Renal Disorders (Exam 2) Flashcards
(143 cards)
1
Q
Functions of Renal System (5)
A
Regulation of water and inorganic-ion balance
Removal of waste from blood
Removal of foreign chemicals
Gluconeogenesis
Hormonal Secretion
2
Q
Ureters
A
Carry urine from kidney to bladder
3
Q
Bladder
A
Stores urine
4
Q
Urethra
A
Carries urine from bladder to outside body
Valves keep flow one-way
5
Q
Bladder is lined with…
A
transitional epithelium
6
Q
Internal urethtral sphincter
A
Smooth muscle we CAN’T control
7
Q
External urethtral sphincter
A
Skeletal muscle we CAN control
8
Q
What is the functional unit of the kidneys?
A
Nephron
9
Q
Where does nephron extend?
A
Between renal cortex and renal medulla
10
Q
20% of volume that enters glomerulus is filtered out into…
A
the Bowman’s capsule
11
Q
What is filtrated into nephron?
A
Salts
Amino acids
Glucose
12
Q
What stays in the blood?
A
Blood cells
Proteins
13
Q
Mechanisms of Renal System
A
Glomerular filtration (passive)
Tubular secretion (active)
Tubular reabsorption (both)
14
Q
What does filtration and secretion serve for renal system?
A
Extracting drug from blood into urine
15
Q
What does reabsorption involve for the renal system?
A
Movement of drug back into blood from primitive urine
16
Q
Nephron Reabsorption Mechanism
A
Ions transported out to make medulla salty
Water flows from filtrate to medulla
As collecting duct passes through salty medulla, more water reabsorbed from filtrate –> Concentrated Urine
17
Q
What is reabsorbed in the nephron?
A
Na+, Cl-, water, HCO3-, Ca2+, Mg2+, amino acids, glucose
18
Q
What is excreted from nephron?
A
H+, urea, NH3, K+
19
Q
What happens when there is too much salt?
A
Too much water is reabsorbed which leads to high BP
20
Q
Glomerular Filtration Rate (GFR)
A
Volume of filtrate formed per unit time
21
Q
GFR normal range
A
110-130 ml/min
22
Q
How is GFR measured?
A
Marker substance that is 100% eliminated unchanged in urine, not plasma bound, excreted only by filtration
23
Q
What do the kidneys produce?
A
Hormones
24
Q
Hormones of the RAAS system
A
Regulate blood pressure
25
Erythropoietin (EPO)
Stimulates RBC production
26
1.25 dihydroxy vitamin D3
controls calcium metabolism
27
Aldosterone for kidneys
Helps retain Na+ and water
Increased volume of water
Increased BP
28
Acute Kidney Injury (AKI)
Kidneys stop working suddenly
Reversible
29
Symptoms of AKI
Not enough urine
Swelling, tired, confused, nausea
Out of breath, pain in chest
30
Renal Autoregulation
How kidneys maintain constant renal blood flow and GFR
31
Prostaglandin 2 (PGE2)
Direct vasodilator by acting on smooth muscle to cause blood vessel dilation
32
Angiotensin II (AII)
Acts on CNS to increase vasoconstriction by vasopressin production
33
Intrinsic AKI
Injury or problem directly to kidneys
34
Post-Renal AKI
Blockage in ureters, bladder, or urethra
35
What can AKI lead to?
Kidney failure
Acute renal failure
36
AKI Treatment
Hemodialysis
37
Hemodialysis
Machine that filters wastes, salts, and fluid from blood when kidneys are unable to do so
38
Chronic Kidney Disease (CKD)
Lasting damage to kidneys that can get worse over time
Eventually leads to kidney failure
39
Chronic renal failure
End result of irreparable damage to kidneys, develops slowly
40
Risk factors of CKD
Diabetes, hypertension
Family history
African-American, Hispanic, Native American, Asian
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CKD Stages
1. Kidney damage but normal function
2. Mild loss of function
3. Moderate to severe loss of function
4. Severe loss of function
5. Kidney failure
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CKD Stage 1
Damage with normal or increased GFR
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CKD Stage 2
Mild reduction of GFR to 60-89 ml/min/1.73 m2
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CKD Stage 3
Moderate reduction of GFR to 30-59 mL/min/1.73 m2
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CKD Stage 4
Severe reduction in GFR to 15-29 mL/min/1.73 m2
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CKD Stage 5
Kidney failure GFR <15mL/min/1.73 m2
Need for renal replacement therapy
47
Complications of CKD
Anemia, bone + heart disease, high K+, Ca2+, P, fluid buildup
48
CKD Treatments
Focus on complications since it is irreversible
49
Tests for CKD
eGFR
Urine test
Blood pressure
50
Nephritic Syndrome
Extensive damage of glomerular capillaries due to inflammation
Ofter occurs in glomerulus
51
Glomerulonephritis
Inflammation of glomeruli and small blood vessels
52
What happens when glomeruli are damaged?
Blood and protein get into urine (intrinsic AKI)
53
Risk factors of Glomerulonephritis
Autoimmune disease
Infections
Diabetes
54
Primary Glomerulonephritis
Starts in glomeruli
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Secondary Glomerulonephritis
Glomeruli affected by systemic disease
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Acute Glomerulonephritis
Develops over short period of time
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Chronic Glomerulonephritis
Develops and progresses slowly
58
In 1% of children and 10% of adults who have acute glomerulonephritis...
Evolves into rapidly progressive, destroying glomeruli and resulting in kidney failure
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Glomerulonephritis Tests
Urine Test
Blood Test
Blood Pressure
Kidney ultrasound and biopsy
60
Glomerulonephritis Treatment
Antihypertensives
Diuretics
Corticosteroids
Immunomodulators
Antibiotics
61
Glomerulonephritis Prognosis
Children usually acute
Adults usually chronic
62
treatment of UTIs is based off of
the pathogen causing the infection
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types of antibiotics used to treat UTIs
penicillins
amoxicillins
azithromycin
clarithromycin
clindamycin
64
how to diagnose a UTI?
symptoms
examination of urine
blood analysis
x-rays, films, CT scans, etc
urine dipstick
65
chronic pyelonephritis
destruction of renal tissue and fibrosis
irregular shrunken small kidney
tubular atrophy with casts
chronic inflammatory infiltrates
66
acute pyelonephritis
sudden and severe inflammation of the kidney due to a bacterial infection
67
features of acute pyelonephritis
small abscesses
inflammation
leukocyte casts in urine
68
common UTI symptom that mainly women feel
burning when urinating
69
predisposing conditions of UTIs
stones
reflux
infections of lower UTI
neoplasms
external compression
70
for UTIs, bacteria enter
through the urethra
travel down to up
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is there only one bacteria that causes UTIs?
NO!
many different bacteria cause UTIs
72
types of UTIs
asymptomatic bacteriuria
symptomatic infections
lower UTI
upper UTI
73
lower UTI consists of
cystitis
urethritis
74
upper UTI consists of
pyelonephritis
75
kidney stones are more predominant in
men (haha sucks to be a man)
76
stones treatment
hydration
ibuprofen
antibiotics
shock waves/surgery for larger stones
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for larger stones that cannot be passed on there own, what is done?
ureteroscopic removal
percutaneous removal
extracorporeal lithotripsy
shock waves
78
main symptom of kidney stones
excruciating, cramping pain in the abdomen, flank or groin
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symptoms of stones
hematuria
pain
difficulty urinating
fever and chills
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risk factors of stones
gout due to increased uric acid
hypercalciuria due to calcium phosphate/oxalate stones
medications
family history
reduced fluid intake
infection
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calcium oxalate/phosphate stones
80% prevalence
diet high in oxalate
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struvite stones
10% prevalence
linked to UTIs
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uric acid stones
6%
urine is too acidic, high protein diet
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cystine stones
1%
genetic disorder, high levels of cystine
85
stones are made up of
calcium oxalate/phosphate, uric acid, cysteine or magnetism ammonium phosphate
86
stones (Calculi)
hard, crystalline mineral deposits formed within the kidney or urinary tract
87
stones are due to
decrease in urine volume
excess of stone forming substances in the urine
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urolithiasis
stones in the lower UT (bladder, urethra)
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nephrolithiasis
stones in the upper UT (kidney)
90
common symptoms of stones
pain
signs/symptoms of UTI
manifestations of renal dysfunction
91
damaging effects of urinary obstruction are due to
stasis of urine
development of back pressure
92
stasis of urine
predisposes to infection and stone formation
93
development of back pressure
interferes with renal blood flow and destroys kidney tissue
94
causes of urinary tract obstruction
stones
developmental defects
pregnancy
BPH
scar tissue
tumors
neurologic disorders
95
simple cysts treatment
ultrasound guided percutaneous drainage
large - surgery
96
polycystic kidney disease treatment
dialysis
kidney transplant
97
tests for cystic kidney disease
ultrasound
CT scan
MRI
blood and urine tests
98
Medullary cystic kidney disease
chronic renal failure in children
progresses to ESKD
99
Polycystic kidney disease
cysts slowly grow with age which reduces blood flow and inc scarring
cysts may appear on other organs (liver)
100
simple renal cysts
develop with age, common in older people
1 out of 10 people have
usually no symptoms, sometimes pain when big
can become malignant
101
Cystic kidney disease risk factors
genetic mutations
CKD
birth defects
age
102
acquired cystic kidney disease
cysts develop due to CKD/renal failure
affects adults/children on dialysis
103
multi cystic dysplastic kidney
one or both kidneys don't develop correctly
cysts replace normal tissue
104
medullary sponge kidney
cysts form on innermost part of kidney
blocks tubules that filter urine
105
difference in PKD dominant and recessive
dominant - variable size cysts, affect adults in large quantities
recessive - tiny fusiform cysts, affect children in smaller quantities
106
polycystic kidney disease
can be dominant or recessive
recessive affects kidney development during birth
107
Glomerulocystic kidney disease
cysts and enlargement of the space in the kidneys near the urinary tract
infants or adults
108
medullary cystic kidney disease
cysts develop in the inner part of the kidneys
inflammation and scarring of tubules
adults
109
nephronophithisis
similar to MCKD
affects infants and children
110
types of cystic kidney disease
genetic or non genetic
111
cystic kidney disease
group of conditions that cause cysts to form in or around the kidneys
can lead to kidney failure
112
cysts can be
filled with air or fluid
113
kidney cysts prevent the kidneys from
filtering water and waste out of the blood
114
diabetic nephropathy is the major cause of
morbidity and mortality in people with diabetes
115
diabetic nephropathy treatment
drugs that lower bp
drugs to control diabetes
statins
restrict dietary proteins
etc
116
diabetic nephropathy tests
urinalysis
blood analysis
hematocrit
kidney ultrasound
kidney biopsy
117
blood analysis usually looks at
creatinine and BUN
118
complications of diabetic neuropathy
body fluid buildup
hyperkalemia
CV disease
anemia
end stage kidney disease
119
symptoms of diabetic neuropathy
no symptoms for 5-10 years
uncontrollable high bp
edema
foamy urine
etc
120
stage 1 and 2 diabetic neuropathy
GFR > 60 ml/min
microalbuminuria
121
stage 3 diabetic neuropathy
GFR 30-60
proteinuria
122
stage 4 diabetic neuropathy
GFR 15-30
proteinuria
some will be nephrotic
123
stage 5 diabetic neuropathy
GFR less than 15
kidney failure
124
diabetic neuropathy
too much sugar in the blood leads to high blood pressure which thickens the nephrons and scars them
nephrons leak proteins into the urine
125
malignant nephrosclerosis treatment
strict blood pressure control (ARB, ACE inhibitors, BB)
dialysis
126
symptoms of malignant nephrosclerosis
proteinuria
hematuria
impaired vision
loss of weight
uremia
127
malignant nephrosclerosis
develops rapidly
high bp --> hyaline accumulation --> tubular atrophy, necrosis
128
benign nephrosclerosis
mostly present over 60 years
gradual and prolonged deterioration of the renal arteries
129
treatment of benign nephrosclerosis
drugs to lower blood pressure
130
(nephrosclerosis) when blood pressure becomes really high,
nephrosclerosis becomes malignant
131
hypertensive nephrosclerosis
high bp --> hyalinosis of afferent arterioles --> fibrosis and tubular atrophy
132
hyaline
clear substance produced by the degeneration of epithelial/connective tissues
133
nephrosclerosis
hardening and narrowing of the kidneys blood vessels
134
hypertensive nephrosclerosis is defined as
CKD caused by chronic HTN
135
big differences between nephrotic and nephritic syndrome
nephrotic - proteinuria, hematuria may not be present; dyslipidemia, hypercoagulability and dec immunity also present
nephritic - hematuria is present, mild proteinuria
136
Nephrotic syndrome complications
atherosclerosis
blood clots
poor nutrition
high BP
renal vein thrombosis
AKI/CKD
fluid overload
137
nephrotic syndrome treatment
control BP (ACE inhibitors, ARBs)
corticosteroids
diuretics
statins
blood thinners
low salt diet
moderate protein diet
138
nephrotic syndrome tests
blood tests (Cr, BUN, albumin)
creatinine clearance
urinalysis (protien, fats, urinary casts)
139
main symptom of nephrotic syndrome
protein in urine, less albumin in blood
140
additional symptoms of nephrotic syndrome
frequent infections
blood clots
hyperlipidemia
lipiduria
edema (and weight gain)
HTN
141
causes and risk factors of nephrotic syndrome
autoimmune diseases
infection
genetic/immune disorders
diabetes mellitus, lupus, multiple myelenoma
142
Nephrotic syndrome
causes the body to pass too much protein in the urine
due to changes in glomerular capillary wall
143
nephrotic syndrome is not
one specific disease
it is a group of disorders caused by kidney damage
