47
Q

pathogenesis of pyelonephritis

A

bacterial infection in the urethra which travels to the bladder and from there to the kidneys

48
Q

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

A 
damage
insufficiency
failure
infection-related
blood flow
49
Q

kidneys filter chemicals, substances, and toxins in the blood which puts them at risk for __________ kidney _________

A

acute (kidney) injury

formerly called acute renal failure

50
Q

Some medications/drugs that can cause kidney injury:

A

Abx, ACE inhibitors, ARBS, chemotherapy, contrast dye, illegal drugs (heroin & meth), protease inhibitors, NSAIDS, cimitidine

51
Q

difference between acute and chronic renal failure

A

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….

52
Q

what are two clinical manifestations of chronic renal failure?

A

axotemia - increased serum urea, increased BUN and creat
uremia - proinflammatory state with many systemic effects - accumulation of urea and other nitrogenous compounds and toxins

53
Q

chronic __________ is the most profound hematologic alteration that accompanies renal failure

A

anemia

54
Q

what is cause of anemia r/t renal failure

A

inadequate production of erythropoietin, decreases RBC production
chronic inflammation, iron deficiency and decreased half-life of eythrocytes

55
Q

a decline in what is r/t normal aging?

A

GFR

56
Q

declining GFR means older persons are more susceptible to the detrimental effects of _____________ ________

A

nephrotoxic drugs (and other things that compromise renal function)

57
Q

treatable causes of incontinence in elderly

A 
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 impaction
58
Q

neural lesion that interrupts innervation of the bladder

A

neurogenic bladder

Patho Units 7-10 (15 decks)

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