week 10 chronic Kidney Disease Flashcards
1
Q
`what are the 3 important concept in chronic kidney disease?
A
fluid & electrolytes
acid base balance
elimination
2
Q
True or false. The kidneys are well protected by the muscles of the back as well as shock absorbing layers of fat and connective tissue.
A
true
3
Q
where does kidneys sit ? this should be anatomy review ( well shat sherlock its been a minute )
A
Kidneys sit in the retroperitoneal space, the kidneys sit
4
Q
where is kidneys located ?
A
located at the downward angle of the last rib called costovertebral angle
5
Q
true or false. The kidneys sit on either side of the spine with the right kidney being slightly lower than the left and this is because the liver sits just above the right kidney
A
true
6
Q
Kidney macrostructure :
describe what the outer layer of kidney looks like
A
fibrous tissue called the capsule, the helium is the only portion not covered by the capsule ( indented area where the blood vessels nerves and the ureter sit the capsule is surrounded by layers of fat and ct)
7
Q
kidney macrostructure
what is the next layer beneath the capsule ? and what is the inner layer called?
A
the cortex, inner layer is called the medulla
8
Q
describe how papillae allow urine passes and how the transportation work.
A
- urine passes through the papillae to enter calyx minor calyx widen and merge to form major calyx
- which form a funnel shaped sac called the renal pelvis
the minor / major calyx
transport urine to the renal pelvis in preparation for transportation to the
bladder via the ureter
The renal pelvis can only store a small volume of urine
about three to five ml at a time
9
Q
renal blood flow :
true or false. 5 mL of blood is filtered every hour ( 5 L = total adult blood vL)
A
true
10
Q
renal blood flow :
how many L is formed per day?
A
only 1 - 3 L of urine is formed per day ( 24 hrs )
11
Q
these terms are important to know in terms of renal blood flow :
blood entry
kidney structure
blood supply
renal artery
describe how they are important and how they contribute to renal blood flow
A
- Blood Entry: Renal artery, originating from the aorta or its branches, delivers blood into the kidney.
- Kidney Structure: Blood enters through the renal hilum, a small indentation.
- Blood Supply: Kidneys have a rich blood supply, receiving blood flow at 600 to 1300 mls per minute.
- Renal Artery Branching: Renal artery divides into smaller branches; the smallest offshoot is the afferent arterial.
12
Q
continuous ….: these terms are important to know in terms of renal blood flow :
glomerulus
capillary count
filtration process
A
- Glomerulus: Blood flows into the glomerulus, comprising a series of capillary loops.
- Capillary Count: Each glomerulus has up to 50 capillaries, facilitating filtration
- Filtration Process: Within these capillaries, water and small particles are filtered from the blood to eventually form urine.
13
Q
Kidney Microstructure : Nephron : describe it
A
the nephron is the functional unit of the kidney
there are 1 million nephrons per kidney
14
Q
what is the anatomy of kdiney ?
A
bowman’s capsule
tubular system ( PCT, DCT, and loop of henle )
15
Q
true or false.
Each nephron is a tube like structure with distinctive parts consisting of bowman’s
capsule a sac like structure surrounding the glomerulus and then the tubular system
the proximal convoluted tubule or pct the distal convoluted tubule or dct and the loop of henle
A
true
16
Q
Kidney Microstructure : Glomerulus ( any negative on these, what is the consequence)?
A
difficulty with filtration
17
Q
What are the 3 layers of glomerular capillary?
A
1) endothelium
2) basement membrane
3) epithelium
18
Q
true or false. Glomerular capillary is how cellular membrane layers of bowman capsule work together to control what leaves the blood to enter the filtrate.
A
true
19
Q
what is the fluid typically called?
A
filtrate
20
Q
which of the following is directly in contact with the blood -this is also made up of single layer of endothelial cells out of the 3 layers of glomerulus
A
innermost endothelial layer
21
Q
what is the basement membrane, it has a unique feature that is important, now describe why
A
mesh like ct layer and it has a unique feature, of being negatively charged, this charge is
important in the filtration process because it will repel any particles in the
blood that are Also negatively charged for example albumin.
22
Q
true or false. The layer of epithelial cells is not small enough to pass through the opening in the membrane, therefore should NEVER pass the memebrane.
A
false it is small enough to get pass the membrane
23
Q
little pores or fenestrations that help to filter
water and small particles from the blood into bowman capsule what is this fluid called ?
A
filtrate
24
Q
the glomerulus continued….
glomerular filtration is controlled by 3 forces : what is it ?
A
1) hydrostatic pressure ( blood pressure )
2) colloid pressure ( pull from albumin )
3) capsular hydrostatic pressure
25
true or false. kidneys filter blood
true
26
The kidneys filter blood . true or false?
Kidneys filter blood yes this is true
27
what is the first process in urine formation?
glomerular filtration
28
the first process is glomerular filtration : now explain it further
as the blood passes the afferent arterial into the glomerulus ( water and elctrolyte and glucose ) and small particles like urea, creatine and glucose are fileted through bowman’s capsule to form glomerular filtrate.
the movement of fluid across this membrane is controlled by the same forces that move fluid in and out of capillaries
everywhere else in the body the hydrostatic pressure
ex: blood pressure - of the blood within the glomerular capillaries causes a portion of blood to be filtered across the semi permeable membrane into bowman capsule
where the glomerular filtrate begins to pass down the tubule
filtration is more rapid in the glomerulus than in ordinary tissue capillaries because of the permeability to the glomerular membrane because this is its whole purpose
29
So working opposite of hydrostatic pressure of blood pressure are two negative pressure. initially two pressure pushing back, what is the first one called ?
first one is called blood colloid pressure and this pressure is caused by plasma proteins such as albumin that stay in the capillaries and draw water back towards themselves
30
the other or second negative force that opposes the hydrostatic or blood pressure is called the _____
capsular pressure - related to the actual structure of the membrane of bowman's capsule this is against the fluid being pushed into the space the net effect is filtrate forward into bowman's capsule
31
true or false. hydrostatic pressure or blood pressure can overcome the colloid pressure but not capsular pressure?
false, it can overcome both
32
recall that hydrostatic or bp can overcome colloid pressure and capsular pressure & therefore fluid moves forward into bowman's capsule. However drastic changes in particular drops to bp or hydrostatic pressure or anything that could increase the opposing pressures like albumin leaking into this space result in decrease
GFR
33
The amount of blood filtered by the glomerular in a given time is termed, the GFR and the normal or average GFR in a healthy functioning kidney or body is above
125 mL per min
34
nephron reabsorption & secretion
these terms undergoes this description : now define what they mean
BC
PCT
LH
DCT
BC ( bowman's capsule ) = collects glomerular filtrate, funnels it into the tubule
PCT ( proximal convoluted tubule ) = reabsorption of 80% of electrolytes ( Na , K , Cl, Ca, etc ) 100% glucose and 70% water.
LH = concentrate the filtrate
DCT = some water & electrolyte reabsorption, including bicarbonate, potassium and hydrogen secretion
34
give the summary of glomerulus filtration : give this in detail
the blood is continuously circulating through the glomerulus and because of the forces and selective permeability of the glomerulus membrane
( various components of blood including water and small particles will move through the three layers and enter the bowman's capsule to become filtrate )
34
true or false. path and processing of the filtrate past bowman's capsule into the tubular system
true
35
true or false. electrolytes, glucose, needs to be returned to the body , because you can't just pee it out.
true
36
Proximal convoluted tubule eventually straightens out and becomes what ?
proximal straight tubule or descending limb of loop of henle
37
recall : cells respond to a drop in bp blood volume or sodium and stimulate the release of renin a hormone that leads to aldosterone production. how does this form ?
it forms from the thick segment of ascending limb of loop of henle the DCT can be permeable to water and some water reabsorption occurs here as the filtrate contributes to move through it ( has specialized cells called Juxtaglomerular Cells
38
loop of henle : is important for what ?
loop of henle - important in conserving water and concentrating the filtrate
39
bowman's capsule : is similar composition to what ?
blood
40
Kidney : Autoregulation
what is the description
kidneys maintain a constant blood flow and blood pressure --> therefore a constant GFR
41
this is the ability for the kidney to constantly adjust the amount of blood entering and leaving the glomerulus
kidney: auto regulation
42
how is GFR controlled ?
controlled by blood pressure and blood flow, kidneys can self regulate their own bp and blood flow to point, keeps GFR constant
43
True or false. GFR is controlled by selectively constricting and dilating efferent and afferent arterials
true
44
if there is too much blood into the kidney - it responds by how ? what happens when it is reduced ?
responds by constricting afferent arterial and dialating the efferent arterial. The opposite will occur when blood flow to the kidney is reduced
45
Kidney : Autoregulation
Response to too much blood or pressure
Response to too little blood or pressure
Limitation of the system
1) less than GFR = by constricting afferent arteriole and dilating efferent arteriole
2) response to too little blood or pressure : increase GFR by dilating afferent arteriole and constricting efferent arteriole
3) limitation of the system : this ability to auto- regulate fails when the systolic BP drops below 65- 70 mmHg
46
ability of the kidney to vary the volume or concentration of urine helps regulate water balance regardless of fluid intake - healthy kidney can prevent dehydration, can also help fluid intake is low and can prevent circulatory overload when fluid is high. true or false.
true
47
auto regulation no longer works when the systolic blood pressure falls below ?
65 - 70 mmHg
48
again AGAIN I wanna EMPHI : major kidney function : regulation
fluid & electrolytes balance
filter & excrete waste products
acid base balance (hydrogen and bases like bicarbonate ammonia )
49
waste products such as urea and creatine are no longer needed in the body therefore are not reabsorbed back into the circulation. true or false.
true
50
where is urea usually produced ?
produced mostly fro the liver metabolism of food sources of protein
51
how is creatine produced ?
creatine is produced when the muscles and other proteins are broken in the body so if glomerular filtration rate decreases below normal levels these waste products will begin to accumulate.
52
Secondary Kidney Function : Hormones
name the categories that undergoes this
Production and Secretion of Renin
Production of Erythropoietin
Activation of Vitamin D
53
Renin is released when blood pressure is low and cascade is sort of action ultimately resulting in angiotensin II producing what
produce causing vasoconstriction blood pressure - increase in BP
54
Secondary Kidney Function : Hormones
Production and Secretion of Renin : give the description on this
RAAs : work to increase BP and BF when low
55
Secondary Kidney function : hormones
Production of Erythropoietin
Hormone released in response to hypoxia , stimulates production of RBCs
56
What is the hormone released when circulating blood oxygen levels are too low ?
erythropoietin
57
The effect of this hormone is to stimulate the bone marrow to produce more red blood cells which are cells that carry oxygen to our tissues
Erythropoietin
58
Secondary Kidney Function : Hormones
Production of Erythropoietin
hormone released in response to hypoxia ( stimulate production of RBCs )
59
Secondary Kidney Function : Hormones
Activation of vitamin D
vitamin d is obtained through diet and must be activated
vitamin d is needed for absorption of ingested calcium
60
true or false. Vitamin d is converted in its active form in the kidney
true , so activated vitamin d is needed to absorb calcium in the intestinal tract to regulate calcium balance
61
simplify and explain the raas system to me :
The Renin-Angiotensin-Aldosterone System (RAAS) is like a control system in your body that manages blood pressure and fluid balance.
Trigger: When your body senses low blood pressure or low sodium levels, it releases a hormone called renin.
Renin Action: Renin acts on a protein in your blood to produce angiotensin I.
Angiotensin II: Another enzyme turns angiotensin I into angiotensin II. This substance makes your blood vessels narrow, increasing blood pressure. It also signals your body to retain sodium and water, further raising blood pressure.
62
what is needed for normal kidney function?
adequate glomerular function ( blood flow )
functional nephrons
63
consequences of abnormal kidney function:
true or false. Renal dysfunction will alter the kidney's ability to filter the blood, and this will be reflected in abnormal blood work.
true
64
recall that : Renal dysfunction will alter the kidney's ability to filter the blood, and this will be reflected in abnormal blood work. define what they are
* ↑ blood urea nitrogen (BUN)
* ↑serum creatinine
* failure to maintain Na+ & K+
* water retention
* acid-base imbalance
65
what do we start to see when kidneys stop filtering ?
physical symptoms
66
what are the renal terminology we need to learn
azotemia
uremia
oliguria
anuria
67
define what they mean
azotemia
uremia
oliguria
anuria
1) an accumulation of metabolic waste in the blood ( urea, creatinine)
2) a group of signs and symptoms that occur due to inadequate renal function
3) urine ooutput that is less than normal (<400 mL/day)
4) the absence of urine production ( <40 mL/day )
68
what is this describing : is the product of muscle breakdown and is only excreted from the kidneys does not get absorbed
creatine
69
what is this describing : product of protein breakdown and the most of it secreted by the kidneys
urea
70
these terminology are concern because it's an indication that there is a build up of what ?
indicates that there is a build up of waste products
and imbalance of electrolytes and acid base in the blood
71
Kidney dysfunction onset : chronic kidney disease ( this is permanent and the treatments tend to focus on mitigating further damage ) : what is the characteristics that lies within the description
gradual onset ( years )
most common cause is diabetic nephropathy
progressive & irreversible
cause of death : CVD
72
Chronic kidney disease has a total loss of ____ that we cannot replace
nephrons we cant reginerate
73
what are the two main causes of CKD ( diagnosis that leads to CKD )?
HTN and Diabetes
74
Kidney dysfunction onset : acute kidney injury
sudden onset ( hours to days )
most common cause is acute tubular necrosis ( atn )
potentially reversible
cause of death : sepsis
75
recall that most common cause of AKI is acute tubular necrosis : explain this
lack of blood flow or ischemia
76
CKD : what is the cause ?
caused by progressive irreversible loss of kidney function through loss of nephrons
most common causes are diabetic nephropathy and hypertension
77
what are the other causes of CKD ?
other causes include glomerulonephritis, pyelonephritis, polycystic disease, acute kidney inury
78
'CKD : what happens to the kidney?'
what happens to the remaining nephrons ?
what is happening over time ?
when can symptoms start to occur >
* Remaining nephrons work harder (hyperfiltration)
* Over time hyperfiltration causes fibrosis and scaring (glomerulosclerosis)
* Symptoms start to occur once 50% of nephrons are lost
* Can lose up to 90% before RRT (renal replacement therapy) is required
79
clinical stages of chronic kidney disease
define the description for stage 1 and stage 2 GFR and symptoms
stage 1 = at risk ; normal kidney function. urine findings indicate renal disease GFR= more than or equal to 90
symptoms= likely asymptomatic
stage 2 = slightly reduced kidney function
GFR= 60-89
symptoms = may be asymptomatic. decreased ability to concentrate urine. albuminuria may be present
80
clinical stages of chronic kidney disease
define the description for stage 3 and stage 4 GFR and symptoms
stage 3 = moderate reduction in renal function
GFR= 30-59
symptoms= albuminuria, may develop ( electrolyte and fluid imbalances ) , anemia, oliguria, azotemia
stage 4 = severe reduction in renal function
GFR= 15-29
symptoms= azotemia, anemia, fluid and electrolyte imbalance ( maybe )
acid and base electrolyte imbalance ( maybe)
81
clinical stages of chronic kidney disease
define the description for stage 5 gfr and symptoms
description: ESRD ( end stage renal disease)
GFR= less than 15
symptoms:
uremia
- renal replacement therapy started
82
'CKD : What does it look like in a patient ?'
when a patient develops enters the final stage of kidney failure they will show what kind of evidence?
fluid retention
electrolyte imbalance
waste production accumulation
hormone insufficiency
increase in blood lipoproteins ( increase in CVD)
changes in bone metabolism
83
fluid retention
electrolyte imbalance
waste production accumulation
hormone insufficiency
increase in blood lipoproteins ( increase in CVD)
changes in bone metabolism
recall that above can all be found when a patient enters the final stage of kidney failure
what term do we use to describe all the above ? " a group of symptoms"
uremia
84
CKD : The signs and symptoms
ps there is too much so just give me 5 examples
anxiety
hypertension
anorexia
hyperparathyroidism
carbohydrate intolerance
85
select all that applies if these are signs and symptoms that correlates with CKD
anxiety
depression
hypertension
heart failure
CAD
pericarditis
peripheral artery disease
anorexia
nausea & vomitting
gastro intestinal bleeding
gastritis
hyperparathyrodism
thyroid abnormalities
amenorrhea
erectile dysfunction
carbohydrate intolerance
hyperlipidemia
all
86
select all that applies if these are signs and symptoms that correlates with CKD
fatigue
headache
sleep disturbances
encephalopathy
hypertensive retinopathy
pulmonary edema
uremic pleuritis
pneumonia
pruiritis
ecchmois
dry, scaly skin
vascular and soft tissue calcifications
osteomalacia
osteitis fibrosa
paresthesia
restless legs syndrome
all
87
true or false. A person can stay alive until 90% of nephrons are lost - filtration is so low they need dialysis
true
88
what is needed for most accurate GFR?
direct measurement of creatinine
89
when nephrons die what happens to the filtration?
filtration decreases, and the kidney is not able to maintain normal blood levels
90
'CKD Blood work : waste product accumulation'
what rises in the blood specifically ?
what waste product builds up and cause symptoms
what is the best indicator of kidney function ( estimated GFR )
urea and creatine levels rise in the blood
nitrogenous waste products build, some will cause symptoms ( those are toxic)
eGFR is the best indicator of kidney function ( estimated GFR )
91
when is the CKD diagnosis given ? what are the values ?
when GFR less than 60 mL/min for more than 3 months ( stage 3 )
92
'CKD Blood Work: Waste Product Accumulation'
what is the Na, K, Phosphate, Mg, Ca levels in the blood
sodium ( initially low but can become high as disease progress )
potassium, phosphate, magnesium build up in the blood
calcium is low
93
Phosphate- Calcium changes
why is phosphate levels increased ?
its increased due to to decrease in excretion
94
decreased activated vitamin d leads to what ?
to decrease absorption of calcium in GI tract ( hypocalcemia )
95
PTH secreted and bone breakdown results to what ?
results to release serum Ca ( phos is also released )
96
when does calcifications (a process in which calcium builds up in body tissue, causing the tissue to harden) occur ?
when Ca and Phos bind
97
Kidney produce a hormone neded to activate vitamin d - activated vitamin d is needed for what ?
needed for intestinal absorption of calcium
98
CKD bloodwork : acid/base balance
in early stages of CKD - what happens to the pH
early stages of CKD - pH does not change as much because of the remaining nephrons
99
what is normally excreted by the kidney but with decreased GFR will increae ** hint we are talking abt acid base balance **
excess hydrogen
net result is metabollic acidosis
100
what is our body initial compensation when we have increased hydrogen? in attempt to normalizing pH
kussmaul's respirations
initially respiratory can compensate for this : increase resps and deeper breathing to breathe off excess C02
101
decreased absorption of bicarb also happens when kidneys are not fully functional, what is the term called ?
called bicarb deficient , pt usually needs a base or alkaline replacement
102
true or false. dialysis is needed if pH is still imbalanced ?
true
103
CKD BLOODWORK : hematological issues
define all the characteristics
anemia is common ( decreased in erythropoietin, iron deficiency) decreased RBC lifespan
platelet aggregation affected by uremia ( GI bleeding is common )
altered leukocyte function ( related to uremia )
104
what entails CKD - H2T?
neurological system: change in multifactorial (electrolyte imbalance, waste product accumulation, metabolic acidosis, fluid accumulation
ureic encephalopathy and ureic neuropathies
105
what is Uremic Encephalopathy and Uremic Neuropathies?
Uremic Encephalopathy: Fatigue, headache, seizures, sleep disturbances, coma
Uremic Neuropathies: Paresthesia, asterixis, tremors/twitching
106
select all that is true regarding cardiovascular system - CKD:
Cardiovascular disease mortality is high
* decreased serum potassium associated with CKD (Hypokalemia)
* Hypertensioniscommon(Na,Water,Renin)
* Heart failure & peripheral edema resulting from fluid overload
* Atherosclerosis (cholesterol and calcium deposits to blood vessels)
* Uremic pericarditis from uremic toxins
its increased potassium (hyperkalemia)
107
what does ureic pleuritic or pneumonitis related to ? go more in depth
respiratory system, thick sputum, tachypnea, fever
dyspnea from fluid overload and HF
increased risk for pneumonia, kussmaul's respirations/tachypnea (metabolic acidosis)
108
what is the GI system for Head to toe CKD:
ureic gastroenteritis - lead to GI bleeding, anorexia, N/V, constipation diarrhea
stomatitis (Inflammation or irritation of the mucous membranes in the mouth), uremic fetor(a urine-like odor on the breath of people with uremia), malnutrition is common
109
what would urinary system look like for head to toe on CKD patient?
polyuria in early stages (nocturne)
oliguria comes with progression with CKD
Eventually anuria can develop in ESRD
Urine may contain protein (proteinuria), casts, pyuria, and hematuria
110
musculoskeletal and integumentary system for CKD pt
Renal osteodystrophy (weakening of bones)
Bone pain
Muscle cramping and weakness
Vascular and soft tissues calcifications (blood vessels, subcutaneous tissue, eyes)
Pruritis, ecchymosis, dry skin, uremic frost
111
not a question just assessment: The assessment of a patient with CKD is guided by abnormalities in the blood work and clinical manifestations can be seen in almost every system.
yeaaaaa
