Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

N935 Advanced Pathophysiology > Week 5 Renal Pathophysiology > Flashcards

Week 5 Renal Pathophysiology Flashcards

1
Q

What percent do the kidneys receive of total cardiac output?

A

15-25%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How much is directed to renal cortex?

A

95%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How much is directed to medulla?

A

5%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How much blood flows through the renal arteries?

A

1-1.25L/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is more vulnerable to ischemic insults?

A

renal medullary papillae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what mean arterial pressures does the kidney successful autoregulate their blood flow?

A

60-160mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What causes vasodilation and vasoconstriction of renal afferent arterioles and regulates the autoregulation of RBF?

A

intrinsic mechanism

innervation intact even in denervated kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the purpose of the glomerulus?

A

separates the afferent arterioles from the efferent arterioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What does the resistance in the efferent arterioles create?

A

hydrostatic pressure within the glomerulus to provide force for ultrafiltration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the capillaries lined with endothelial cells called?

A

podocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Glomerular filtration rate is

A

the rate at which blood is filtered through all of the glomeruli measure overall kidney function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SNS activation does what to renal blood flow?

A

reduces renal blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Example of SNS activation and RBF:

A

shunt to skeletal muscle during exercise
surgical stimulation can increase vascular resistance
stimulates the adrenal medulla-> catecholamine release
if BP decreases SNS will also stimulate RASS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antidiuretic hormone is released in response to

A

DECREASED stretch receptors in the atrial and arterial wall

Increased osmolality of the plasma (monitored by hypothalamus)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Where is ADH synthesized?

A

hypothalamus and is released from the posterior pituitary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is the half life of ADH

A

16-24 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the two primary functions of ADH

A

increases reabsorption of water in the kidneys

causes vasoconstriction and PVR to increase blood pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Perioperative causes of ADH release include:

A 
hemorrhage
positive pressure ventilation
upright position
nausea
medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Renin is

A

enzyme secreted by the kidneys that hydrolyzes angiotensin to angiotensin 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Where is renin released?

A

juxtaglomerular cells located near the afferent arterioles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is renin released in response to?

A

a decrease in arterial blood pressure
a decreased in sodium load delivered to the distal tubules
SNS beta 1 receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Angiotension 1 is converted to angiotension 2 where?

A

the lungs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Angiotensin 2 is

A

a potent vasoconstrictor and stimulates the hypothalamus to secrete ADH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Aldosterone is a

A

mineralocorticoid hormone release from the adrenal gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is the plasma half-life of aldosterone?
20 minutes
26
What does aldosterone do?
stimulates epithelial cells in the distal tubule and collecting ducts to reabsorb sodium and water exchanges potassium to maintain electroneutrality
27
What does aldosterone the opposite of?
atrial natriuretic hormone function
28
Acute kidney injury is defined as
sudden inability of the kidneys to vary urine volume and content appropriately
29
Causes of AKI
pre-renal intrinsic renal post renal
30
Characteristics of AKI
develops rapidly but may resolve | has a 50% mortality rate
31
Spiralactone is what diuretic?
potassium sparing diuretic that blocks aldosterone receptors
32
Pre-renal is caused by
hemodynamic or endocrine factors that impair perfusion hypoperfusion or hypovolemia activates mechanism to conserve salt and water can progress to permanent parenchymal damage
33
Examples of hypoperfusion or hypovolemia (pre-renal)
``` skin loss fluid loss hemorrhage sequestration vascular occlusion (thrombosis, aortic or renal artery clamping) ```
34
Renal or Acute Tubular Necrosis (ATN)
tissue damage from prolonged ischemia or nephrotic injury, glomerulonephritis
35
Patients with parenchymal disease will have trouble
concentrating urine | high urine sodium and low osmolality
36
Post-renal d/t
obstruction (calculi, blood clots, neoplasm) surgical ligation edema
37
Oliguric
<0.5ml/kg/hr
38
Polyuric
>2.5L/day of non-concentrated urine
39
Risk factors for AKI/AKF
``` renal reserve decreases with age pre-existing renal dysfunction cardiac bypass, aortic aneurysms (supra-renal aortic clamping), ventricular dysfunctions sepsis use of nephrotoxic agents diabetes, HTN ```
40
Contrast Induced Nephropathy
results from administration of iodinated contrast media | transient and reversible form of acute renal failure
41
What is the treatment of CIN?
mainly supportive, consisting of careful fluid and electrolyte management although dialysis may be required in some cases
42
What is the suggested pathology of CIN?
direct toxicity of CM which could be related to harmful effects of free radicals and oxidative stress while in renal tubules, excreted CM generates osmotic force causing marked increase in sodium and water excretion diuresis will increase intratubular pressure which will reduce the GFR contributing to the pathogenesis of acute renal failure
43
Treatment of CIN
only supportive prevention key risk vs benefit should be considered
44
Oliguria is a sign of
inadequate systemic perfusion
45
What monitors can assess fluid status intraoperatively
``` urinary catheter TEE CVP blood pressure SVV ```
46
How do you treat oliguria?
assume prerenal oliguria is related to fluid until proved otherwise selective dopamine DA1 receptor agonist can cause renal arteriolar vasodilation -fenoldopam, low dose dopamine
47
What do you not give in the setting in intravascular hypovolemia?
diuretics furosemide mannitol
48
What population has a 1.5 greater risk of developing kidney failure?
hispanic americans
49
ESRD rates are how many time higher among African americans in comparison to whites?
4 fold
50
How many more times are native americans likely to be diagnosed with kidney failure?
1.8
51
What is the leading cause of kidney failure among american indians
diabetes
52
What is most prevalent among african american and major cause of ESRD in this population?
hypertension
53
what increased the risk of developing kidney disease and limit access to preventive measure and treatment in communities with socioeconomic and cultural differences?
``` language barriers education and literacy levels low income unemployment lack of adequate health insurance certain culture-specific health belieds and practices ```
54
Chronic renal failure is
slow progressive irreversible decreased functioning nephrons decreased RBF decreased GFR, tubular function, and reabsorptive capacity
55
Common causes of chronic renal failure
``` glomerulonephritis pyelonephritis diabetes vascular or hypertensive insults congenital defects ```
56
Stages of Chronic renal failure
decreased renal reserve renal insufficiency end stage renal failure or uremia
57
Decreased renal reserve is asymptommatic until
<40% of normal nephron remain
58
Define renal insufficiency
10-40% of functioning nephrons remain | compensated, little renal reserve
59
Define end stage renal failure or uremia
>95% of nephrons are nonfunctioning GFR is <5-10% of normal Severely compromised electrolyte, hematologic, and acid-base balances Dialysis dependent
60
In ESRF, what is eventually lethal?
uremia
61
What are the six manifestations of chronic renal failure?
``` hypervolemia acidemia hyperkalemia cardiorespiratory dysfunction anemia bleeding disturbances ```
62
What are the three treatments of chronic kidney failure?
hemodialysis peritoneal dialysis kidney transplant
63
What are the four components of a urinalysis?
specific gravity urine osmolality proteinuria urinary pH
64
Define specific gravity
measurement of solutes in the urine, indicates kidneys ability to excrete concentrated urine. It reflect tubular function
65
CHF, Liver Failure can lead to
hypovolemia, decreased CO and decreased effective circulating volume
66
NSAIDs, ACE inhibitors and cyclosporine can lead to
impaired kidney autoregulation
67
hypovolemia, decreased CO and decreased effective circulating volume and impaired kidney autoregulation can cause
pre-renal AKI
68
Two causes of Post- renal AKI are
bilateral uretotrophic obstruction | bladder outlet obstruction
69
ischemia, sepsis and nephrotoxins can lead to
acute glomerulophritis, tubular damage
70
Vascularitis, TTP/HUS and Malignant hypertension can lead to
vascular damage
71
vascular damage and acute glomerulophritis, tubular damage can lead to
Intrinsic renal AKI
72
GFR criteria and UOP criteria for renal failure risk
increased Cr x1.5 or GFR decrease <25% | UO <0.5ml/kg/hr x 6h
73
GFR criteria and UOP criteria for Renal Injury
Increased creatinine x2 or GFR decrease >50% | UO <0.5ml/kg/hr x 12 hrs
74
GFR criteria and UOP criteria for Renal failure
increased creatinine x3 or GFR decrease > 75% or creatinine >4mg/ 100ml (acute rise of >0.5mg per 100ml/dl) OU <0.3ml/kg/hr x 24 hour or anuria x 12 hr
75
What does selective dopamine DA1 receptor agonist do?
causes renal arteriolar vasodilation Fenoldopam Low dose dopamine
76
3-10mcg of dopamine effects
increases contractility, minimal change in HR and SVR increase Renal BF increase splanchnic BF
77
>10 mcg dopamine effects
increase HR, vasoconstriction, decrease/increase renal BF, increase decrease splanchnic BF
78
>10 mcg dopamine effects
increase HR, vasoconstriction, decrease/increase renal BF, increase decrease splanchnic BF
79
Three causes of pre-renal failure
absolute decrease in ECF volume decreased RBF altered intra-renal hemodynamics
80
Examples of absolute decrease in ECF volume for pre-renal failure
GI losses | hemorrhages
81
Examples of decreased RBF for pre-renal failure
heart failure | renal artery stenosis
82
Examples of altered intra-renal hemodynamics for pre-renal failure
``` Drug induced- NSAIDs/COX 2 inhibitors calcineurin inhibitors ACE inhibitors Angiotensin 2 receptor blockers sepsis hypercalcemia cirrhosis, Hepatorenal syndrome abdominal compartment syndrome ```
83
Two causes of intra-renal failure
tubulo-interstitial disorders | glomerular disorders
84
Types of tubulo-intestitial disorders for intra-renal failure
``` tubular injury (ischemic, nephrotic) Interstitial nephritis (allergic type or NSAID type) ```
85
Types of glomerular disorders for intra-renal failure
glomerulonephritis thrombotic microanglopathies atheroembolic disease
86
Two causes of post-renal failure
anatomic obstruction | tubular obstruction
87
Types of anatomic obstruction for post-renal failure
``` bladder outlet (prostate, pelvic tumor) ureteral (tumor, stones, strictures) ```
88
Types of tubular obstructution causing post-renal failure
crystals (Calcium oxalate Drugs: indinavir, methotraxate proteins (myeloma cast neuropathy)
89
Define urine osmolality
the number of moles per solute per kilogram of solvent more specific than specific gravity ability to excrete concentrated urine indicates good tubular function
90
Define proteinuria
when >150mg is excreted per day when >750mg (3+ or 4+) is indicative of severe glomerular famage failure of renal tubules to reabsorb protein
91
Define urinary pH
inability to excrete an an acid urine in the presence of acidosis is indicative of renal insufficiency
92
Glucose is freely filtered where?
the glomerulus
93
Where is glucose reabsorbed?
proximal tubule
94
Glycosuria is a sign
that the ability of the renal tubules to reabsorb glucose has been exceeded by an abnormally heavy glucose load usual indicative of diabetes
95
What are the 4 laboratory tests for renal function
BUN serum creatinine Creatinine clearance glomerular filtration rate
96
Define BUN
blood urea nitrogen not a direct measure of renal function influenced by exercise, steroids, and tissue breakdown
97
When is BUN elevated?
when kidney disease is reduced to about 75%
98
Define serum creatinine
muscle tissue turnover and dietary intake of protein
99
How is creatinine treated at the glomerulus?
freely filtered and neither reabsorbed or secreted
100
What is a good measure of GFR?
creatinine clearance
101
What is the best measure of glomerular function?
glomerular filtration rate
102
What is a normal GFR?
125ml/min
103
What is an symptomatic GFR?
<30-50% of normal GFR
104
What can be seen in an electrocardiogram in patients with renal disease?
peaked T waves | small or indiscernible P waves
105
What clinical situations contribute to increased K in renal failure patients?
``` LR Succinylcholine acidosis, electrolytes missed dialysis Vomiting diarrhea rhabomylasis ```
106
During blood storage what consistently leaks from cells?
potassium
107
How long are RBCs stored in blood bank?
42 days
108
How can potassium overload from transfusion be avoided?
using blood less then 5 days old | washing any unit of blood immediately before infusion to remove extracellular potassium
109
What does US describe in renal disease?
kidney size, hydronephrosis, vasculature, obstructions and masses
110
What does CT describe in renal disease?
detects stones of all kinds, masses may be evaluated using contrast
111
What does MRI describe in renal disease?
detailed tissue characterization, nice alternative to a contrast CT, reduced radiation exposure
112
What is gadolinium?
paramagnetic intravenous contrast agent | commonly used in MRA
113
What effects does GA have on renal function?
Pulse pressure variation and CO decrease | causing depression of renal BF, GFR, urinary flow and electrolyte secretion
114
What effect does regional anesthesia have on renal function?
parallels with degree of SNS blockade decreased venous return decrease in blood pressure
115
What are the peri-operative indirect effects of anesthesia on renal function?
circulatory and endocrine, SNS and patient positioning
116
What are the direct peri-operative effects of anesthesia on renal function?
medications that target renal cellular function
117
What is the effect of surgery on renal function?
stress and catecholamine release fluid shifts secretion of vasopressin and angiotensin
118
What are the three opioids effected by renal function?
morphine, meperidine, fentanyl
119
Why is morphine important in renal function?
active metabolite that depend on renal clearance mechanisms for elimination principally metabolized by conjugation in the liver, and water soluble glucuronides (morphine 3 and morphine-6 glucoronide) are excreted via the kidney
120
Why is meperidine important to note with renal function?
active metabolite, normeperidine, depended on renal excretion accumulation can lead to seizures and CNS toxicity
121
Why is fentanyl important to note with renal function?
not grossly altered by renal failure, but a decrease in plasma protein binding may result in higher free fractions Ie decrease dose
122
Is ketamine dosing increased or decreased in CKD? Why?
not needed despite being metabolized in liver into active metabolite then metabolite being excreted in kidney
123
Name two gabapentinoids
gabapentin (neurtonin) and pregabalin (lyrica)
124
How are gabapentinoids effected in CKD?
liberal administration can increase risk of over sedation and coma Agents do not undergo hepatic metabolism and are excreted solely by kidneys reduction of 50% of the dose for each 50% decline in GFR or CCr and increasing time interval between dose recommended
125
What physiological renal responses occur with VA?
decrease in BP and kidneys increase renal vascular resistance causing decrease in renal blood flow
126
Isoflurane and renal physiological response
decrease BP in dose dependent fashion
127
Desflurane and renal physiological response
with increase HR, may maintain a greater degree of cardiac output and therefore renal perfusion
128
Sevoflurane and renal physiological response
free fluoride ion metabolite | compound A
129
When can compound A occur?
CO2 absorbents containing soda lime (KOH, NaOH, h20, CaOH2) degrade sevo resulting in production of vinyl ether
130
Risk of compound A exposure is dependent on (3)
duration of exposure fresh gas flow rate concentration of sevoflurane
131
Succinylcholine causes a rapid, transient increase in serum potassium by
0.5mEq/L
132
In patients with renal failure, succinylcholine can
be exaggerated to >0.5mEq/L
133
When is succinylcholine okay (with caution) to use in renal patient?
dialysis within 24 hours and normal serum K+
134
Non-depolarizing muscle relaxants and renal failure
the duration of action may be prolonged with renal failure
135
what two NDMRs are not effected by renal failure
cisatracurium and atracurium
136
How is sugammadex excreted?
the resultant sugammadex neuromuscular blocker complex by the kidney
137
What is an intermediate in the metabolism of sodium nitroprusside?
cyanide
138
What is the final metabolic product of sodium nitroprusside?
thiocyanate
139
Is the half life of thiocyanate prolonged in renal failure?
yes, normal 4 days but longer in CKF
140
Describe albumin role in kidney disease
may be protective by maintaining renal perfusion, binding of endogenous toxins and nephrotic drugs and preventing oxidative damage
141
What fluids can be associated with acute kidney injury and should be avoided?
hetastarch/ dextran
142
how hetastarch cause AKI?
breakdown of the synthetic carbohydrates to degradation products that cause direct tubular injury and plugging of tubules
143
What drugs can impair renal doses to dopamine?
anti-dopaminergics | metoclopramide, phenothiazines, droperiodol
144
Dopamine and fenoldopam
dilate afferent and efferent arterioles and increase renal perfusion selective D1 agonist
145
What are the four renal pathophysiologies that require surgery?
renal cell carcinoma renal dysplasia polycystic kidney disease wilm's tumor
146
what is the most common renal malignancy?
renal cell carcinoma
147
Where does renal cell carcinoma originate?
proximal tubules
148
What is the cure to renal cell carcinoma?
surgical resection | refractory to chemo and radiation
149
What is the triad of renal cell carcinoma?
hematuria flank pain renal mass
150
When may CBP be needed for renal cell carcinoma?
when the tumor extens into the renal vein and the IVC and right atrium
151
What is renal dysplasia?
malformation of the tubules during fetal development | consists of irregular cysts of various sizes
152
how is renal dysplasia diagnosed?
in utero by US
153
Ureteropelvic junction and vesicoureteral reflux is also seen with
renal dysplasia
154
What does renal dysplasia lead to?
CKD, dialysis, transplant
155
Polycystic kidney disease is
an inherited massive enlargement of kidneys with compromised renal funciton cyst can also occur on other organs (liver, pancreas, spleen) non-functioning fluid filled cysts that range in size from small to mass effect producing size
156
How is polycystic kidney disease painful?
due to distention of cysts and stretching of fascia
157
What exacerbates PKD pain?
hemorrhage, rupture or infection
158
How does PKD progress into adulthood?
bilateral disease
159
Complications of PKD
HTN due to activation of RAAS cyst infection bleeding decline in renal function
160
Treatment of PKD
symptom management dialysis transplant
161
How does wilm's tumor present?
unilaterally and painless, palpable mass
162
what is wilm's tumor associated with?
congenital/genetic malformations | Beckwith-wiedermann and WAGR
163
What is the most common malignant tumor in children?
wilm's tumor | 1/3 occur in age under 1
164
Where does wilm's tumor metastasize?
lungs
165
treatment of wilm's tumor includes?
resection and possible chemotherapy | capacity for rapid growth
166
Name the 5 stages of wilm's tumor
stage 1: limited to kidney and completely excised stage 2: tumor extends beyond the kidney but is completely excised stage 3: inoperable primary tumor of lymph node metastasis Stage 4: lymph node metasases outside the abdominal pelvic region Stage 5: bilateral renal involvement
167
Total nephrectomy
renal artery and vein are ligated and then it involves removal of the kidney, the ipslateral adrenal gland, perinephric fat, and the surrounding tissue
168
partial nephrectomy
nephron sparing considered with patients with solitary functional kidney, small leisons (< 4cm) or bilateral tumors, or for patients with increased risk because of other diseases such as diabetes or hypertension
169
Anesthetic requirements for nephrectomy
``` standard risk assessment identify smoking and age risk factors note any pre-existing renal dysfunction many are anemic (CBC and TC) K (BMP) regional anesthesia include blockade of nerve roots T8-L3 ERAS Opioid sparing ```
170
PTH increased Ca++ reabsorption exchanges
phosphate
171
Erythropoietin is
released by kidney in response to anemia, hypoxia
172
aldosterone is secreated from
adrenal cortex and causes reabsorption of Na
173
ADh/Vasopressin constricts
efferent arteriole and reabsorbs water
174
ANP
atrial distension (fluid overload) stimulates excretion of sodium and water
175
Dopamine is what receptor in renal vasculature and excretes?
Da1 receptor | sodium excretion

N935 Advanced Pathophysiology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions