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From Flashcardlet > Patho 15 - Kidneys > Flashcards

Patho 15 - Kidneys Flashcards

1
Q

What does the urinary tract consist of?

A 
Kidneys
Renal pelvises
Ureters
Urinary ladder
Urethra
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2
Q

What is the upper urinary tract?

A

Kidneys and renal pelvises

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3
Q

What is the lower urinary tract?

A

Ureters
Bladder
Urethra

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4
Q

What does the collecting system do?

A

Consists of a series of spaces that carry urine from the kidney and hold it for urination

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5
Q

What structures comprise the collecting system?

A

Renal pelvis
Ureter
Bladder
Urethra

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6
Q

What is the renal pelvis?

A

Broad, funnel shaped space that gathers urine from the kidney and channels it into the ureter

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7
Q

What do waste products in urine usually derive from?

A

Protein metabolism

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8
Q

What are some protein wastes in urine?

A

Urea
Creatinine
Uric acid
Ammonia

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9
Q

What factors can influence the composition of urine?

A

Thirst
Sweating
Respiratory activity

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10
Q

Where is the collecting system located?

A

Retroperitoneum

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11
Q

What kind of epithelium is located in the collecting system?

A

Transitional or urothelial epithelium

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12
Q

Why is urothelial epithelium called transitional?

A

Its ability to transition between round and flat as the bladder mucosa stretches to accommodate increasing urine volume

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13
Q

What is the ureterovesical junction?

A

Where the ureters descend in the bladder at a shallow angle

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14
Q

What does the UVJ act as?

A

A one way valve to prevent back flow of urine from the bladder into the ureter

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15
Q

What is the muscle of the bladder wall?

A

Detrusor muscle

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16
Q

What does the bladder look like as it empties?

A

The dome collapses, leaving the inferior part of the bladder unchanged

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17
Q

What forces move urine down into the ureters?

A

Gravity and peristaltic contraction

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18
Q

How does the body recognize the need to void?

A

The stretched bladder sends a signal to the brain, bringing an increasing sense of urinary urgency

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19
Q

What are the functions of the kidney?

A
  • Excretion of metabolic waste
  • Adjustment of blood pH excretion of acid/production of bicarb
  • Adjustment of plasma salt concentration by secretion of salt and water
  • Adjustment of blood volume and pressure by secretion of renin
  • Stimulation of RBC production with EPO
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20
Q

What is the inner part of the kidney?

A

Medulla

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21
Q

What is the outer part of the kidney?

A

Cortex

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22
Q

What structures are located in the cortex?

A

Glomeruli and tubules

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23
Q

What structures are located in the medulla?

A

Only tubules

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24
Q

What are glomeruli?

A

The filtering apparatus of the kidney

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25
Q

What are mesangial cells?

A

Interstital cells that support the glomerular capillaries

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26
Q

What is the glomerulus contiguous with?

A

Proximal end of renal tubule

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27
Q

What is the nephron unit composed of?

A

Glomerulus and renal tubule

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28
Q

What two layers of the tubule create the Bowman’s space?

A

Empty space between visceral and parietal epithelial cells

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29
Q

Where do renal tubules terminate?

A

Cross from cortex into medulla and terminate in renal pelvis

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30
Q

What structure supplies blood to the glomerulus?

A

Afferent arteriole

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31
Q

What structure allows the exit of blood from the glomerulus?

A

Efferent arteriole

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32
Q

Which arteriole to the glomerulus is bigger, and why?

A

Afferent arteriole is larger, ensuring glomerular filtering pressure remains high

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33
Q

What is the JGA?

A

Juxtaglomerular apparatus - afferent arteriole and small adjacent segment of the distal convoluted tubule

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34
Q

What does the JGA do?

A

Senses blood pressure and blood flow in the afferent arteriole and sodium concentration in the DCT - secretes renin in response

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35
Q

What three layers compose the glomerular membrane?

A

Capillary endothelium
Glomerular basement membrane
Glomerular visceral epithelium

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36
Q

How does the glomerular membrane affect the composite o the glomerular filtrate?

A

It acts as a filter, allowing through water, dissolved waste, salts, glucose, and amino acids, but does not allow RBCs and proteins

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37
Q

What is the barrier effect?

A

Large particles cannot pass through the mesh of the glomerular membrane

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38
Q

What is the functional unit of the kidney?

A

Nephron

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39
Q

Where is pressure high when entering the kidney and why?

A

High pressure in the afferent arteriole creates a gradient into the kidney allowing blood flow

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40
Q

Which layer of the Bowman’s capsule is associated with the basement membrane?

A

Visceral layer

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41
Q

What is the glomerular filtrate?

A

Fluid initially filtered from blood, entering the Bowman’s space

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42
Q

What is tubular fluid?

A

Fluid that leaves the Bowman’s space, previously known as glomerular filtrate

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43
Q

What happens to tubular fluid to create urine?

A

As tubular fluid moves down tubule, water, electrolytes, acids and other substances are exchanged between tubular fluid and blood vessels

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44
Q

How much urine is produced in a day?

A

1-1.5 L

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45
Q

How much GF is produced in a day?

A

180 L

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46
Q

How much GF is reabsorbed by the renal tubules?

A

99%

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47
Q

What is the glomerular filtration rate?

A

The amount of plasma that is cleaned per minute

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48
Q

What is the GFR of a normal healthy person?

A

125 ml/min (greater than 100)

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49
Q

What substance causes the water of the tubular fluid to be reabsorbed into blood?

A

ADH from posterior pituitary

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50
Q

What structure regulates the amount of ADH secreted?

A

Hypothalamus detects plasma osmolality and commands secretion of more or less ADH to adjust concentration of plasma

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51
Q

What happens to GFR as we age and why?

A

GFR decreases because we naturally lose nephrons as we age

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52
Q

What is stage 3 kidney disease GFR?

A

Consistently less than 60

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53
Q

Can we regenerate nephrons once they are lost?

A

No

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54
Q

What happens to the GFR of a dehydrated patient?

A

GFR is decreased because there is less fluid to be filtrated - once hydrated again the GFR will increase

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55
Q

How much glucose and amino acids are reabsorbed by the tubules?

A

All

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56
Q

What does fluid that is not reabsorbed by the tubules become?

A

Urine

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57
Q

When does the tubule not reabsorb all glucose?

A

At a threshold when high concentrations of glucose are present and glucose starts spilling out into the urine

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58
Q

What is the renal threshold for glucose?

A

180 - 200

59
Q

What does the body try to do to urine if glucose is spilling over?

A

The body wants to dilute the urine because the urine has a higher osmotic pressure - more urination, blood volume decreases, you drink more.. diabetes

60
Q

What are the principal a waste products in urine?

A
  • Nitrogenous wastes from protein metabolism
  • Acids from carb and fat metabolism
  • Toxins and drugs not metabolized by liver
61
Q

What are the principal nitrogenous wage products in urine?

A

Urea and creatinine

62
Q

What does it indicate if creatinine levels are elevated?

A

Kidneys are not filtering properly

63
Q

What test measures urea levels?

A

BUN - blood urea nitrogen

64
Q

What are the characteristics of normal urine?

A
  • Odorless
  • Sterile
  • Crystal clear
  • Pale yellow
  • Slightly acidic
  • Specific gravity 1.016-1.022
65
Q

What substances are tested for on a dipstick?

A
  • Glucose
  • Bilirubin
  • Ketones
  • Specific gravity
  • Blood and hemoglobin
  • pH
  • Protein
  • Urobilinogen
  • Nitrite
  • Leukocyte esterase
66
Q

What is the best specimen for urinalysis?

A

Cahertization, or first urine voided upon arising because it is the most condensed

67
Q

What is the common cause for blood in the urine?

A

Menstrual blood contamination

68
Q

When are ketones found in the urine?

A

When body must burn fatty acids instead of glucose for metabolism

69
Q

When might ketones be found in urine if the patient is not diabetic?

A

If they patient hasn’t eaten - the body needs sugar but doesn’t have it so it breaks down fatty acids instead

70
Q

When might you commonly see proteins along with blood in the urine?

A

UTI - will reverse after infection clears

71
Q

What do casts indicate?

A

Renal disease

72
Q

What are casts made up of?

A

Formation of compacted protein, white or red cells, or epithelial cells in lumen of tubules

73
Q

What condition is present when protein casts are seen in urine?

A

Nephrotic syndromes, glomerular disease

74
Q

What condition is present when red cell casts are seen in urine?

A

Glomerular bleeding into the GF

75
Q

What condition is present when white cell casts are seen in urine?

A

Inflammation in the kidney

76
Q

What condition is present when calcium oxalate crystals are seen in urine?

A

Kidney disease

77
Q

What is azotemia?

A

Renal failure manifested only by abnormal lab tests - no clinical signs are present

78
Q

What are the most commonly detected abnormalities in azotemia?

A

Elevated BUN and creatinine

79
Q

What is uremia?

A

Renal failure that is manifested not only with increased nitrogenous wastes in blood but also with cynical signs and symptoms

80
Q

What are the clinical signs of uremia caused by?

A
  • Accumulation of wage products in blood

- Failure of kidney functions

81
Q

What are some common signs and symptoms of uremia?

A
  • Hypertension
  • Anemia
  • Edema
  • Oliguria
  • Pericarditis, gastroenteritis
  • Bleeding/coagulation defects
  • Neuropathy, encephalopathy
82
Q

What is pre renal azotemia caused by?

A

Renal hypo perfusion from shock, hemorrhage, dehydration, heart failure, or any condition in which renal blood flow is reduced

83
Q

What is post renal azotemia caused by?

A

Obstruction to the free flow or urine from the kidney

84
Q

What is acute renal failure?

A

Rapid onset of azotemia and oliguria

85
Q

How can we treat acute renal failure?

A

Acute renal failure can reverse itself when patient is resuscitated with fluids and lab results will go back to normal

86
Q

What is chronic renal failure?

A

Long standing, unremitting deterioration of renal function

87
Q

What are the four stages of chronic renal failure?

A
  • Diminished renal reserve
  • Renal insufficiency
  • Chronic renal failure
  • End stage kidney disease
88
Q

Why does anemia result with kidney disease?

A

Decreased EPO production results in decreased numbers of RBCs, causing anemia

89
Q

Why does hypertension result with kidney disease?

A

Increased renin output due to restriction of glomerular blood flow

90
Q

Why does edema result with kidney disease?

A
  • Loss of proteins to urine causes loss of osmotic pressure - fluid leaves capillaries and resides in spaces
  • Retention of salt and water
91
Q

What is glomerular disease caused by?

A

Autoimmune inflammatory reactions

92
Q

What is a glomerular disease caused by autoimmune inflammatory reaction called?

A

Glomerulonephritis

93
Q

What is a glomerular disease that is not caused by an autoimmune inflammatory reaction called?

A

Glomerulopathy

94
Q

What are the two immune mechanisms that cause glomerular disease?

A
  • Direct immune attack on glomerulus

- Deposition of circulation gimmune complexes

95
Q

What are the four types of glomerular injury?

A
  • Thickening of basement membrane
  • Hypercellularity
  • Hyalinosis
  • Sclerosis
96
Q

What is the thickening of the basement membrane due to?

A

Derives from deposition of immune ecompexes

97
Q

What does hypercellularity derive from?

A

Influex of inflammatory cells and increase in number of mesangial, endothelial, or epithelial cells

98
Q

What does epithelial hypercellularity result in?

A

Formation of crescents

99
Q

What is hyalinosis?

A

Accumulation of homogenous, smooth proteinaceous extracellular material deposited from plasma into the glomerulus

100
Q

What is sclerosis?

A

Accumulation of collagenous scar tissue in glomerulus

101
Q

What is nephritic syndrome caused by?

A

Inflammatorion of the glomerulus

102
Q

What symptoms present with nephritic syndrome?

A
  • Hematuria
  • Proteinuria
  • RBC casts
  • Hypertension
  • Edema
  • Azotemia
  • Oliguria
103
Q

What are the two types of nephritic syndrome?

A

Acute and hereditary

104
Q

What causes acute nephritic syndrome?

A

Poststreptococcal glomerulonephritis

105
Q

What is nephrotic syndrome?

A

Marked proteinuria and severe generalized osmotic edema due to low plasma albumin

106
Q

What symptoms present with nephrotic syndrome?

A
  • Proteinuria
  • Albuminemia
  • Edema
  • Hyperlipidemia and lipiduria
107
Q

What is nephrotic syndrome usually caused by?

A

Disease in which the glomerulus is secondarily involved, like diabetes, amyloidosis, and SLE

108
Q

How do we classify glomerular disorders if the etiology is known?

A

According to etiology or clinical syndrome

109
Q

How do we classify glomerular disorders if the etiology is not known?

A

Anatomical lesions, or according to the pathology found in the glomerulus

110
Q

What are nephritic and nephrotic syndromes both a result of?

A

Damage to the glomerulus - blood and protein are able to enter the glomerulus

111
Q

What are the two most common causes of asymptomatic hematuria?

A

TBMD and IgA nephropathy

112
Q

What is TBMD?

A

Thin basement membrane disease - glomerular condition that needs no treatment - renal function is normal

113
Q

What is immuoglobulin A nephropathy?

A

Autoimmune glomerular disease due to increased IgA secretion by MALF lymphoid tissue in response to infection with glomerular deposition

114
Q

What is rapidly progressing glomerulonephritis?

A

Form of GN that represents a common pathway toward chronic GN for many glomerular diseases

115
Q

What is post streptococcal glomerular nephritis?

A

Autoimmune disorder where immune complexes deposit in the kidneys and destroy or damage the glomeruli

116
Q

What signs and symptoms present with post streptococcal glomerular nephritis?

A
  • Red cell casts in urine
  • Hematuria
  • periorbital edema
  • Hypertension
  • BUN, Cr elevated
117
Q

What happens as post streptococcal glomerular nephritis progresses?

A

Most patients fully recover but the condition can progress to chronic GN

118
Q

What is lupus nephritis?

A

Type III hypersensitivity causes immune complexes to deposit in distant organs like the glomeruli

119
Q

What is chronic glomerulonephritis?

A

Long standing, end stage chronic glomerular disease

120
Q

What do the glomeruli look like chronic glomerulonephritis?

A

Shriveled and scarred and tubulointerstitial framework is obliterated by inflammation and scar that aerates trace of pathogenesis

121
Q

What is the next test ordered after a urinalysis?

A

Renal biopsy

122
Q

What does a renal biopsy look at?

A

Looks at glomeruli and tries to determine what is going on at a microscopic level

123
Q

What happens in the kidney with a type III hypersensitivity reaction that allows leakage of proteins and blood into the glomerulus?

A

Immune complex binding stimulates complement fixation which causes inflammation and injury, leading to leaky vessels, allowing protein and blood to leak into glomeruli

124
Q

How do we treat type III hypersensitivities that affect the kidney?

A

Immunodepressants to fight the autoimmune component

125
Q

What is the most common cause of nephrotic syndrome?

A

Membranous glomerulonephritis

126
Q

What is membranous glomerulonephritis?

A

Thickening of the basement membrane owing to antibody deposits

127
Q

How do we see membranous glomerulonephritis in lab testing?

A

Fluorescent microscopy

128
Q

What is another name for crescentic glomerulonephritis?

A

Progressive glomerular nephritis

129
Q

Is crescentic glomerulonephritis severe?

A

Yes, is it fast acting and results in swiftly deteriorating renal function

130
Q

What is the crescent shape in rapidly progressive glomerulonephritis due to?

A

Adaption of the kidney in chronic renal disease - the kidneys are atrophied, small and shriveled, and lessen the cortex

131
Q

What is the most common cause of secondary glomerular disease?

A

Diabetic glomerulosclerosis

132
Q

What is Diabetic glomerulosclerosis caused by?

A

High sugar levels damage membranes and proteins start spilling out in small amounts

133
Q

What kind of complexes deposit into membranes in Diabetic glomerulosclerosis?

A

Glycosylated proteins deposit into membranes and damage capillaries that interfere with filtering process

134
Q

What test is ordered each year for diabetics to test for glomerulosclerosis?

A

Microalbumin test - if glycosylated proteins have damaged glomerular membranes, proteins will spill out

135
Q

What does TIN stand for?

A

Tubulointerstitial nephiritis

136
Q

What causes primary TIN?

A

Direct tubulointerstital injury:

  • Shock
  • Toxin
  • Myoglobin
  • Drugs
  • Analgesics or anti-inflammatory drugs
137
Q

What is myoglobin and how does it damage the kidney?

A

Part of muscles, if muscle break down occurs, myoglobin is released and damages the kidneys

138
Q

What is another name for acute tubular injury?

A

Acute tubular necrosis

139
Q

What are the two kinds of primary TIN?

A
  • Ischemic or toxic injury to tubules

- Inflammatory conditions that directly inure tubules and interstitium

140
Q

What are three symptoms of TIN?

A
  • Pale cortex
  • Acute renal failure
  • Azotemia
141
Q

What are some examples of pre-renal causes of tubulointerstital injury?

A
  • Loss of volume
  • Dehydration
  • Hypoperfusion
  • Hemorrhage
  • CHF
142
Q

What is an example of post-renal causes of tubulointerstital injury?

A

Obstructive forces like enlarged prostate which compresses the urethra or kidney stone that causes back flow of urine to the kidney

143
Q

What is hydronephrosis?

A

Fluid around the kidney

From Flashcardlet (133 decks)

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