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PHRM 844 > Lecture 3 - Renal > Flashcards

Lecture 3 - Renal Flashcards

1
Q

physiological functions of kidneys

  • ___ functions
  • control of solutes and fluids
  • ___ control
  • ___ balance
  • drug metabolism and excretion
  • metabolic waste excretion
A
  • endocrine
  • BP
  • acid/base
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2
Q

Where in the nephron is 100% filtrate produced

A

Bowman’s capsule

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3
Q

major reabsorption site of kidney: 80% filtrate reabsorbed

A

proximal convoluted tubule

active and passive absorption

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4
Q

Where in the nephron does H2O and salt conservation take place?

A

loop of henle

6% of filtrate reabsorbed

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5
Q

Where in the nephron does variable reabsorption and active secretion take place?

A

Distal convoluted tubule

9% filtrate reabsorbed

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6
Q

Where in the nephron does variable salt and H2O reabsorption take place?

A

Collecting tubule

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7
Q

measuring kidney function

serum creatinine
* predominantly removed by ___
* increase = (bad or good)

blood urea nitrogen
- measure of liver break down of ___
- increase = (bad or good)

creatinine clearance
- useful for prediciting ___ and ___ clearance

___ filtration rate

A
  • filtration
  • bad
  • amino acids
  • bad
  • secretion, drug

glomerular

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8
Q

markers of kidney damage

  • urinary abnormalities - protein, RBC suggestive of ___ malfunctions
  • imaging abnormalities - MRI/CT scans
A
  • membrane
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9
Q

kidney function declines with age due to decrease in ___

A

nephrons

kidney mass decreases

important to consider for drug dosing in aging

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10
Q

compensatory response to renal injury

  1. decrease in # of ___
  2. nephrons work harder to ___
  3. hard work eventually causes glomeruler and tubular ___
  4. more loss of ___, can no longer compensate
  5. progressive decrease in ___
  6. ___temia
  7. ___ syndrome
  8. death
A
  • nephrons
  • compensate
  • lesions
  • nephrons
  • GFR
  • azotemia
  • uremic
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11
Q

2 largest sources of kidney injury/failure

A

diabetes (38%) and HTN (24%)

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12
Q

T or F: AKI death rate is more than breast cancer, prostate cancer, heart failure, and diabetes combined

A

T; 300,00 people die annually from AKI

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13
Q

criteria of AKI

  • increase in SCr > ___ mg/dL ( > or equal to 26.5 umol/L) within 48 hr
    or
  • increase in SCr > ___ % which is known or presumed to have occured within the prior 7 days or
  • a reduction in urine output (oliguria of < ___ mL/kg/h for 6 h)
A
  • 0.3
  • 50
  • 0.5
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14
Q

Normal glomerular capillary pressure is maintained by afferent ___ by increased ____ and efferent ___ by increased ___

A

vasodilation, prostaglandins
vasocontriction, angiotensin II

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15
Q

Disruption autoregulation

NSAIDs
- decreased ___ prostaglandins ( ___ afferent resistance)
- Glomerular capillary pressure drops, ___ decreases

ACE-I
- decreased ___ ( ___ efferent resistance)
- Glomerular capillary pressure drops, ___ decreases

A
  • vasodilatory, increased
  • GFR
  • angiotensin II, decreased
  • GFR
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16
Q

primary causes of acute kidney injury (3)

A
  • sepsis
  • ischemia
  • nephrotoxins
17
Q

classification of major causes of AKI

Prerenal
- ___volemia
- decreased ___ output
- congestive heart failure
- liver failure
- impaired renal ___ due to NSAIDs, ACE-I, cyclosporine

Intrinsic (Intrarenal)
- acute ____ nephritis
- tubules and interstitium: ___ , ischemia, nephrotoxins
- vascular: vasculitis, malignant hypertension, TTP-HUS

Postrenal
- bladder outlet ___

A
  • hypovolemia
  • cardiac
  • autoregulation
  • glomerular
  • sepsis
  • obstruction
18
Q

Pathophysiology of chronic kidney disease (CKD)
- ___ glomerular capillary pressure
- ___uria
- glomerulosclerosis

A
  • increased
  • proteinuria
19
Q

Key abnormalities that cause CKD-MBD
- impaired ___ excretion
- decreased production of ___

MBD = mineral and bone disorder

A
  • phosphate
  • Vit D3
20
Q

Urine volume = ___ % of total filtrate volume

A

1%

21
Q

Managing CKD pts requires dealing with ___ homeostasis

A

Ca

22
Q

Uremia

uremic illness is due largely to the accumulation of ___ that are normally cleared by the kidneys

A

organic waste products

23
Q

Nephitic Vs Nephrotic

Nephritic syndrome
- ___ disrupting glomerular basement ___
- resulting in ___, cola-colored urine
- BP ___
- serum albumin: ___

Nephrotic syndrome
- ___ damage leading to glomerular charge-barrier disruption
- massive ___
- BP: ___
- edema: ___
- serum albumin: ___

A

Nephritic
* Inflammation, membrane
* hematuria
* raised
* normal/slightly reduced

Nephrotic
- podocyte
- proteinuria
- normal
- present (++++)
- low

24
Q

Glomerulonephritis

  • Inflammation of glomeruli and ___
  • in both acute and chronic forms
  • present with ___ and/or hematuria
  • primary cause: inheritable trait ( ___ syndrome)
  • secondary causes: infections, ___ , autoimmune disorders
A
  • small blood vessels
  • proteinuria
  • Alport
  • drugs
25
Q

Pathogenesis of Glomerular Diseases

immune reaction
- ___ associated injury
- ___ mediated
- glomerular ___

A
  • antibody
  • cell
  • injury
26
Q

Pyelonephritis

  • inflammation of kidney ___
  • acute and chronic
  • presents ___ pain with painful ___
  • caused by ___ from blood or urinary tract
  • ___ cells in urine
  • may lead to ___
A
  • tissue
  • flank, urination
  • bacteria
  • WBC
  • sepsis
27
Q

Pathogenesis or urinary tract infection

5 steps

A
  1. colonization
  2. uroepithelium penetration
  3. ascension
  4. pyelonephritis
  5. AKI
28
Q

interstitial nephritis

aka ___ nephritis
- primary injury to renal tubules and interstitium
- undetected unitil causes significant decrease in renal function
- causes: drugs (70-75%) mostly ___, infection (4-10%), autoimmune (10-20%), SLE, sarcoidosis

Drugs associated:
- antibiotics ( ___, cephalosporins, sulfonamides)
- anticonvulsants (phenytoin, carbamazepine, phenobarbital)
- diuretics (thiazides, furosemide)
- analgesics (NSAIDs)
- other (allopurinol, cimetidine)

A
  • tubulointerstitial
  • antibiotics
  • penicillins
29
Q

Autosomal Dominant (Adult) Polycystic Kidney Disease APKD

characterized by multiple expanding cysts of ___ kidneys that ultimately destroy the intervening ___

Pathogenesis of APKD
- inherited mutation of ___ or ___ gene in renal tubular cells
- intermittent ___
- hypertension and urinary infection, ultimately fatal, renal ___ necessary

A
  • both
  • parenchyma
  • PKD1, PKD2
  • hematuria
  • transplantation
30
Q

Autosomal Recessive (Childhood) Polycystic Kidney Disease

Pathogenesis
- autosomal ___ inheritance
- mutation in ___ - fibrocystin (polyductin)

Clinical Features
- present at ___
- young infants may die quickly from pulmonary or renal failure
- pts who survive infancy develop ___ (congenital hepatic fibrosis)

A
  • recessive
  • PKHD1
  • birth
  • liver cirrhosis
31
Q

Nephtolithiasis

aka ___
- more prevalent in ___ over 40
- arises from supersaturation of ___ (calcium)
- hematuria
- pain radiates in ___

risk factors
- infection
- urinary stasisi
- immobility
- hyper___
- increased ___ acid
- increased urinary ___

A

kidney stones
- men
- solutes
- flank
- hypercalcemia
- uric
- oxalate

32
Q

nephrolithiasis treatment and prevention

A

treatment
- analgesics
- hydration
- lithotripsy
- surgical removal

prevention
- diet (hydration, eliminate Ca supplements)
- diuretics

33
Q

T or F: contrast media administration can be associated with nephropathy

A

T
* 25% increase in SCr within 72 hrs of administration
* 1/3 of hospital acquired AKI
* 1-2% US population

34
Q

Non-infection stones (3)

A
  • Ca oxalate
  • calcium phosphate
  • uric acid
35
Q

infection stone

A

struvite

36
Q

genetic stone

A

cystine

PHRM 844 (52 decks)

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