Chapter 16 Flashcards by Desiree Namou

kidney functions

excrete ________ of food metabolism: ____ and other acids are end products of protein metabolism, that only kidneys can excrete
regulate _____ and _____ balance - by excreting minerals and water that have been ingested in excess of the bodys requirements and conserving them as required
endocrine function: a hormone called _________ which regulates red blood cell production in bone marrow

waste products 
urea 
mineral
water
eryhropoietin

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diagnostic tst for kidney function

1) BUN: ___________
2) _____ levels in blood/urine
3) GFR: __________

blood urea nitrogen
creatinine
glomerular filtration rate

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indicates an increased amount of urine

polyuria

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a decreased daily output of urine

oliguria

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a state in which no urine is produced

anura

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presence of increased protein in the urine

proteinuria

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presence of increased glucose in urine

glucosuria

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presence of blood in uria

hematuria

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presence of pus in urine

pyuria

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painful and burning urination

dysuria

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developmental disorders
________ (not formed)- bilateral (________: deadly) or unilateral which leads to ______ of existing kidney and _______ increases risk of renal failure later in life

renal agenesis
potter syndrome
hypertrophy
hyperfiltration

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fusion of kidneys at the lower pole

horseshoe kidney

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unilateral: cysts are embedded in connective tissue. the disorder usually occurs in one kidney

multi cystic renal dysplasia

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caused by presence of two abnormal genes. lot of cysts (___ filled) , wieght of kidney close __ kg

autosomal _____ form presents in young adults as hypertension (due to increased ____), ____ and worsening renal failure
due to mutation in the ____ or ____ gene; cysts develop over time
_______, _______ cysts, and ______ prolapse

ADPKD (Autosomal Dominant polycystic kidney disease)
water
1 
dominant
renin
hematuria 
APKD1, APKD2
berry aneurysm, hepatic 
mitral valve

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very rare, slightly enlarged kidney and renal failure in ______

ARPKD (autosomal recessive polycystic disease)

infancy

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massive proteinuria is generally characterized by excretion of more than ___ grams of protein per day. unlike disorders with greater distruption of glomerular structure, proteinuria in this syndrome is __________ by increased urinary ___ or ___ cells

_________ (low alubumin) results from proteinuria and is often marked by a serum concentration of less than __ g/100 mL
edema results from decreased ___________ pressure

nephrotic syndrome
4
unaccompanied
red
white
hypoalbuminemia
3
plasma colloid oncotic

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Caused by deposit of ___ deposition in mesangium
of glomeruli & most common nephropathy
worldwide
• May occur due to severe bacterial or viral infection
pathogenesis- not well known
• Microscopic findings show IgA deposits over the
____ area.
• Symptoms- ____ and _____ in urine.
• Treatment: ___ inhibitors and _____

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Berger's disease
IgA
cortex
blood, protein
ACE, steroids

Autoimmune disease. Is caused by an antiglomerular
basement membrane (anti-GBN). This
reacts with _____ and GBN leading to ______
hemorrhage and ________ This antibody
is ____

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Goodpasture syndrome
alveolar
pulmonary
glomerulonephritis
IgG

it is the prototype of nephritic syndrome. it is an immune complex disease with the antigen of streptococcal origin
This disorder most often follows or accompanies
infection with nephritogenic strains of group _____________Unlike rheumatic fever, which
chiefly follows streptococcal tonsillitis, it can also
occur after ____ infections.
• Presents 2-3 weeks after infection as ______
(cola-colored urine), oliguria, hypertension, and
______ edema
• ______ recovery in almost all children and many
adults follows. A very small minority develops rapidly
progressive glomerulonephritis

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poststreoptococcal glomerulonephritis
AB hemolytic streptococci 
hematuria
perioribital
complete

This disease is hereditary nephritis associated
with nerve deafness and ocular disorders, such
as lens _______ and _______.
• Clinical characteristics include the _______
syndrome, often progressing to end-stage renal
disease by ___ years of age.
• The cause is a mutation in the gene for the ___
chain of type __ collagen.
• Results in ____ and _____ of the glomerular
basement membrane

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alport syndrome
dislocation
cataracts
nephritic 
30
a5
IV
thinning
splitting

Clinical characteristics include slow progression to
chronic renal disease.
• Histologic characteristics include both basement
membrane ________ and cellular proliferation with a
characteristic ______ appearance best seen with
_____ stains.
• Divided into two types based on location of deposits
• Type I (________deposits): associated with
____ and _____
• Type II (________ disease):associated with
overactivation of _______ system.
• Poor response to ______s; progresses to chronic
renal failure

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membrano-proliferative glomerulonephritis 
thickening
tram-track
silver
subendothelial
HBV, HCV
dense deposit 
complement
steroids

It is a major cause of nephrotic syndrome and is
clinically similar to minimal change disease,
although it occurs in both _____ and older
_______
• It should be suspected in cases of presumed
minimal change disease which do not respond to
_____
• It is more common in ______ and is
associated with ____
• Poor prognosis to _____ and resulting in chronic
renal failure.

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focal segmental glomerulosclerosis 
children
parents
steroids
African Americans
HIV
steroids

Nodular and diffuse thickening of glomerular
basement membranes
• Electron microscopy demonstrates a striking increase
in thickness of the ______ basement membrane.
Thickening of ______ basement membranes
observable by electron microscopy is one of the
earliest morphologic changes in _______
• An increase in _____ matrix results in two
characteristic morphologic patterns: a) ______
glomerulosclerosis is marked by a diffusely
distributed increase in mesangial matrix,
b) _________
glomerulosclerosis is marked by nodular
accumulations of mesangial matrix material
_________ nodules).

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diabetic nephropathy
glomerular 
vascular 
diabetes mellitus
mesangial
diffuse
nodular 
Kimmelstiel-Wilson nodules

calcium phosphate or calcium
oxalate stones (75%)-Increase of Ca concentration.

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calcium stones

(15%): Staghorn calculi are magnesium phosphate stones that form in alkaline urine, which is commonly found in patients with persistent ____

struvite stones | UTIs

(5%): found in gout

uric acid stones

(1%) occur in patients with | cystinosis, an inborn error of metabolism.

cystine stones

increased concentration of salts in ruine a) ____ will increase uric acid production due to defective _____ metabolism b) increase of __ ions due to _____________ urinary tract infection: a) _____ solubility of salts b) ______(UTI) are responsible for crystalizing the salts symptom: high intensity of pain in the _____ radiating to the ____ shoulder treatment: ______/____ therapy, drugs which will pass the stone

``` urolithiasis: kidney stone formation gout purine Ca hyperparathyroidism decrease bacteria back right surgery/wave ```

Incidence of infection of the urinary tract and kidney is greatly increased in _____, because of the shorter length of the _____ urethra; the incidence is increased during _____ • This condition can be caused by _______ bacterial dissemination to the kidney or by external entry of organisms via _____ into the _____ and then spread upward from the bladder into the _____ (______ reflux) and through the ureters to the ______ ( _______ infection). • Most frequently ____ (normal flora). The most common pathogen in young, sexually active women is Staphylococcus________. Others include: _________ & _________ (alkaline urine with____ scent)

``` UTI women female oregnancy hematogenuous urethra bladder ureters vesicoureteral kidney ascending E. coli saprophyticus Klebsiella pneumoniae proteus mirabilis ammonia ```

conditions that predispose UTI - any condition that imprairs free _______ of urine because stagnation of urine favors multiplication of bacteria. example: _______ in male - injury to _____ by _____ stone, disrupting protective epithelium, bacteria invading deeper _____ - introduction of ____ or non medical devices that may carry bacteria

``` drainage benign protstatic hyperplasia (BPH) mucosa kidney tissue catheter ```

UTI _______: affects only the bladder. young sexually active women (sexual intercourse promotes transfer of bacteria from _____ to _____ ) and Common in older men due to ____. ___________: Infection of the kidney. Usually due to _____ infection; increased risk with ______ reflux. May need antibiotics via ____ diagnosis: lab findings - - urinalysis: ____ urine with >__ WBCs/high power field -dipstick: positive _________ (due to pyuria) and _____ (bacteria convert nitrates to this) -culture: greater than _____ colony forming units ( gold standard)

``` cystitis urethra bladder BPH pyelonephritis ascfending vesicoureteral IV cloudy 10 leukocyte esterase nitrites 100,000 ```

UTI clinical symptoms Urinary frequency: a compelling necessity to void ____ amounts of urine at frequent intervals. • ____: painful, burning sensation on urination • pyuria: large numbers of _____ in the urine •_____: blood in the urine • ______: usually defined as more than 10^5 organisms per milliliter of urine • Cystitis. Characteristics include pyuria and often hematuria, but urinary ____cell casts are not found. • Additional diagnostically significant findings in acute pyeonephritis: with ____,___ pain,____ casts, and _____. Greatly increased frequency in _____, especially during ______

``` small dysuria neutrophils hematuria bacteriuria cystitis white fever, flank, WBCs, leukocytosis women, pregnancy ```

Pre-renal azotemia. This condition results from decreased renal blood flow caused by _____ loss, _____ cardiac output, systemic ______ (as in massive burns), or peripheral ______ of blood due to marked vasodilation (as in gram-negative sepsis). It is characterized by increased _____ reabsorption of _____ and _____, resulting in _____, concentrated urine. • Measurement of urinary ____ is diagnostically significant in addition to oliguria. • Oliguria may be caused by decreased renal ____ flow with ______ glomerular filtration rate. Oliguria may be a manifestation of acute _______ , in which case tubular reabsorption is greatly _____ and urinary sodium is not ______ • The BUN: _______ ratio is characteristically greater than 15 due to a combination of both decreased glomerular filtration and increased tubular reabsorption of urea. • Postrenal ______ ( which is an elevation of blood urea nitrogen (BUN) and serum creatinine levels) results from mechanical _______ of urinary flow.

``` acute renal failure (ARF) blood decreased hypovolemia pooling tubular sodium, water oliguria sodium blood decreased tubular necrosis impaired decreased creatinine azotemia blockage ```

Injury and necrosis of tubular epithelial cells most common cause of acute renal failure (_________ • Necrotic cells plug ______; obstruction decreases _____ _______, ______casts are seen in the urine. • BUN: _________< 15, decreased reabsorption of sodium, and inability to concentrate urine (urine osmolarity < 500 mOsm/kg). •_______: Decreased blood supply results in necrosis of tubules. • ________: Toxic agents result in necrosis of tubules. Example: ______, heavy metals (____), _______ dye, _______ (associated with oxalate crystals in urine), chemotherapy & postoperative ____ therapy. • ATN may lead to _____ .

``` acute tubular necrosis (ATN) intrarenal azotemia tubules GFR brown, granular creatine ratio creatine ischemia tephrotoxic NSAIDs, lead, radiocontrast ethylene glycol antibiotic CTN (chronic tubular necrosis) ```

Treatment of ATN & CTN: _______ • It substitutes for the functions of the kidneys, which removes waste products from the patient’s blood • Waste products from the patient’s blood diffuse across a semipermeable membrane into a solution (the _____) on the other side of the membrane There are two types • _______ (more common) – Patient’s circulation connected to artificial kidney machine • ______(less common) – Patient’s own peritoneum used as dialyzing membrane

kidneys dialysate extracorporeal peritoneal

When kidneys fail, renal transplantation may be attempted • The kidney is obtained from a close relative or cadaver donor • The survival of the transplant depends on the similarity of ____ antigens( ___) between donor and recipient • Only ______ twins will contain identical HLA antigens in their tissues

HLA MHC identical twins

Tumor of infancy and childhood (_ to _ years of age) • Composed of _____ cells resembling renal _____ • Most often, the presenting feature is a palpable ___ mass (often huge). Wilms tumor is often associated with ____ of the short arm of chromosome 11. The ____ and ____ genes localized to this chromosome are ____ suppressor genes. • May be familial or bilateral in 10% cases • Good prognosis when surgery is combined with chemotherapy

``` Wilm's Tumor 2, 4 immature blastoma flank deletions WT-1, WT-2 cancer ```

This cancer is the most common renal malignancy. • It is more common in men, occurs most often from __ to __ years of age, and has a higher incidence in _______ • In some instances, it is associated with gene deletions in chromosome _; Tumors arise in older adults (>50 years). • Presenting features may include the triad of _____ pain, _____ mass , and _____. Additional findings include secondary _____(results from erythropoietin production) &____ production of hormones or hormone-like substances (e.g., ACTH, prolactin, gonadotropins, and renin). Paraneoplastic PTH-like hormone can cause _________ • This cancer is the most common form

``` renal cell carcinoma 50, 70 cigarrette smokers 3 flank pain, palpable mass, hematuria polycyhtemia ectopic hypercalcemia ```

This cancer is the most common tumor of the urinary collecting system and can occur in _____, ____ or ______. It is often multifocal in origin due to the field effect. • This carcinoma is likely to ____ after removal. • Most often, the presenting feature is _______. There is a tendency to spread by local extension to surrounding tissues. • Associated toxic exposures may sometimes be involved, including the following: Industrial exposure to_______ or _________, an aniline dye, _______, Long-term treatment with _______

``` transitional cell carcinoma renalpelvis, ureter, bladder recur hematuria benzidine,= B-napthylamine cigarette smoking cyclophosphamide ```

• Most common cancer of the urinary Tract. Most tumors are transitional carcinomas but may be ______ or ______ • Variable prognosis—depends on the ___ and ____ of the tumor -______, _______ and lower ____ pain • Diagnosis made on urine cytology and cystoscopic biopsy • Grade _ tumors localized to mucosa—__% 5-year survival but tend to recur • Grade __ tumors with metastases—__% 5-year survival

``` carcinoma of urinary bladder squamous adenocarcinomas hematuria, dysuria, abdominal grade, stage I 98% 15% ```

_________ diseases with apperance of RBCs in the urine may have casts on examination of the urine. in congrast, renal diseases that are _______ are characerized by presencfe of protein spilled into urine

nephritic | nephrotic

Chapter 16 Flashcards

(41 cards)