wk 11, lec 1 Flashcards

1
Q

azotemia

A

reduced GFR –> accumulate nitrogenous waste products (mostly ammonia)

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2
Q

hypo/hypervolemia impact

A

baroreceptor in afferent arteriole which modulates ATII and renin secretion which vasoconstrictors and effects the GFR

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3
Q

acute kidney injury 3 stages

A

increasing creatinine in serum and reducing urine output

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4
Q

acute kidney injury

A

abrupt decline in renal function leading to increased
nitrogenous waste products

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5
Q

3 causes/types of acute kidney injury

A
  1. pre renal (inadequate plasma flow or hemodyanmics; fall hydrostatic pressure)
  2. renal (intrinsic) (in kidney parenchyma)
  3. post renal (obstruction distal to papillary duct (from renal pelvis to distal urethra)
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6
Q

most common acute kidney injury

A

pre renal

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7
Q

examples of acute kidney injury

A

pre renal: liver failure, NSAIDs, congestive heart failure, ACE inhibitors
–> hypovolemia, decreased cardiac output etc

intrinsic/ renal: acute glomerulonephritis, sepsis, ischmia, nephrotoxins, vascultiits

post renal: bladder outlet obstruction

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8
Q

impaired auto regulation and hypovolumia causing pre-renal acute kidney injury

A

hypovolemia: absolute or effective

impaired auto regulation: medication induced (ACE, NSAIDs impact tubuloglmerular feedback)

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9
Q

auto regulation at glomerulus and what impacts it

A

Glomerular Autoregulation
A. Normal: Regular perfusion pressure, normal GFR.

B. Reduced perfusion: Still within autoregulation range, GFR maintained.

C. NSAID effect:
Blocks vasodilatory prostaglandins → increased afferent resistance
Lower glomerular pressure → GFR decreases

D. ACE-I/ARB effect:
Inhibits angiotensin II → reduced efferent resistance
Less glomerular pressure → GFR decreases

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10
Q

tubuloglomerular feedback

A

prostaglandin release –> increase renin and prevent excessive vasoconstriction in afferent arteriole

if increase Na+ then ATP from macula densa will decrease GFR and renin

if decrease Na+ then PDG will increase renin

if increase tubular flow then NO will blunt reduce GFR

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11
Q

absolute vs effective hypovolemia causing pre-renal acute kidney injury

A

absolute: loss of blood volume (hemorrhage or lose ECF) i.e. vomit, diarrhea, hemorrhage, infection, sweat

effective: no volume loss, but low blood pressure/volume from:
- low cardiac output (heart failure), dysregulated hemodynamics (shock, sepsis)
-third spacing: excess ECF in pathological compartments (cirrhosis)

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12
Q

renal/intrinsic acute kidney injury

A

damage glomerular filtration barrier

vascular injury (sepsis, vascultiits, renal artery obstruction from plaques)

renal ischemia

nephrotoxins

interstitial

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13
Q

post renal acute kidney injury is uncommon- why>

A

becasue can function with just 1 kidney/ureter

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14
Q

blood labs for acute kidney injury

A

eGFR via serum creatinine (for filtration)

BUN (nitrogenous waste and see if pre renal AKI) (i.e if fluid depleted, ADH elevates, preserve urea)

sodium, potassium, calcium, phosphate (electrolytes)

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15
Q

urine dipstick for acute kidney injury

A

▪ Hematuria

▪ Leukocytes (pyuria)

▪ Nitrites (urease-
producing organisms)
* Enterococci,
staphylococci do
not produce nitrites

▪ (Large amounts of)
protein

▪ Specific gravity
* Urine concentration

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16
Q

key urine labs for acute kidney injury

A

creatinine clearance

fractional excretion of sodium (should be reabsorbed) (if pre renal AKI then we save sodium and exert less, intrinsic/renal may lose sodium if tubules are broken)

protein in urine (albumin)

17
Q

fraction excretion of sodium in urine

changes in prernal and renal acute kidney injury

A

Pre-renal AKI: Kidneys retain sodium to conserve fluid (FENa < 1%).
Intrinsic (renal) AKI: Damaged tubules lose sodium (FENa > 3%).

18
Q

types of casts in urine and causes

A

RBC casts (kidney damage): vasculitis, malignant hypertesnion

WBC casts (from infection or inflammation): pyelonephritis, interstitial nephritis

granular casts (tubular damage): vascultitis

eosinophiluria: allergic or inflammatory

crystalluria: toxic or metabolic

ETC SLIDE 24

19
Q

chronic kidney disease staging via

A

compare eGFR to amount of albumin lost in urine/day

20
Q

2 mechanisms of damage in chronic kidney disease

A
  1. initiating event: damage nephrons i.e. hypertension, diabetes, inflammation, allergy

as more nephrons are damaged then the healthy ones need to work harder and filter more

hyperfiltration –> higher pressure in viable glomeruli –> distort glomerular capillary and podocyte end feet –> damage filtration barrier –> glomerulosclerosis

21
Q

compensation in chronic kidney disease

and what it leads to

A

Hyperfiltration refers to an increased filtration rate in the remaining functional nephrons when some nephrons are lost due to kidney damage.

leads to increase glomerular pressure, proteinuria, glomeruloscleoris

22
Q

glomerular changes in chronic kidney disease

A

hyperfiltration and hypertrophy or remaining nephrons

  • reduction in nephron
    number
  • enlargement of capillary
    lumens
  • focal adhesions
23
Q

impacts of proteinuria in chronic kidney disease

A

albumin leak into tubules and so does pro inflammatory and pro fibrotic cytokines –> inflame and fibrosis of intersititum

oxidized lipoproteins leaks and make ROS

24
Q

chronic kidney disease for how long

25
Q

most common causes of chronic kidney disease

A

diabetes mellitus and hypertension

26
Q

findings in chronic kidney disease

A

albuminuria
proteinuria
hematuria
GFR <60ml/min

27
Q

uremia

A

renal excretory failure and metabolic waste products accumulate

azotmeia plus accumulation of metabolic waste

ammonia and other nitrogenous breakdown products more dangerous than urea

28
Q

uremai can cause

A

metabolic, endocrine problems: anemia, vitamin D deficiency, secondary hyperparathyroidism

GI
peripheral neuropathy
heart and lung (pleural effusion, CVD)
dehydration, edema, osterodystrophy, myopathy, dermatitis etc