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Renal Flashcards

(105 cards)

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1
Q

What do the kidney contain?

A

Cortex ➡️ outer layer of kidney
Contains glomeruli and tubular system of the nephron

Medulla ➡️ inner portion
Contains collecting ducts

Pelvis ➡️ upper end of ureter
Divides to form funnel shaped callyses that direct urine from kidneys to ureter
Contains filtered blood that was process into urine

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2
Q

Where are most nephrons found?

A

The outer area of cortex

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3
Q

Where are the juxtamedullary nephrons found?

A

Deeper in the cortex, closer to Medulla

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4
Q

What is the function of nephrons and what are the two major portions?

A

Nephrons are the functioning unit of the kidney

2 major portion:

  1. Renal corpuscle ➡️ glomerulus: located in Bowman’s capsule
  2. Renal tubules
    - proximal convoluted tubule
    - nephron loop
    - distal convoluted tubule
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5
Q

The glomerulus originates from

A

Afferent arteriole ➡️ arriving to glomerulus

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6
Q

How does the kidney flow?

A

Bowman’s capsule ➡️ proximal convoluted tubule ➡️ descending limb ➡️ loop of Henle ➡️ ascending limb ➡️ distal convoluted tubule

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7
Q

Where is most of the filtered water and sodium reabsorbed?

A

Proximal Convoluted Tubule

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8
Q

Controls volume and sodium concentration within the vascular system

Activated when kidneys receive signal of low BP, low renal blood flow, low serum Na

A

Renin – angiotensin – aldosterone system

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9
Q

Renin – angiotensin – aldosterone system

A

Juxtaglomerular apparatus secretes renin

Renin converts angiotensinogen into angiotensin I ➡️ inc peripheral ctx, secretes aldosterone

Angiotensin I is converted to angiotensin II

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10
Q

What are the two main functions of angiotensin II

A

Strong vasoconstriction

Stimulates release of length from the adrenal glands which results in sodium reabsorption by kidney

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11
Q

What is synthesized by the nephrons to control renal perfusion by acting as a potent renal vasodilator?

A

Prostaglandins

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12
Q

What does the kidney do in terms of acid-base balance?

A

Alters absorption and secretion of hydrogen and bicarb ions

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13
Q

if a substance has the ability to except a free H+ ions, it’s a ?

A

Base

The ability to gain or lose an H+ ion determines whether a substance is an acid or a base

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14
Q

What are the two electrolyte imbalances increase H+ concentration?

A

Hypokalemia and hypochloremia

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15
Q

What is renal compensation?

A

Kidneys control pH and HCO3 the blood

Increase bicarb occurs in the proximal tubule when it senses increase H+ ions

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16
Q

What is the kidneys role in red blood cell production?

A

Decreased hematocrit or O2 tension
Produces erythropoietin
Increases red blood cell

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17
Q

What is the active form of vitamin D called?

A

Calciferol

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18
Q

Creatinine normal value

A

0.5-1.1 mg/dL

End product of muscle and protein metabolism

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19
Q

BUN and normal value

A

10-30 mg/dL

Concentration of urea in the blood

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20
Q

Estimation of filtrate that is cleared in the glomerulus

A

Glomerular filtration rate

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21
Q

Refers to kidneys concentrating ability

A

Urine osmolality

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22
Q

What is the difference in kids kidneys?

A

Proportionately larger
Renal blood flow and GFR are low at birth and gradually increase as the child develops
Limited ability of the newborn to conserve sodium and excrete excess sodium
Less able to concentrate urine
renal function mature by 1-2 years of age

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23
Q

Renal system purpose

A 
F and E balance
Acid-base balance
Detoxification of blood and waste elimination
Regulates blood pressure
Erythropoietin production
Vit D activation
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24
Q

Two types of fluid compartments

A

Intracellular fluid

Extracellular fluid

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25
Three types of extra cellular fluid
Interstitial fluid Plasma – intravascular Transcellular water
26
‼️Normal sodium‼️
‼️ 135-145 mEq/L ‼️
27
The role of sodium
``` Main electrolyte in ECF Regulates fluid balance Osmolality Acid-base balance Nerve impulse Muscle contraction Filtered freely at glomerulus ```
28
Causes: Diarrhea, vomiting/NG suctioning, SIADH, burns, fever Manifestations: Seizures, lethargy, cerebral edema, decreased LOC, dyspnea, respiratory failure
Hyponatremia
29
Low sodium levels that are corrected to quickly can result in
Osmotic demyelinization syndrome
30
High sodium levels that are corrected to quickly can result in
Cerebral edema
31
Causes: increased sodium intake, insensible water loss, heat exposure, exercise, DI, diuresis Manifestations: Irritability, lethargic, coma, seizures, high pitched cry, flushed skin, muscle weakness, thirst
Hypernatremia ‼️athletes/sport in summer prone to ⬆️Na ‼️
32
Treatments of hypernatremia
Hypotonic saline | Dialysis
33
‼️ Normal potassium ‼️
3.5-5.5 mEq/L
34
The roles of potassium
➡️Mostly intracellular ➡️Responsible for neuromuscular activity and skeletal and cardiac muscles ➡️Renal function is essential 80-90% of intake is excreted by kidneys The rest is eliminated through bowel and sweat
35
Relationship between serum pH and potassium
INVERSE ⬇️ pH = ⬆️ K ‼️ Acidosis = hyperkalemia ⬆️ pH = ⬇️ K ‼️ Alkalosis = hypokalemia
36
Causes for hypokalemia
Not usually related to diet G.I. fluid loss Severe diaphoresis Metabolic alkalosis ➡️ K moves into cell as H+ moves out Diuretics, corticosteroids, beta adrenergic agonist, Alpha adrenergic antagonist, insulin
37
Manifestations of hypokalemia
``` Lethargy Muscle weakness Hypo reflexia Paresthesia PVCs and flattened T waves ➡️ u waves Depressed ST Prolonged PR interval Wake irregular pulse Decreased bowel sounds and constipation ```
38
Hypokalemia can potentiate the action of
Digoxin and lead to dig toxicity
39
Causes for hyperkalemia
Acidosis ➡️ moves K+ out of cell while H+ moves in Crushing and burn injuries Medicines: beta adrenergic blockers, potassium sparing diuretics, chemo, ACE inhibitors, NSAID's Sickle cell disease Insulin deficiency
40
Manifestations of hyperkalemia
``` Ventricular arrhythmias Peaked T waves Widening QRS Flatten P waves with a prolonged PRI AV conduction delays Muscle weakness Hyperactive reflexes Cramping and diarrhea Paresthesia ```
41
Managing MILD hyperkalemia
Loop diuretic | Correct underlying problems ➡️ manage acidosis
42
Treatment of moderate to severe hyperkalemia
‼️ 1. Calcium chloride or gluconate to manage cardiac effects ‼️ 2. 1-2 ml/kg 25% glucose and 0.1 units/kg regular insulin ‼️ 3. Sodium bicarb to move K+ into cells ‼️ 4. Sodium Ploystyrene sulfonate ➡️ kayexalate Dialysis Albuterol moves K+ into the cell and stimulates insulin release
43
Why are phosphorus levels higher in younger children?
Because of increased rate of skeletal growth
44
‼️ Normal phosphate level ‼️
2.5 - 4.5 mEq/L
45
The role of phosphate
3.5-6.5 for children under 5 Body controls phosphate through renal excretion Vitamin D helps the reabsorption of phosphate and calcium from bone to ECF Neuromuscular activity Affect the production of red blood cell and teeth
46
Hypophosphatemia causes and manifestations
Causes: Malabsorption Excessive antacid ingestion ``` Manifestations: Irritability seizures ⬇️ myocardial function hemolytic anemia premature ectopic beats ```
47
Hyperphosphatemia Causes and Manifestations
Causes: Renal failure chemo tumor lysis syndrome ``` Manifestations: Tachycardia hyperreflexia muscle cramps Tetany Diarrhea ```
48
Treatment for hyperphosphatemia
Calcium | Dialysis
49
Ionized calcium is
Free and not bound to albumin
50
‼️Normal total calcium and ionized calcium level‼️
Total calcium= 9-11 mg/dL ICa= 1.2-1.8 or 4.8-5.2 mg/dL
51
The role of calcium
Neuromuscular excitability CV function Contributes to coagulation and thrombin formation Reacts with phosphite to form bone salts
52
Causes for hypocalcemia
``` Vitamin D deficiency Renal disease Diuresis Hypoparathyroidism pancreatitis alkalosis ```
53
Manifestations of hypocalcemia
``` Depressed cardiac function neuromuscular irritability seizures Tetany Tingling Prolonged QT interval ```
54
Causes for hypercalcemia
Acidosis hyperparathyroidism prolonged immobilization malignancies
55
Manifestations of hypercalcemia
``` Muscle weakness Lethargy Coma seizures anorexia nausea, vomiting and constipation bradycardia shortened QT ```
56
‼️Normal magnesium level‼️
1.8-2.3 mEq/L
57
Causes for Hypomagnesemia
``` Diarrhea malabsorption diuresis laxative ingestion burns ```
58
Manifestations of Hypomagnesemia
``` Neuromuscular excitability seizures headaches coma respiratory distress tachycardia PVCs ```
59
Causes for Hypermagnesemia
Renal disease | magnesium administration
60
Manifestations of hypermagnesemia
``` ‼️Decreased ability to swallow‼️ Lethargy Muscle weakness seizures decreased gag reflex hypotension prolonged PRI Prolonged QRS and QT ```
61
What is acute renal failure (ARF) or Acute Kidney Injury (AKI)?
Sudden decrease or loss of kidney function due to loss of filtration and tubular reabsorption
62
What happens to the kidney on acute renal failure?
The kidney can no longer regulate: water and electrolytes acid-base balance nitrogenous waste products hormone release
63
Three types of causes of ARF
Prerenal intrinsic post renal
64
Prerenal Failure
Decreased perfusion Low urine sodium and high urine osmolality Ex. Children, dehydration
65
Intrinsic Failure
Damage to filtering structures | affects glomerulus or tubules
66
Post renal Failure
Usually due to an obstruction | Obstruction causes the GFR to fall due to an increase in pressure
67
Since prerenal failure is due to have a perfusion what gets activated?
Renin angiotensin aldosterone system Therefore, the child's urine sodium level would be low
68
Pathophysiology to ARF
Decreased perfusion Ischemic cell damage Damage to nephrons
69
Findings on ARF
BUN > 80 Cr > 1.5 Oliguria is often present
70
What type of electrolyte imbalances on ARF patient?
``` Increased ‼️P U M P‼️ ⬆️Potassium ⬆️Urea ⬆️Magnesium ⬆️Phosphorus ``` ``` Decreased ⬇️Calcium ⬇️Sodium ⬇️Glucose ⬇️Bicarb ```
71
What preventative measure increases the fluid flow and helps the renal tubules avoid obstruction?
Diuretics - mannitol reduces swelling of the cells - furosemide reverses the GFR
72
What type of medications has the highest potential to lead to intrinsic renal failure?
Antibiotics and contrast media
73
Obstructed renal tubules from inflamed cells in cellular debris Can be due to extreme have a perfusion, anoxia, toxins, or obstructions
Acute Tubular Necrosis
74
What happens to the glomerular permeability on acute tubular necrosis?
⬆️ for protein ⬇️ for potassium
75
Increased glomerular permeability to plasma proteins due to a disturbance in the basement membrane
Nephrotic syndrome
76
Three types of nephrotic syndrome
Primary secondary congenital
77
‼️4 signs of nephrotic syndrome‼️
Massive proteinuria Hypoalbuminemia Hyperlipidemia Edema
78
‼️Massive edema in nephrotic syndrome is followed by‼️
Massive proteinurea Hypovolemia - Renin, ADH, aldosterone release
79
Manifestations of nephrotic syndrome
``` Wt gain Edema Ascites Dark frothy urine - d/t protein Diarrhea ‼️Muehrcke lines‼️ ```
80
️Muehrcke lines
Lines in nail parallel with nail bed
81
Inflammation of glomeruli d/t autoimmune process against strep that causes antigen-antibody complex to become entrapped in the glomerular capillary membrane
Acute glomerulonephritis
82
What does the inflammatory damage and occlusion to the glomeruli result in?
⬇️ GFR and selective permeability
83
Manifestations of acute glomerulonephritis
``` Hematuria - rusty urine Mild proteinurea - low serum albumin Edema - systemic and periorbital HTN Hypervolemia Oliguria ```
84
Management of acute glomerulonephritis
‼️monitor and manage complications: CHF and encepalopathy‼️ Manage symptoms
85
Manifestations of ARF
``` Edema CHF Plum congestion Enlarged liver Tachycardia from shock or dehydration Cardiac arrhythmias Electrolyte imbalances - ⬆️ PUMP CNS signs - sz, lethargy ⬇️ or absent UO ```
86
Goals of treatment: ARF
``` Reduce sx Supportive care until renal function returns Meds - diuretics, low dose dopamine Dietary restrictions Dialysis if indicated ```
87
Inability of kidneys to filter and excrete waste
Chronic Renal Failure
88
Characteristics of chronic renal failure
Azotemia - BUN > 28, Cr > 1.5 | Uremia - ⬆️ nitrogenous waste products
89
Why do children with chronic renal failure often experience growth retardation?
Calcium depletion affect bone growth
90
Water moves from an area of low particle concentration to high particle concentration
Osmosis
91
Particles move from high to low concentration
Diffusion
92
Differences in hydrostatic pressure cause water and particles to move
Filtration
93
A pressure causes water and particles to move through a membrane
Convection
94
Peritoneal dialysis
Catheter placed in anterior wall of abdomen Peritoneal cavity acts as a semi-permeable membrane for water and solute diffusion
95
What is the role of glucose in peritoneal dialysis?
Osmotic pressure of glucose draws fluid from vascular space into peritoneum ⬆️ Glucose = ⬆️ Vascularity = ⬆️ fluid off
96
Who is not a candidate of PD?
Anyone who has: 1. Draining abdominal wounds 2. Respiratory distress 3. Bowel perforation
97
Complications of PD
Peritonitis | Leak around cath
98
Hemodialysis
Rapidly removes fluid and wastes Access: 1. temporary vascular access: subclavian, IJ 2. Femoral
99
Who is not a candidate for hemodialysis?
Patients with hemodynamic instability: - Hypovolemia - coagulation disorder - vascular access problems
100
‼️ What is seen in disequilibrium syndrome d/t osmotic shift in the brain? ‼️
``` Headache N/V Muscle Twitching Blurred vision Restlessness ```
101
``` Proximal Tubular Diuretic Osmotic agent ⬆️ GF volume Slow the re absorption of Na and water at the proximal tubule Can temporarily ⬆️ intravascular volume ```
Mannitol
102
Carbonic anhydride inhibitor - limits the formation of carbonic acid from CO2 in the proximal cells Less urinary bicarb is returned to the blood
Acetazolamide
103
Block reabsoption of Na and Cl is the distal tubule Nephron is still able to concentrate urine Potassium and calcium is lost in urine
Thiazides
104
Potassium sparing diuretic Stop Na reabsoption and potassium secretion in the distal tubule Can be used in combination with other drugs
‼️ Spironolactone ‼️
105
Loop of Henle diuretic Inhibit NaCl transport in the ascending limb Increased loss of K, H, Ca
Furosemide

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