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Flashcards in Renal Path Deck (60):
1

What do the kidneys do?

-Excrete waste
- Regulate water and salt balance
- Regulate pH: acid/base
- Endocrine function

2

What endocrine function do the kidneys have?

-Renin
-Erythropoietin
-1- alpha- hydroxylate production for Ca2+

3

How much do those little bitches way (kidneys)?

150 grams each

4

What are the 4 components of the kidney?

Glomeruli
Tubules
Interstitium
Blood vessels

5

What is synonymous with foot processes?

Podocytes
Visceral epithelium

6

What are the other layers of the capillaries in the glomerulerus?

-Fenestrated endothelial cells
- Glomerular basement membrane

7

What type of collagen monomers make up the GBM?

Type IV collagen

8

What separates foot processes?

Filtration slits
- 20-30 nm

9

What are the slit diaphragm proteins?

Nephrin and Podocin

10

What is characteristic of nephrotic syndrome?

-Protein defects in Nephrin and Podocin
- podocyte fusion

11

What is the origin of Mesangial Cells and Mesangial matrix?

Mesenchymal origin

12

What is the purpose of Mesangial cells?

-Contractile
-phagocytic
-proliferation
-Secrete inflammatory mediators
- lay down collagen

13

what is highly permeable in the glomerular?

Water and lower molecular weight proteins

14

What makes up the juxtaglomerular apparatus?

1. Macula densa
2. Juxtaglomerular cells
3. extraglomerular mesangial cells

15

What is the purpose of the the juxtaglomerular cells?

Secrete renin

16

What is the purpose of the macula densa?

Detects Cl- delivery. Synonymous with Na+ delivery

17

Where are the peritubular capillaries located?

Interstitium
- contains fibroblast like cells

18

What are the categories of renal disease?

-Glomerular
-Tublointerstitial
-Vascular

19

What are the common causes of glomerular pathology?

Immune mediated

20

What is the common cause of tubulointerstitial pathology?

Toxic/ischemic and inflammatory reactions

21

What is uremia?

Azotemia and clinical sx's
- like gastroenteritis, anemia, neuropathy, pruitis, pericarditis ect

22

What is the classic presentation of nephritic syndrome?

1. Hematuria
2. Mild to moderate proteinuria
3. HTN

23

What is the classic presentation of nephrotic syndrome?

1. >3.5 gram/day proteinuria
2. hypoalbuminemia
3. edema
4. hyperlipidemia
5. lipiduria

24

What are the classic presentations of acute renal failure?

-Rapid decline of GFR
-Rapid onset Azotemina
-Oliguria or anuria
-Due to glomerular, tubulointerstitial or vascular

25

What is the classic presentation of chronic renal failure?

GFR persistently <60 ml/min/1.73m^2
- at least 3 months
- persistent albuminuria

26

What is the classic presentation of renal tubular defects?

-Polyuria
-Nocturia
-Electrolyte imbalances
-Inherited or acquired

27

What is the classic presentation of urinary tract infections?

Pyuria and bacteriuria
Pyelonephritis and cystitis

28

What is the classic presentation of nephrolithiasis?

Renal colic
Hematuria

29

What are the 4 stages of renal dz?

1. Diminished renal reserve
2. Renal insufficiency
3. Renal failure
4. End stage renal dz

30

What is the definition of diminished renal reserve?

GFR around 50% of normal
- Normal range of BUN/CR and asymptomatic

31

What is renal insufficiency?

GFR is 20-50% normal
- onset azotemia
-anemia
- HTN

32

What is renal failure?

GFR <20-25% normal
- edema
- metabolic acidosis
- uremia

33

What is end stage renal disease?

GFR <5% of normal
- terminal stage of uremia

34

What is the best overall measure of kidney function?

GFR
-Clearance= UV/P
Urine conc.*urine flow/Plasma conc.

35

What are some analytes to measure clearance?

Insulin
Iothalamate
EDTA
Iohexol
Creatinine

36

What can cause extrarenal elimination of Cr?

Bacteria

37

Is Cr perfect for GFR clearance?

no
-close but 10-20% is secreted by proximal tubule
- serum levels related to body muscle mass and diet

38

What is the estimated creatinine clearance formula?

140-age*weight/72*serum cr (.85 females)

39

How does one calculate MDRD?

175 x (SCr)^-1.154 x (age)^ -0.203 x 0.742 if female, or 1.212 if black

Adjusted for body surface area. (ml/min/1.73m^2)

40

What are clearance measurements still used?

-Unsual body habitus- muscle wasting
- rapidly changing kidney function
- Kidney donors or research protocols

41

What is BUN?

Major end product of protein nitrogen metabolism
- normal is 10-20 mg/dL

42

What affects BUN? Prerenal and increase synthesis of urea?

Catabolism - burns fever and stress
- high protein diet
- GI bleed
- Hemolysis
- Maliganancy

43

What increases BUN? Prerenal but decrease renal perfusion?

HoTN/Shock
- CHF
-Dehydration
- Renal vein thrombosis

44

What is a caveat of BUN?

When renin is releases in hypovolemia, this increases aldosterone which causes increased resorption of Na/H2o.
- BUN passively follows. Thus increase in BUN which is out of proportion to any change in GFR

45

What are some postrenal increase in BUN?

Benign prostatic hypertrophy
- Prostatic carcinoma
-tumor of bladder or ureter
- retroperiotoneal mass
- urinary calculi

46

What are some factors that cause a decrease in BUN?

Decrease synthesis- low protein intake, liver dz
- hemodilution

47

What are factors that can cause hemodilution?

Pregnancy
- overhydration
- psychogenic polydipsia
- DI

48

What is the purpose of creatinine?

Energy storage reservoir for conversion to ATP
- usually constant daily excretion
- normal is 0.7-1.2 mg/dL
- slightly better estimate of GFR than BUN
- less affected by kidney perfusion

49

What are some pre-renal increases in creatinine causes?

Increase syn:
- muscle hypertrophy
- muscle necrosis
- anabolic steroid use
- high meat diet
- intense exercise

50

What are some pre-renal increase in Cr by decrease perfusion?

CHF
HoTN
Shock

51

What are some post-renal increases in Cr?

Urinary tract obstruction

52

What is a normal BUN:Cr ratio?

10-20 or 15:1

53

What is a common ratio of BUN:Cr in renal dz?

40:4 or 10:1

54

What is a common ratio of BUN:Cr in pre-renal dz?

80:2 or 40:1

55

What is the fraction of excreted Na+?

helps diff between renal dz and pre-renal.
- urine (Na*plasmaCr*100/Urine cr*plasma NA)

56

What favors pre-renal dz?

FeNA <1%

57

What favors ATN?

>2.0% FeNa

58

What is normal protein in the urine over 24 hrs? Whats its make up?

150mg
1. Albumin
2. Small Globulins
3. Tamm-Horsfall protein

59

What are some function things that cause decrease protein in urine?

Heavy exercise
cold exposure
Fever

60

what are some cause sof proteinuria without Renal dz?

CHF
Massive obesity
Constrictive pericarditis
Renal vein thrombosis