B5-042 CBCL: Kidney Failure Flashcards
(110 cards)
1
Q
developed in less than 3 months
A
acute
greater than 3 is chronic
2
Q
prerenal vascular problems cause low blood flow/perfusion which leads to changes in
A
glomerular filtrating pressure
3
Q
when the hydrostatic pressure in the glomerulus is lower, what happens to the net ultrafiltration pressure and GFR?
A
both lower
4
Q
what type of kidney failure does renal artery stenosis cause?
A
prerenal
5
Q
causes of intra-renal tubular injury
A
ischemia, toxins (ATN)
inflammatory (pyelonephritis)
6
Q
pyelonephritis causes the inability to concentrate urine, leading to […]uria
A
polyuria
7
Q
acute tubular necrosis (ATN) causes an intial phase of […]uria
A
oligouria
8
Q
heavy proteinuria (>3.5 g/day)
nephrotic or nephritic
A
nephrotic
9
Q
hypoalbuminemia with pitting edema
nephrotic or nephritic
A
nephrotic
10
Q
hyperlipidemia and hypercholesterolemia
nephrotic or nephritic
A
nephrotic
11
Q
hematuria
nephrotic or nephritic
A
nephritic
12
Q
oligouria and azotemia
nephrotic or nephritic
A
nephritic
13
Q
RBC casts and dismorphic RBCs in urine
nephrotic or nephritic
A
nephritic
14
Q
proteinuria below 3.5 g/day
A
nephritic
15
Q
what is the first thing that happens when the kidneys don’t function properly?
A
volume overload
16
Q
what is the most important reason volume overload occurs?
A
sodium retention
17
Q
how does kidney insufficiency cause acidosis?
A
low acid excretion –> accumulates
18
Q
what type of anemia accompanies kidney insufficiency?
A
normocytic, normochromic anemia
kidneys can’t make EPO
19
Q
treatment for anemia caused by renal insufficiency
A
EPO
iron supplement
B12 and folate supplements
20
Q
signs of bone disease in kidney insufficiency
A
- bone pain
- increased risk of fracture
- osteomalacia
- rickets (kids)
21
Q
how does renal insufficiency cause bone disease?
3
A
- kidneys activate vitamin D, which is necessary to increase/maintain calcium levels in plasma
- reduced GFR –> less phosphate excretion —> stimulates PTH secretion
- metabolic acidosis
22
Q
treatment for bone disease in renal insufficiency
A
calcitriol
calcium supplement
23
Q
how do you measure function of the tubules?
A
using fractional excretion of sodium
24
Q
the clearance of […] is used to measure GFR
A
creatinine
25
as kidney function decreases, plasma creatinine
increases
26
normal value of FE Na
1-3%
27
indicator of both glomerular and tubular function
BUN/creatinine ratio
28
filtered and reabsorbed in the tubules and provides an estimate of GFR and tubular function
urea
| BUN
29
normal BUN/Cr
15-20
30
useful to differentiate the origin of kidney failure (prerenal, intrarenal, postrenal)
BUN/Cr
31
glomerular function impaired
tubular function intially maintained
| prerenal, intrarenal, or postrenal
prerenal
32
glomerular function intially maintained
tubular function impaired
| prerenal, intrarenal, or postrenal
intrarenal
33
glomerular pressure and function impaired
tubular function impaired at late stages
| prerenal, intrarenal, or postrenal
postrenal
34
* decreased GFR
* Azotemia, oliguria
* increased BUN
* Normal FE Na
* Normal osmolarity
| prerenal, intrarenal, or postrenal
prerenal
35
* azotemia
* oliguria with brown casts
* decreased BUN/Cr
* elevated FE Na
* low osmolarity
| prerenal, intrarenal, or postrenal
intrarenal
36
* azotemia, oliguria
* decreased GFR
* decreased BUN/Cr or normal
* elevated FE Na
* low osmolarity
| prerenal, intrarenal, or postrenal
postrenal
37
treatments to control hypertension
* sodium restriction
* diuretics
* ACE/ARBS
* beta blockers
* calcium channel blockers
38
treatment of patients with renal insufficiency should aim to control
| 4
* hypertension
* electrolytes
* pH
* anemia
39
involves more than 50% of glomerulus
diffuse
| less than 50% = focal
40
portions of the glomerulus affected
segmental
| all = global
41
thickening of capillary wall
membranous
| combination of membranous and proliferative = membranoproliferative
42
hypercellularity in glomerulus, mesangial expansion
proliferative
| combination of membranous and proliferative = membranoproliferative
43
sclerosis with capillary collapse
glomerulosclerosis
44
nephrotic triad
* proteinuria
* hypoalbuminuria
* hyperlipidemia/cholesterolemia
45
* most common in children
* usually idiopathic
* podocyte effacement
* excellent response to corticoids
minimal change glomerulonephritis
46
* most common in hispanic or AA
* idiopathic or associated with sickle cell and HIV
* partial sclerosis of some glomeruli
* podocyte effacement
focal segmental glomerulosclerosis
47
* most common in white adults
* idiopathic or associated with NSAID, malignancy, chronic antigenic stimulation
* thickening of GBM
* granular IgG and C3
* sub-epithelial deposits
membranous glomerulonephritis
48
* most common cause of ERSD in US
* sclerosis of mesangium, KW nodules
* hyaline artherosclerosis of arterioles
diabetic nephropathy
49
* amyloid in mesangium/expanded mesangium
* green birefringence under polarized light with Congo Red
amyloidosis
50
characteristics of glomerulonephritis
| 5
* glomerular inflammation/hematuria
* oliguria
* azotemia
* RBC casts/dysmorphic RBCs in urine
* proteinuria below 3.5
51
* after Group A hemolytic strep infection
* reduced C3-C4 in first 6-8 weeks
* hypercellular inflammed glomeruli
* immunocomplex deposition (sub-epithelial humps)
post-streptococcal glomerulonephritis
52
* progresses rapidly to renal failure
* ANCA
* presents with rapidly progressive glomerulonephritis
* cresents of fibrin in Bowman's space
ANCA-associated glomerulonephritis
ANCA-associated vasculitis
53
* inherited alteration of type IV collagen
* thinning and splitting of GBM
Alport syndrome
54
* anti-GBM antibodies
* IgG deposition along glomerular capillary loops
* fibrin in crescents
* linear or diffuse IgG staining of GBM
* responds to corticosteroids
Goodpasture syndrome
55
diseases that cause glomerulonephritis and can lead to both nephrotic/nephritic syndromes
| 3
* membrane proliferative glomerulonephritis
* IgA nephropathy (Berger)
* Lupus nephropathy
56
* Ig+ with chronic antigenemia or Ig- with alternative complement antibodies
* double contours and lobular hypercellularity
* sub-endothelial deposits
membrane proliferative glomerulonephritis
57
* common in young white males and asians
* IgA granular deposit in mesangium and hypercellularity
IgA nephropathy (Berger)
58
* "full house" (IgG, IgA, IgM, C3, C1q)
* deposits everywhere, GB may show dense depositis
lupus nephropathy
59
* episodic hematuria after infection
* Henoch-Shein purpura
* proteinuria --> nephritic syndrome
* rarely progress to nephrotic syndrome
IgA nephropathy (Berger)
60
* focal or segmental glomerular mesangial expansion
* deposits of IgA in glomerular membrane
* healing lesions may lead to sclerosis
IgA nephropathy
61
genetic or acquired abnormality of immune regulation with abnormal increase in the polymeric form of secretory IgA in blood
IgA nephropathy
62
in IgA nephropathy, IgA is abnormally [...]
glycosylated
63
IgA trapped in glomerular mesangium causing it to proliferate
IgA nephropathy
64
diagnosis of IgA nephropathy
* urine test for blood or protein
* kidney biopsy for IgA
65
treatment of IgA nephropathy
* HTN medications
* inmunosuppressants (steroids)
* omega-3 fatty acids
66
* fatigue, headaches, malaise
* nausea, vomiting, lack of appetite
* itchy skin, leg swelling
diabetic nephropathy
67
microalbuminuria at first, then progresses to heavy proteinuria
diabetic nephropathy
68
* GBM thickening
* mesangial widening with KW nodules
* intracapillary glomerulosclerosis
* hyalinosis
* tubulointerstitium
diabetic nephropathy
69
caused by high glucose levels and protein glycosylation
diabetic nephropathy
70
diagnosis of diabetic nephropathy
* urine test for microalbuminuria or proteinuria
* US of kidneys
71
treatment of diabetic nephropathy
* HTN medications
* control ESRD
72
what amount of urine is associated with oliguria?
< 400 mL/day
73
common skin symptom of patients in ESRD
pruritis
| related to high BUN levels
74
what indicates recovery in nephrotic syndrome?
disappearance of protein from urine
75
characterized by hematuria, proteinuria, edema, oliguria, azotemia
nephritic syndrome
76
sudden reduction in renal function after infectious glomerulonephritis will present with
| 3
* hypertension
* oliguria
* fatigue
77
* back pain
* nausea
* vomiting
| associated with
renal calculi
78
* dysuria
* frequent urinating
| symptoms of
UTI
79
diabetic nephropathy progresses into
nephrotic syndrome
80
what filtration pressure does hydronephrosis increase?
hydrostatic pressure in Bowman's capsule
81
which filtration pressure would multiple myeloma impact?
increase oncotic pressure in glomerular capillaries
82
hypotensive hospitalized patients are the most common antecedent to
acute tubular necrosis
83
earliest event in glomerulonephritis
loss of negative charge of GBM
84
extreme pruritis and crystallized white deposits are associated with
increased urea
85
what type of diet is best for ESRD?
low protein
low sodium
low potassium
low phosphate
86
chronic kidney diease, DM, and vomiting all can lead to
primary metabolic acidosis
87
as kidney disease progresses, the distal nephron loses its ability to secrete K+ leading to
hyperkalemia
88
renal insufficiency is accompanied by [...] retention
sodium
89
most common manifestation of acute renal failure secondary to NSAIDs
hyperkalemia
90
in ESRD, lack of activation of vitamin D causes
spontaneous fractures
91
broad and waxy casts
chronic renal failure
92
muddy brown granular casts
acute tubular necrosis
93
red blood cell casts
nephritis
94
white blood cell casts
| 2
* interstitial nephritis
* pyelonephritis
95
renal insufficiency is accompanied by
| 4
* anemia
* low bone density
* hypervolemia
* hyperkalemia
96
three most common causes of CKD
* DM
* HTN
* glomerulonephritis
97
urinary casts indicate
tubular damage
98
does renal insufficiency cause hypo or hyper kalemia?
hyperkalemia
99
does renal insufficiency cause hypo or hyper natremia?
hypernatremia
100
does renal insufficiency cause hypo or hyper calcemia?
hypocalcemia
101
does renal insufficiency cause hypo or hyper phosphatemia?
hyperphosphatemia
102
renal damage accompanying DM leads to excessive release of
| 2
renin and aldosterone
103
filtration in the glomerulus is [...] in renal insufficiency
| decreased or increased
decreased
104
plasma sodium is [...] in renal insufficiency
| increased or decreased
increased
105
fibromuscular dysplasa and renal artery stenosis cause [...] kidney insufficiency
pre renal
106
kidney stones cause [...] kidney insufficiency
post renal
107
commonly presents after an infection of the respiratory tract
Berger (IgA nephropathy)
108
first sign of Berger
hematuria
109
brown cell casts and urine sediment
acute tubular necrosis
110
consequences of renal failure
**M**etabolic **A**cidosis
**D**yslipidemia
**H**igh potassium
**U**remia
**N**a+/H2O retention
**G**rowth retardation
**E**rythropoietin deficiency
**R**enal osteodystrophy
| MAD HUNGER
