Renal (P2) Flashcards
(181 cards)
1
Q
Upper urinary system consists of
A
kidneys & ureters
2
Q
lower urinary system consists of
A
bladder and urethra
3
Q
Renal artery + nerves enter the kidney at the
A
hilus
4
Q
renal vein and ureter exit at the
A
hilus
5
Q
kidney converts vitamin d to its active form which is called
A
calcitrol
6
Q
main function of vitamin d calcitrol
A
absorbs calcium from the intestine into the blood
7
Q
GFR below ____ is a problem
A
60 ml per minute
8
Q
GFR glomeular filtration rate normal rate
A
60 to 125 ml per minute
9
Q
normal amount of urine per day
A
1-2 liters
10
Q
below ____ of urine production per day is a problem
A
800 ml
11
Q
filtration is caused by
A
hydrostatic pressure in capillaries
12
Q
reabsorption is caused by
A
oncotic pressure in capillaries
13
Q
part where the waste products and water are secreted into
A
into the nephron for excretion
14
Q
what does increased aldosterone do to urine
A
decreases urine output
increases sodium retention and potassium excretion
15
Q
the nephron is the
A
filtration units of the kidney consisting of the renal copuscle (bowman’s capsule) and renal tubule
16
Q
bowman’s capsule function
A
surrounds the glomerulus (renal corpuscule) and allows for small particles smaller than cells and large proteins to be filtered out of the glomerulus capillaries
17
Q
proximal convoluted tubule function
A
leaves the bowman’s capsule carrying reabsorbed 65% of filtered load including water, sodium, potassium, glucose, amino acids, bicarbonate
18
Q
blood enters the glomerulus via the
A
afferent arteriole
19
Q
blood leaves the glomerulus via the
A
efferent arteriole
20
Q
the glomerular capillaries and bowman’s capsule are bound together by
A
the basement membrane
21
Q
how pores of the glomerulus are made
A
the epitheial cells of the basement membrane leave foot processes making pores between feet for filtration
22
Q
hydrostatic and oncotic pressure are defined as
A
pressure forces that regulate fluid movement across capillary walls
23
Q
hydrostatic pressure is
A
the force of fluid excreted on the endothelial walls of blood vessels (pushes fluid out)
24
Q
oncotic pressure is
A
the pulling effect on water created by albumin (and other plasma proteins)
25
the glomerulus is not permeable to large colloids such as
plasma proteins
26
daily amount of blood filtered by the glomeruli
180 liters
27
____ of the filtrate is reabsorbed into the peritubular capillaries and returned to the blood
99%
28
key factors that influence GFR
filtrate osmotic pressure, hypoproteinemia, BP, renal artery size and afferent afferent artery size
29
renin is produced and secreted by
juxtaglomerular cells
30
glomerular filtrate does not contain
proteins
blood cells
31
4 steps of filtration
1 glomerular filtration
2 tubular re-absorption
3 tubular excretion
4 water conservation
32
glomerular filtration does what
creates a plasma like nitrate of the blood
33
tubular reabsorption does what
removes useful solutes from the filtrate, returns them to the blood
34
tubular secretion does what
removes additional wastes from the blood and adds them to the filtrate
35
water conservation does what
removes water from the urine and returns it to the blood, concentrates waste
36
tubular system is where ______
filtrate is changed into urine
37
which part of the kidney converts vitamin d to calcitrol
the proximal tubules
38
loop of Henle function
filters water and regulates urine concentration
39
aldosterone is made in the
adrenal cortex
40
vasopressin is made by the
posterior pituitary
41
proximal tubule main function
80% of glomerular filtrate is returned to the blood stream
42
______ secretes urea, creatinine, hydrogen, and ammonia
the proximal tubule
43
loop of Henle most important function
glomerular filtrate becomes highly concentrated
44
distal tubule most important function
glomerular filtrate is made further concentrated
45
collecting duct main function
reabsorbs remaining 2% NA+ only of the hormone aldosterone is present
46
______ makes the final adjustments in urine concentration for excretion
the collecting duct
47
RBF stands for
renal blood flow
48
increased intake of protein and glucose in diet _______ RBF
increases renal blood flow by 20-30%
49
two conditions that cause the kidney to make erythropoeitin
hypoxia or decreased renal blood flow
50
EPO stimulates ____
increased red blood cell production in the bone marrow
51
why does anemia occur in renal failure
because the kidney is not able to make EPO to compensate
52
what is the main metabolic component of acid base control in the body
the kidney
53
HCO3 is ______ and ______ by the kidney which hydrogen is _______
HCO3 is reabsorbed and conserved by the kidney while hydrogen is removed
54
pH range for extracellular fluid
7.35-7.45
55
ADH (vasopressin) is necessary for ____
water reabsorption in the kidney and overall water balance
56
ADH (vasopressin) allow for tubules to be ______
permeable to water reabsorption (oncotic pressure)
57
ADH (vasopressin) is released in response to
decreased B/P (plasma volume)
increased plasma osmolality (blood concentration)
58
adrenal cortex secretes aldosterone in response to
decreased blood volume and increased sodium concentration in blood
59
angiotensin II in RAAS secretes
aldosterone
60
renin main function
changes angiotensinogen from the liver into angiotensin I by using the ACE enzyme made by the lungs
61
ACE (angiotensin converting enzyme) main function
converts angiotensin I into angiotensin II
62
angiotensen II main function
stimulates the release of aldosterone
causes peripheral vasoconstriction
stimulates the release of antidiuretic hormone (vasopressin)
63
Natriuretic peptides function to
counteract the effects of the RAAS system on fluid volume and blood pressure
64
Atrial natriuretic peptide (ANP) is secreted from ____
the myocardial cells in the atria
65
Brain natriuretic peptide (BNP) is secreted from ______
the myocardial cells in the ventricles
66
ANP and BNP function to
inhibit sodium and water absorption by the kidney tubules
inhibit secretion of renin and aldosterone
vasodilate the afferent arterioles and constrict the efferent arterioles
67
results of ANP and BNP action upon release
increased urine formation
decreased blood volume
decreased blood pressure
sodium and water loss
68
renal prostaglandins are secreted by the
renal medulla
69
renal cortex is located ______ and renal medulla is located ______
cortex is outer and medulla is inner
70
ibuprofen is dangerous to the kidneys because it can inhibit ______
renal prostaglandins which are responsible for lowering renal blood pressure
71
renal prostaglandins function to
vasodilate increasing renal blood flow and decrease vascular resistance and blood pressure
72
renal failure ends up in hypertension because of ____
decreased renal prostaglandin production
73
medication doses need to be lowered for renal failure patients becase
they are not processed by the kidneys leading to toxic buildup of the drug concentrations
74
administering regular dose of certain medications to renal failure patients can be ____
fatal
75
before it reaches the ureters, urine catches in the _____
renal pelvis
76
adult urine output
1500 ml per day
77
bladder capacity
600 - 1000 ml
78
cause of urge incontinence
overactive detrusor muscle
79
cause of stress incontinence
weak urethral sphincter
80
cause of reflex incontinence
s2 to s4 damage
81
cloudy and foul smelling urinalysis
UTI
82
dark yellow urinalysis
dehydration
83
acetone odor urinalysis
DKA
84
protein urinalysis
injured glomerular membrane
85
glucose present in urinalysis
diabetes mellitus
86
ketones present in urinalysis
increased fatty acid metabolism
87
crystals present in urinalysis
possible renal stone formation
88
which renal structure reabsorbs water
collecting duct
89
ADH (vasopressin) main function is to
cause water reabsorption in the kidney and increase overall water balance in the body
90
furosemide effects the _____ to ______
loop of Henle and tubules to prevent reabsorption of sodium potassium and chloride thus causing increased excretion.
91
aldosterone does what to specific gravity?
increases specific gravity due to higher concentrations of potassium in the urine
92
hydronephrosis is
expansion of the kidney with urine reflux increases intrarenal pressure
93
hydronephrosis can lead to
compression of blood vessels inside the kidney leading to renal ischemia
94
stasis of urine can cause ______ and ______
infection and stones
95
prevalence of kidney stones in the United States in order by region
1. southeast
2. southwest
3. midwest
96
urolithiasis effects ____ out of every ____ individuals in the US annually
1 out of 11
97
renal colic is
sudden pain in the urethral tract causes by an obstruction caused by kidney stones
98
hydroureter is
severe dilation of the ureter
99
hydronephrosis is specifically in
dilation of renal pelvis and calyces
100
urinalysis can show ______ with kidney stones
WBC's and hematuria
101
best diagnostic procedure for for kidney stones
non contrast CT
102
how to find smaller kidney stones
IVP ultrasound
103
IVP is i
intravenous pyelogram which is used with iodine contrast to go into a vein and visualize the inside of the kidney, ureters, and bladder
104
four physiological defense barriers against UTI's
one way valves where ureters attach to bladder (vesicourethal valves)
Urinating (washes organisms out of urethra)
Acidity of urine prevents many organisms from proliferation. urine is normally sterile
immune system in general
105
most common acquired healthcare infection
UTI's
106
2nd most common bacterial infection
UTI's
107
cystitis is a
bladder infection which can end up causing a urinary tract infection by spreading upwards
108
pyuria is
elevated number of white blood cells in the urine
109
in asymptomatic bacteriuria, ______ is not usually necessary
antibiotic therapy not usually necessary
110
a key sign of cystitis with older adults is
sudden onset incontinence
111
number of bacteria in urine analysis needed to diagnose cystitis
greater than 100,000 per ml
112
less than 100,000 may mean that
urine specimine is contaminated and that the urine analysis should be repeated
113
purulent discharge from male oragan is indicative of
urethra inflammation
114
urethra inflammation is caused by
bacterial or viral infection, ureaplasm, trichomonas, clamydia, and gonnorrhea
115
urethra inflammation is most common in ____ and _____
men and post menopausal women
116
interstitial cystitis is also called
bladder pain syndrome
117
dyes are contraindicated in patients with
pyelonephritis
118
four common causes of urinary tract obstruction
kidney or bladder stones
benign prostatic hyperplasia
tumors
urethral strictures
119
low dietary calcium can paradoxically lead to stone formation due to
increased absorption of oxalates.
120
struvite stones are caused by
result of chronic UTI's that cause buildup of ammonia
121
struvite stones made up of ammonia are called
staghorn calculi
122
cystine stones are caused by
rare genetic disorder called cystinuria which leads to excessive cystine in the urine
123
typical signs of renal colic
flank pain which comes in waves
discomfort
nausea / vomiting
hematuria
124
acute pyelonephritis is associated with
bacterial infection
abscess formation in capsule, cortex, or medulla
temporary kidney dysfunction
125
chronic pyelonephritis is associated with
repeat infection that causes scarring and ongoing inflammation
seen with obstructions and reflux
can lead to permanent decline in renal function
126
the basement membranes connects the
glomerulus to the bowman's capsule
127
the foot processes are the ____
pores between the glomerulus and bowman's capsule
128
damage to a portion of the glomerulus
focal damage
129
damage done to the entire glomerulus
diffuse or global damage
130
the outermost layer of the glomerulus consists of the
podocytes
131
which type of glomerular damage results in crescent formation
fibrous scarring
132
leading cause of chronic kidney disease in the US
glomerulonephritis
133
primary glomerulonephritis is
when the glomerulonephritis is the only glomerular abnormality present
134
secondary glomerulonephritis is
glomerular abnormality resulting from other disease process
135
glomerulonephritis is caused when
formation of antigen/antibody immune complexes are deposited into the glomerulus and cause inflammation
136
glomerulonephritis causes _____ leading to ______
thickening of the basement membrane leading to increased permeability to proteins and red blood cells.
137
primary causes of glomerulonephritis
group A strep
gram negative sepsis
pneumonia
STD's
epstein-Barr
138
glomerulonephritis secondary causes
lupus
chronic liver disease
vasculitis
good pasture syndrome
IgA neuropathy
diabetic glomerulopathy
139
acute post strep glomerulonephritis develops
5-21 days after infection with strep
140
chronic glomerulonephritis develops over a period
2 - 3 years or longer
141
chronic glomerulonephritis assessment signs
proteinuria / hematuria
HTN
hypercholesterolemia
increased BUN / Creatinine
142
what is needed to diagnose chronic glomerulonephritis
renal biopsy
143
only two treatments for chronic glomerulonephritis
dialysis
transplantation
144
assessment questions for glomerulonephritis
recent infection?
travel?
sore throat?
145
antistreptolysin O (ASO) is
the antibody produced by the immune system in response to strep A
146
nephrotic urine sediment contains mostly _____ and not much _____
contains proteins and lipids but not much blood
147
first manifestation of diabetic nephropathy
persistent albuminuria
148
for a patient suspected of having diabetic nephropathy ______ at every visit
urine analysis is checked at every visit
149
oliguria is categorized as _____
less than 400ml output in 24 hours
150
anuria is categorized as ______
no urine output or less than 40 ml in 24 hours
151
most common cause of intrarenal injury
acute tubular necrosis
152
what causes acute tubular necrosis
ischemia
sepsis
nephrotoxic drugs
obstruction
153
renal ischemia is a _____ injury
pre renal
154
4 phases of acute kidney injury in order
1. prodromal
2. oliguric
3. diuretic
4. recovery
155
prodromal stage of AKI
asymptomatic as undamaged nephrons compensate for those injured
156
oliguric stage of AKI
solutes and water are reabsorbed, decreasing the amount of urine formed. uremia begins to develop
157
diuretic stage of AKI
healing is beginning. increased urine due to lack of kidney's ability to concentrate urine
158
chronic kidney disease does not ___
recover
159
chronic kidney disease is diagnosed when
decreased GFR > 3 months
160
in chronic kidney disease, functioning nephrons must _______ leading to ______
filter more leading to hypertrophy
161
stage 1 CKD is marked by
GFR lower than normal but not below 90
162
stage 2 CKD is marked by
GFR 60-89
163
stage 3 CKD is marked by
GFR 30-59
164
stage 4 CKD is marked by
GFR 15-29
165
stage 5 end stage renal disease is marked by
GFR less than 15
166
ESKD causes ________ because of the excess water retention
dilutional hyponatremia due to the body holding too much water from lack of excretion
167
ESKD causes _______ due to decreased excretion of potassium
hyperkalemia
168
carbonic acid is made from
co2 and h2o
169
carbonic acid dissociates into
hydrogen ions and bicarbonate ions
170
what is the primary ECF buffer system
bicarbonate
171
phosphate is a
base
172
hemoglobin acts as pH control by
binds to or releases hydrogen and or co2
173
primary IC buffer
albumin and plasma globulins
174
if there is too much extra cellular fluid, _____ moves in and pushes _____ out
hydrogen moves into the cell and pushes potassium out creating risk for hyperkalemia
175
pCO2 range
35 to 45
176
HCO3 range
22 to 26
177
medulla contains
long loop of henle and collecting duct
178
the ascending loop of Henle yields
highly dilute filtrate
179
the descending loop of henle yields
highly concentrated urine
180
primary causes of glomerulonephritis
auto immune
post infection
181
secondary causes of glomerulonephritis
lupus
goodpasture
vasculitis
diabetes
