Acute Renal Failure and Chronic Kidney Disease

Question 1

What do kidneys do?

Answer 1

Filtration!

make/release erythropoietin ( to stimulate RBC manufacturing)

Question 2

What are some things Kidneys filter?

Answer 2

BUN - blood urea nitrogen
Creatinine (muscle waste product)
Sodium ( fluid volume)
Potassium ( regulates heart)

Question 3

What is the normal potassium level? Why is it important for potassium to stay within this range?

Answer 3

3.5-5 UNITS???

elevated or decreased potassium levels can kill someone

Question 4

What can happen to Kidney patients?

Answer 4

a lot of different things because the kidney filters many things that affect other systems and organs

Question 5

What is the functional unit of the Kidney?

Answer 5

Nephron

Question 6

What is the Nephron made up of?

Answer 6

Glomerulus
Proximal Convoluted Tubule
Loop of Henle
Distal Convoluted Tubule
Collecting Duct

Question 7

Where is the Glomerulus located? What does it do?

Answer 7

located in the Bowman’s Capsule

Filters - made up of a bunch of capillaries

Question 8

What does the Proximal Convoluted Tubule do?

Answer 8

drains the Bowman’s Capsule, reabsorbs electrolytes, plays a part in the buffer system (acid/base balance)

Question 9

What is the purpose of the Loop of Henle?

Answer 9

reabsorbs water (controls the concentration of urine)

Question 10

What is Glomerulonephritis?

Answer 10

a group of diseases that results from inflammation or injury to the glomerulus

Question 11

What are the First - Third leading causes of Renal Failure?

Answer 11

#1 = Diabetes
#2 = HTN
#3 =  Glomerulonephritis

Question 12

What causes Glomerulonephritis?

Answer 12

damage to the glomerulus

- HTN, Stress, Drugs, Infection, Diabetes

Question 13

What are the manifestations of Glomerulonephritis?

Answer 13

headache
^ BP
facial/periorbital edema
lethargic
low grade fever
weight gain (edema)
Proteinuria
Hematuria
Oliguria
Dysuria

Question 14

Proteinuria

Answer 14

protein in the urine

damaged capillary beds in the kidney so the proteins leaks out

Question 15

Hematuria

Answer 15

blood in the urine

damaged capillary beds in the kidney so blood leaks out

Question 16

Oliguria

Answer 16

No urine output

*have edema because they are holding onto water/sodium

Question 17

Dysuria

Answer 17

painful urination

Question 18

What is Nephrotic Syndrome

Answer 18

another name for Glomerulonephritis

Increase in the glomerular permeability resulting in a decrease in GFR

Question 19

How will a person with Nephrotic Syndrome present due to change in permeability?

Answer 19

massive proteinuria
generalized edema
ascites
hyperlipidemia
hypoalbuminemia
hypoproteinemia (less protein in blood because they are urinating them out)

Question 20

What is Nephrotic Syndrome characterized by?

Answer 20

an increase in capillary permeability in the glomerulous

Question 21

How can Asymptomatic Glomerulonephritis be detected?

Answer 21

a simple urine sample

Question 22

What is Primary Glomerulonephritis?

Answer 22

caused by an infection of the kidney

Question 23

What is Secondary Glomerulonephritis?

Answer 23

not initially a kidney based issue

e.g. diabetes, drugs/NSAIDs, etc.

Question 24

What is Pyelonephritis?

Answer 24

a Tubulointerstitial Disorder

infection of the kidney usually caused by an ascending bladder infection, could also be caused by blood born infection (septicemia)

can have Chronic Pyelonephritis which could lead to chronic renal failure

-Intrarenal reflux - reflux of urine into parenchymal tissue of the kidney

Question 25

What is Polycystic Kidney Disease?

Answer 25

a Tubulointerstitial Disorder PKDs are a group of INHERITED kidney disorders characterized by fluid-filled sacs or segments that have origins in the tubular structures of the kidney

Question 26

Describe the progression of Polycystic Kidney Disease.

Answer 26

progresses slowly but will eventually lead to renal failure

Question 27

What is the treatment for Polycystic Kidney Disease?

Answer 27

control blood pressure | keep patient free of infection (UTI)

Question 28

What are the manifestations of Polycystic Kidney Disease?

Answer 28

pain from enlarged cysts on the kidney episodes of gross hematuria (cysts bleeding) HTN b/c they have compression of blood vessels and activates renin-angiotensin mechanism (regulation mechanism that doesn't need to be activated then which is why it causes HTN)

Question 29

What is Hydronephrosis?

Answer 29

an obstructive disorders urine filled dilation of the renal pelvis due to obstruction of urine outflow (water inside the kidney)

Question 30

What will untreated Hydronephrosis lead to?

Answer 30

``` atrophy of kidney distended ureter distended kidney Kidney could burst kidney could become "shot" ```

Question 31

What is the damaging effect of Hydronephrosis?

Answer 31

urinary stasis | - higher risk of infection

Question 32

What is one specific cause of Hydronephrosis?

Answer 32

Kidney Stones (renal calculi)

Question 33

What are Renal Calculi?

Answer 33

stones that form in any part of the urinary tract

Question 34

What are the types of Renal Calculi (things they are made of)?

Answer 34

1. Calcium (most common) 2. Uric acid 3. Struvite 4. Cystine (less common)

Question 35

What is the most common type of renal calculi?

Answer 35

calcium

Question 36

Where does uric acid come from?

Answer 36

purines | - animal proteins, alcohol intake, obesity

Question 37

What type of Renal Calculi are usually seen after an UTI?

Answer 37

Struvite

Question 38

What puts a patient at a higher risk for developing Uric Acid Renal Calculi?

Answer 38

consumption of animal proteins (red meats), alcohol | being obese

Question 39

What other disease/disorder have we learned about that is also associated with Uric Acid beside the formation of Kidney stones?

Answer 39

Gout

Question 40

What is Diabetic Nephropathy?

Answer 40

- most common single cause of renal failure - elevated blood sugars - increased renal workload - protein leakage (Microalbuminuria, Macroalbuminuria)

Question 41

What is Microalbuminuria?

Answer 41

small amount of albumin (a protein) in urine one of the 1st signs of Kidney Failure

Question 42

What is Macroalbuminuria?

Answer 42

large amount of albumin (a protein) in urine occurs closer to the end stages of renal disease

Question 43

How does elevated blood sugar ruin kidneys? -diabetic patient

Answer 43

- your cells are starving/dying because sugar cannot enter the cells - 2 of the most sensitive areas to this effect are the kidneys and eyes - high levels of sugar also makes the kidney work harder to get rid of some sugar (wears kidneys out)

Question 44

What is Renal Cell Carcinoma?

Answer 44

malignancy of the kidney (cancer) * generally found accidently while tending to other issues unrelated

Question 45

What is highly linked to Renal Cell Carcinoma?

Answer 45

smoking

Question 46

What are some other risk factors of Renal Cell Carcinoma?

Answer 46

- male - over 50 - family history - long term abuse of OTC analgesics (ex. Tylenol, Motrin, NSAIDs) - smoking - being on dialysis

Question 47

What are the S/S of Renal Cell Carcinoma?

Answer 47

hematuria abdominal mass unintentional weight loss fatigue * symptoms don't appear until the disease has progressed (metastasized) * one of those cancers that creeps up on you

Question 48

What is Renal Replacement Therapy?

Answer 48

Dialysis

Question 49

How often should Type 1 diabetics be tested for Microalbuminuria (proteinuria)

Answer 49

should be tested 5 years after diagnosis then yearly after that

Question 50

How often should Type 2 be tested for Microalbuminuria (proteinuria)?

Answer 50

should be tested right after diagnosis and then yearly after that *at a greater risk than type 1