Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PHAR 255 > Kidney > Flashcards

Kidney Flashcards

(64 cards)

Start Studying
1
Q

What are the three functions of the kidney?

A

Excretory
Endocrine
Metabolic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Blood enters the glomerulus through the:

A

Afferent arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Blood leaves the kidney through the:

A

Efferent arteriole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the filtrate composed of? (The urine)

A

Glucose
Electrolytes
Amino acids
Water
Urea
Uric acid
Creatinine
Protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What does the kidney secrete to maintain acid-base balance?

A

Acids (H+)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What do the kidneys do in acidosis?

A

In response to excess acid, kidneys reabsorb all filtered bicarbonate and produces new bicarbonate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What do the kidneys do in alkalosis?

A

In response to too little acid, kidneys excrete bicarbonate to restore H+ concentration to normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the key renal blood pressure mechanisms?

A

Renin-angiotensin-aldosterone system (RAAS)
Antidiuretic hormone (ADH)
Atrial natriuretic peptide (ANP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

The filtrate should not contain a significant amount of:

A

Protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Why do we check renal function?

A

Monitoring and early recognition of CKD
To adjust doses of medications excreted by the kidneys
Monitoring nephrotoxic medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is creatinine?

A

A by-product of muscle metabolism that is primarily eliminated by glomerular filtration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens to SCr when GFR is low?

A

It is increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the equation used for classifying the severity of kidney disease?

A

CKD-EPI (measures GFR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the equation used for making renal dose adjustments to medications?

A

Cockcroft-Gault

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T or F: the CKD-EPI equation is used to estimate kidney function in a patient receiving dialysis.

A

False. Don’t report a GFR in dialysis, wouldn’t be relevant or accurate.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When will our estimate of GFR be in accurate if we are using creatinine?

A

AKI
Extremes of muscle mass/body size
High protein diet
Dialysis
Muscle wasting diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the impact of eliminating race as a factor when using the CKD-EPI equation?

A

Lower eGFR in black patients
Higher eGFR in non-black patients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When do we use indexed or normalized eGFR?

A

For CKD staging/progression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

When do we used non-indexed or without normalization eGFR?

A

For drug dosing (but caution in obese patients)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What happens to urea (blood urea nitrogen-BUN) in renal impairment?

A

Urea levels are increased

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What can affect urea concentrations?

A

Dietary protein
GI bleeding
Hydration status (could be high when dehydrated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Is urea a renal function test?

A

No. Urea can be high without having renal impairment.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is proteinuria and what does it tall us about kidney function?

A

Presence of increased amounts of protein in the urine.
Persistent increase in urine protein is a marker of kidney damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is albuminuria and what can it tell us about kidney function?

A

Albumin in the urine(a small amount is normal)
Increased levels are an early predictor of glomerular dysfunction (may even see this before we see a decrease in GFR)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the categories of albuminuria in CKD?
A1: ACR<3mg/mmol - normoalbuminuria A2: ACR=3-30mg/mmol - microalbuminuria A3: ACR>30mg/mmol - macroalbuminuria
26
T or F: the term microalbuminuria means that the protein in the urine are small.
False. This means that there is a small amount in the urine which could either be normal or mildly increased.
27
What can cause albuminuria without causing a concern for CKD?
Recent major exercise UTI Febrile illness Decompensated congestive HF Acute severe elevation in BP or BG
28
What characteristics does a urinalysis look at?
Colour, turbidity Presence of cells, micro-organisms, “casts”, crystals Urinary eosinophils = interstitial nephritis pH analysis, specific gravity Glucose, ketones = indicative of diabetes/DKA Leukocyte esterase and nitrite = positive in UTIs
29
What are the urinary sediment abnormalities that are markers of kidney damage?
RBC casts WBC casts Fatty casts in diseases with proteinuria Granular casts - second most common cast Isolated microscopic hematuria with abnormal RBC morphology (Casts are protein structures formed within the tubule of the kidney) Cells in the urine are indicative of a problem!!
30
What is an AKI?
A sudden decline in renal function (hours or days) as evidenced by changes in laboratory values (SCr, BUN, and urine)
31
How is an AKI defined by KDIGO?
Any of the following: - increase in SCr by >/= 0.3mg/dl within 48 hours - increase in SCr to >/= 1.5 times baseline, which is known or presumed to have occurred within the past 7 days - urine volume < 0.5mL/kg/hr for 6 hours (need to rule out other causes first) (also a non-specific marker)
32
How can AKI’s be classified?
Anuric - less then 50mL/day urine output Oliguric - less then 500mL/day urine output Non-oliguric - greater then 500mL/day urine output (normal urine)
33
How is CKD staged?
RIFLE category or AKIN criteria(stage 1-3) Stage would be based on the worst criteria met
34
What does RIFLE category stand for?
Risk Injury Failure Loss ESRD
35
What do the staging systems depend on?
SCr and urine output
36
What do we need to know about the patient when using the staging systems for an AKI?
Need to know there baseline as the criteria are based on change in SCr
37
What are the symptoms of an AKI?
Most people are asymptomatic ~50% are oliguric Symptoms of dehydration Uremia - malaise, nausea, vomiting Severe abdominal or flank pain Decreased force of urine stream Cola-coloured urine Excessive foaming of urine Sudden weight gain, edema
38
Can an AKI be due to dehydration or fluid overload?
It can be due to either one!
39
Susceptibilities for AKI
CKD Dehydration Advanced age Female Black race Chronic disease Diabetes Cancer Anemia
40
Exposures that increase risk of AKI
Sepsis Critical illness Circulatory shock Burns Trauma Cardiac surgery Nephrotoxic drugs
41
What % of AKI’s are caused by drugs?
~20%
42
What are the three ways to classify the cause of an AKI?
Pre-renal (blood supply) Intra-renal or intrinsic (within kidney) Post-renal (after urine is produced: collecting tubule, ureter, bladder, urethra)
43
What is the most common cause of an AKI?
Pre-renal (~60%)
44
What is a pre-renal AKI?
The kidneys are not getting adequate blood supply but the kidneys themselves are healthy. Kidney perfusion is decreased, from: - intravascular volume depletion(hemorrhage, dehydration, burns, diuretic therapy) - decreased effective circulating volume (HF, cirrhosis) - hypotension (vasodilation medications, septic shock) - decreased glomerular filtration pressure (ACEi/ARB + NSAIDs)
45
How would filtration be increased for a pre-renal AKI?
Dilate the Afferent arteriole and constrict the efferent arteriole to increase filtration.
46
What is the second most common cause of an AKI?
Intrinsic AKI (25-35%)
47
What is an intrinsic AKI?
Results from direct damage to the kidneys and there are 4 main types.
48
What are the 4 types of intrinsic AKI’s?
Acute tubular necrosis*most common* (endogenous(myoglobin) or exogenous(aminoglycosides) toxins, ischemia) Acute interstitial nephritis (idiopathic hypersensitivity immune reaction to drugs(NSAIDs, penicillin), infection) Acute glomerulonephritis (post-strep antigen-antibody complexes) Vascular kidney injury (renal artery stenosis, HTN)
49
What is a post-renal AKI?
Obstruction to urinary flow anywhere in the urinary tract: - urethral obstruction - ureter obstruction - bladder neck obstruction
50
What are the cause of a post-renal AKI?
Nephrolithiasis (kidney stones) Prostate enlargement *most common* Cervical cancer tumors Drugs that crystallize (sulfonamides, acyclovir, MTX)
51
How are AKIs diagnosed?
1. Get a full history 2. Labratory data (increased SCr, increased BUN, acidosis, hyperkalemia) 3. Urinary sodium concentration 4. Fractional excretion of sodium (decreased with pre-renal AKI, increased with tubular damage) - also note this is not specific - sodium excretion may be increased with diuretic use 5. Urinalysis If necessary: renal ultrasound or kidney biopsy
52
What are casts(cellular debris) on urinalysis seen with?
Acute tubular necrosis
53
What do hematuria or proteinuria in urinalysis indicate?
Glomerular injury
54
What do increased WBC in urinalysis mean?
UTI or pyelonephritis (kidney infection)
55
What does pyuria, urinary eosinophils on urinalysis mean?
Acute interstitial nephritis
56
What do crystals on urinalysis mean?
Post renal AKI
57
What would a pre-renal AKI look like on urinalysis?
Few WBCs, casts, and decreased fractional excretion of sodium
58
What is the treatment for pre-renal AKI?
Hydration with IV fluids - stop diuretics if hypovolemic BP support with vasopressors Diuretics for fluid removal in state of volume overload Stop/hold drugs that impair kidney function/urine flow (NSAIDs)
59
What is the treatment for intrinsic AKI?
Discontinue offending agents Manage underlying autoimmune disease
60
What is the treatment for post-renal AKI?
(Remove obstruction) Catheter to restore urine flow Identify and remove obstruction Adequate hydration when giving drugs with potential to crystallize
61
What is our main concern with AKI and treatment?
Hyperkalemia Moderate (K+ 5.1-7mmol/L) Severe (K+ >7mmol/L)
62
How do we treat hyperkalemia caused by AKI?
Mild: may not require therapy or can use kayexalate (sodium polystyrene sulfonate) or furosemide IV to increase urinary excretion Severe(medical emergency): calcium gluconate to stabilize myocardium, drive K+ into cells with insulin +/- glucose, kayexylate to eliminate excess K+ from body, dialysis if refractory
63
How is metabolic acidosis with AKI treated?
Sodium bicarbonate IV
64
When to dialyze in AKI?
(AEIOU) Acidosis Electrolyte abnormalities (hyperkalemia) Ingestion of toxins Overload of fluid Uremia

PHAR 255 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions