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Pathology 1 > Week 11 - Part 1 > Flashcards

Week 11 - Part 1 Flashcards

Renal Disorders

1
Q

What are (7) roles of the kidneys?

A
  • Filtration of the blood
  • Removes wastes
  • Maintains appropriate
    concentrations of
    electrolytes
  • Maintains acid base
    balance
  • Regulation of blood volume
    and blood pressure
  • Activation of vitamin D
  • Production of erythropoietin
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2
Q

What is the functional unit of the kidneys?

A

Nephron

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3
Q

Each nephron contains what (3) things?

A
  • Glomerulus
  • Tubule
  • Collecting duct
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4
Q

What has a bunch of capillaries and filtration surfaces for filtering blood?

A

Glomerulus

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5
Q

What is responsible for reabsorption and secretion of various ions and
molecules?

A

Tubule

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6
Q

What are the (3) tubules?

A
  • Proximal tubule
  • Loop of Henle
  • Distal convoluted
    tubule
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7
Q

What is responsible for more reabsorption/secretion and delivery of urine to bladder?

A

Collecting duct

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8
Q

What are (4) things that happen if kidneys fail?

A
  • Increase of metabolic wastes in the circulation
  • pH imbalance
  • Decreased activation of vitamin D
  • Decreased erythropoietin
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9
Q

What happens when there is a decrease in activation of vitamin D?

A

Results in decreased calcium absorption and then hypocalcemia

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10
Q

Decreased erythropoietin leads to?

A

Anemia

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11
Q

What are (3) General Types of Kidney Failure?

A
  • Pre-renal failure
  • Intrinsic failure (intrarenal)
  • Post renal failure
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12
Q

What type of kidney failure has a problem that is outside the kidney?

A

Pre-renal

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13
Q

What is the cause of pre-renal failure?

A

Decrease in blood supply to the kidneys
-> Ischemia to the kidney

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14
Q

What type of kidney failure has a problem within the kidneys?

A

Intrinsic failure (intrarenal)

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15
Q

What type of kidney failure has a problem with the collecting system outside of the kidneys (ureters/bladder/urethra)?

A

Post renal failure

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16
Q

What are (3) lab tests of kidney function?

A
  • GFR (Glomerular filtration rate)
  • BUN (Blood urea nitrogen)
  • Creatinine (blood)
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17
Q

What lab test estimates how much blood passes through the glomeruli each minute?

A

GFR - Glomerular filtration rate

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18
Q

As GFR goes down, what do we see a decrease in?

A

Decrease in the functional filtration rate of the kidney

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19
Q

What lab test measures urea level in blood which indicates retention of nitrogenous products?

A

BUN - Blood urea nitrogen

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20
Q

What is a by-product of muscle metabolism?

A

Creatinine

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21
Q

The more creatinine that is retained (goes up) in the blood, what happens?

A

GFR decreases

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22
Q

Decreased filtration function (GFR) leads to imbalances in what?

A

Electrolytes

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23
Q

Prolonged disruption of blood flow in kidneys will lead to?

A

Permanent ischemic damage (tubular epithelial cells)

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24
Q

Impaired perfusion in pre-renal failure can be caused by what (5) things?

A
  • Dehydration
  • Shock
  • Heart failure
  • Burns
  • Drugs - nephrotoxins
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25
Q

What drugs are nephrotoxins?

A

Drugs that dilate peripheral blood vessels

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26
Q

What is a substance that can damage the kidneys and cause nephrotoxicity (Poisoned) referred to as?

A

Nephrotoxin(s)

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27
Q

Intrinsic renal failure includes diseases of what (2) things?

A

Diseases of the glomeruli and tubes

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28
Q

What type of conditions cause sclerosis of the functional units of the kidney?

A

Acute or chronic conditions

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29
Q

What are immunologic causes of glomerular injury?

A

Primary and secondary glomerular disease

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30
Q

What are (4) non-immunologic causes of glomerular injury?

A
  • Diabetes - MAIN
  • Hypertension - MAIN
  • Drugs
  • Chemicals
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31
Q

What are heredity mechanisms causes of glomerular injury?

A

Alport syndrome

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32
Q

What syndrome is a rare genetic disorder that causes kidney disease, hearing loss, and eye abnormalities?

A

Alport syndrome

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33
Q

What type of renal failure is caused by obstruction of urine outflow from the
ureter, bladder, or urethra?

A

Post renal failure

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34
Q

What substance in post renal failure backs up into the kidneys from bladder and causes damage to the functional units of the kidney?

A

Urine

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35
Q

What are the causes of post renal failure by the ureters? (2)

A
  • Calculi (kidney stones)
  • Strictures (narrowing)
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36
Q

What are the causes of post renal failure by the bladder? (2)

A
  • Tumors
  • Neurogenic bladder
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37
Q

What is the cause of post renal failure by the urethra?

A

Prostatic hyperplasia (enlarged prostrate)

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38
Q

What is the #1 common cause of post renal failure?

A

Prostatic hyperplasia (enlarged prostrate)

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39
Q

What disease is abrupt in onset, and usually reversible?

A

Acute renal failure (ARF)

40
Q

Acute renal failure (ARF) is rapid decline in kidney function marked by (3)?

A
  • Inability to maintain fluid balance
  • Inability to maintain electrolyte
    balance
  • Inability to excrete nitrogenous wastes (Azotemia)
41
Q

What is the gold standard manifestation of renal failure?

42
Q

What condition occurs when your kidneys can’t get rid of enough nitrogen waste?

43
Q

Azotemia is accumulation of what (4) nitrogenous wastes in the blood?

A
  • Urea
  • Nitrogen
  • Uric acid
  • Creatinine
44
Q

An increase in nitrogenous waste in the blood means what for the GFR?

A

It means the GFR is decreased/decreasing

45
Q

What are ways we can prevent and early diagnosis acute renal failure?

A
  • Identifying patients at risk
  • Recording of urine output
  • Urine tests (proteinuria)
  • Blood tests (BUN, creatinine)
  • Identifying and correcting cause
  • Monitoring and treating infections
  • Hemodialysis or continuous renal replacement therapy (CRRT)
46
Q

What is ATN?

A

Acute tubular necrosis

47
Q

What is the most vulnerable part of the functional unit of the kidney?

A

The tubular structures

48
Q

ATN describes an acute destruction of what cells?

A

Tubular epithelial cells with acute
impairment of renal function.

49
Q

What are (5) etiological factors of acute tubular necrosis (ATN)?

A
  • Ischemia
  • Sepsis
  • Nephrotoxic effects of drugs
  • Tubular obstruction
  • Toxins from massive infection
50
Q

What is the onset or initiating phase of ATN?

A

It is the time of onset of the precipitating event until tubular injury occurs

51
Q

What is the maintenance phase of ATN?

A

Marked decrease in GFR, with sudden retention of metabolites and low urine output

52
Q

In the maintenance phase of ATN, what are examples of metabolites that are retained? (2)

A
  • Potassium
  • Creatine
53
Q

In the maintenance phase of ATN, the fluid retention results in what problem?

A

Edema; pulmonary congestion

54
Q

What (3) things happen in the recovery phase of ATN?

A
  • Repair of renal tissue occurs
  • Urine output increases
  • Serum creatinine falls.
55
Q

Does acute or chronic renal failure cause nephrosclerosis?

56
Q

Is polycystic kidney disease seen chronic or acute kidney failure?

57
Q

Is oliguria with increased serum urea an early sign of acute or chronic kidney failure?

58
Q

Is polyurea with dilate urine is an early sign of acute or chronic kidney failure?

59
Q

Do burns cause acute or chronic renal failure?

60
Q

What disease is a progressive decline in kidney function due to permanent loss
of nephrons?

A

Chronic kidney disease (CKD)

61
Q

CKD can result from multiple etiologies however most common are those that are extrinsic or intrinsic in nature?

62
Q

Examples (4) of etiologic diseases that lead to CKD?

A
  • Hypertension
  • Diabetes
  • Glomerulonephritis
  • Autoimmune
63
Q

In CKD, there is a decreased GFR greater
than how many months?

64
Q

What units in the kidney are fewer in CKD?

65
Q

In CKD, the remaining nephrons must
filter more, this leads to?

A

Hypertrophy (growing)

66
Q

If your GFR is less than 15 mL/min, what does this mean?

A

Kidney failure and/or dialysis

67
Q

What are (6) Clinical Manifestations of CKD?

A
  1. Fluid, electrolyte and acid-base balance
  2. Calcium and phosphorous balance and bone disease
  3. Hematologic function
  4. Cardiovascular function
  5. Accumulation of nitrogenous wastes
  6. Drug elimination
68
Q

What is hyponatremia?

A

Low serum sodium

69
Q

Loss of ability to reabsorb Sodium in tubules and inability to concentrate urine (polyuria) refers to what manifestation?

A

Hyponatremia

70
Q

How much of potassium is excreted through kidneys?

71
Q

What manifestation is associated with inability to remove potassium with severe kidney impairment?

A

Hyperkalemia (High serum potassium)

72
Q

Low serum pH is AKA?

A

Metabolic Acidosis

73
Q

What manifestation causes loss of ability to eliminate hydrogen ions (acidic) and to reabsorb bicarbonate (buffer of acid)?

A

Metabolic acidosis (Low serum pH)

74
Q

What manifestation directly results in a
demineralization of bone?

A

Metabolic acidosis (Low serum pH)

75
Q

What manifestation which describes inability to eliminate phosphate results in rising serum phosphate?

A

Hyperphosphatemia (high serum phosphate)

76
Q

How does phosphate work with calcium inversely?

A

They balance each other out

77
Q

With high phosphate levels, calcium is excreted at higher amounts leading to high or low serum levels?

A

Low serum levels

78
Q

Hypocalcemia triggers what kind of response?

A

A parathyroid response

79
Q

Kidneys activate which vitamin that is absorbed through the GI tract?

80
Q

Inability to activate Vitamin D occurs with progressing kidney impairment, which leads to?

A

Vitamin D deficiency

81
Q

Does low Vitamin D lead to a increased or decreased absorption of Calcium in GI?

82
Q

Low Calcium results in stimulation of Parathyroid gland leading to?

A

Reabsorption (decay) of bone

83
Q

Decay of bone replaces serum Calcium and acts as?

A

a buffer of acidosis

84
Q

What are (6) Manifestations of disorders of Calcium, Phosphate & Bone?

A
  • Bone pain and muscle weakness
  • Develop gait abnormalities
  • Spontaneous fractures
  • Impaired healing of fractures
  • Metastatic calcifications (occurring in healthy tissue)
  • Hyperparathyroidism
85
Q

Treatment of Disorders of Calcium & Phosphate? (4)

A
  • Dietary restrictions of foods high in phosphorus content (milk)
  • Phosphate binding antacids: Ca carbonate
  • Activated vitamin D supplement
  • Hyperparathyroidism medications
86
Q

Renal failure erythropoietin production is insufficient to stimulate RBCs which causes what disease?

87
Q

What are manifestations of anemia? (8) name a few

A
  • Weakness
  • Fatigue
  • Depression
  • Insomnia
  • Decreased cognitive functioning
  • Increased Heart Rate
  • Can worsen patients with angina
  • Spontaneous bleeding
88
Q

Why do patients manifest increased heart rate with anemia?

A

Due to decreased blood viscosity

89
Q

Treatment for anemia?

A

Iron supplement

90
Q

Cardiovascular disease is worsened or
develops due to what disease?

91
Q

What are some common cardiovascular diseases associated with CKD?

A
  • Hypertension
  • Left ventricular hypertrophy
  • CHF
  • Pericarditis
92
Q

Progressive failure of kidney function drugs leads to accumulation of?

A

Active drug and/or metabolites

93
Q

What are (5) ways that pts can slow the progression of the disease (loss of kidney function)?

A
  1. Prompt treatment of UTIs
  2. Blood pressure control
  3. Glycemic control in diabetics
  4. Smoking Cessation
  5. Dietary management
94
Q

What are (5) CKD dietary management goals?

A
  • Restriction of dietary proteins.
  • Restriction of Sodium intake
  • Restriction of Potassium
  • Restriction of Phosphorus
  • Adequate calories in the form of carbohydrates and fats.
95
Q

(3) overall management of CKD?

A
  • Hemodialysis
  • Peritoneal dialysis
  • Transplantation

Pathology 1 (14 decks)

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