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CRRAB 2 Week 3 > Renal Patho > Flashcards

Renal Patho Flashcards

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1
Q

Mesangial cells and matrix

A

Secrete mediators of inflammation and lay down collagen. Contractile, phagocytic, and proliferative
Matrix supports the glomerular capillaries

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2
Q

T/F The GBM is made up of Type IV collagen

A

T

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3
Q

What are the 3 layers of the GBM?

A

Lamina rara interna, lamina densa, and lamina rara externa

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4
Q

Another name for visceral epithelial cells?

A

Podocytes

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5
Q

Job of podocytes?

A

Interdigitate with lamina rara externa
Foot processes separated by filtration slits of 20-30 nm
Synthesis of GBM components

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6
Q

What are the 2 filtration slit diaphragm proteins?

A

Nephrin and podocin

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7
Q

Filtration slit diaphragm job?

A

Visceral epithelial cells maintain glomerular barrier function (exclusion of large proteins and albumin) through the slit diaphragm

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8
Q

T/F Mutations in genes encoding proteins involved in the slit diaphragm lead to nephrotic syndrome

A

T

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9
Q

T/F Proximal tubules very sensitive to ischemia

A

T

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10
Q

Pertinence of interstitium

A

Contains peritubular capillaries and fibroblast-like cells

Expansion in disease states

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11
Q

3 categories of renal disease

A

Glomerular – typically immune mediated
Tubulointerstitial – toxic/ischemic and inflammatory reactions
Vascular- occlusive and vasculitis

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12
Q

Azotemia

A

biochemical abnormality= increased BUN and Cr-

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13
Q

Uremia

A

azotemia and clinical symptoms- gastroenteritis, anemia, peripheral neuropathy, pruritis, pericarditis, etc.

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14
Q

Nephritic Syndrome

A

Hematuria
Mild to moderate proteinuria
Hypertension

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15
Q

Nephrotic Syndrome

A 
>3.5gm/day proteinuria
Hypoalbuminemia
Edema
Hyperlipidemia
Lipiduria
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16
Q

Acute renal failure presentation

A

Rapid onset azotemia (increase BUN/Cr)
Oliguria or anuria
Due to glomerular, tubulointerstitial, or vascular disease

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17
Q

Chronic kidney disease presentation

A

GFR persistently

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18
Q

Renal tubular defects presentation

A

(problem just in your tubules)
Polyuria
Nocturia
Electrolyte imbalances (metabolic acidosis)
Inherited (RTA, cystinuria) or acquired (lead)

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19
Q

Diminished Renal Reserve

A

GFR is around 50% of normal

Normal range BUN/Cr and asymptomatic

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20
Q

Renal insufficiency (CRI)

A

GFR is 20 – 50% of normal
Azotemia
Anemia
Hypertension

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21
Q

4 stages of Renal Disease

A
  1. Diminished Renal reserve
  2. Renal insufficiency
  3. Renal failure
  4. End stage Renal disease (ESRD)
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22
Q

Renal failure (3)

23
Q

End stage renal disease

24
Q

How many stages are there for chronic kidney disease?

Study These Flashcards
A

5

Stage 1 is normal= GFR of 90 or above

25
Stage 2 GFR
60-89; estimate progression
26
Stage 3 GFR
30-59; eval and tx complications
27
Stage 4 GFR
15-29; prep for kidney replacement
28
Stage 5 GFR
Less than 15 or dialysis; replacement if uremia is present
29
Clearance tests
Clearance is an approximation of glomerular filtration rate (GFR)
30
Clearance equation
Clearance = UV/P U = urine concentration (mg/dl) V = urine flow (ml/min) P = plasma concentration (mg/dl)
31
Cockcroft Gault Formula
Cr Cl (ml/min) = (140 - age[yrs] x weight [kg])/72 x serum creatinine (mg/dl) x 0.85 if female
32
T/F GFR is adjusted for BSA in MDRD
T-body surface area and if black
33
At what GFR should you refer to a nephrologist?
30
34
T/F GFR below 60 - high risk of CV disease
T
35
Example of when clearance tests don't work
Unusual body habitus- Such as severe muscle wasting Rapidly changing kidney function- acute situation GFR > 60 it isn't as accurate
36
Other common tests to determine kidney function?
Serum BUN & Serum Cr
37
BUN
Major end product of protein nitrogen metabolism Liver produces urea from ammonia (which is produced by amino acid deamination) Rough estimate of glomerular function Affected by kidney perfusion and body nitrogen balance (anabolism/catabolism) Normal is 10 - 20 mg/dl
38
To determine cause of Azotemia?
BUN and serum Cr-
39
Pre-renal causes of increase in BUN
Increased synthesis of urea thus increasing BUN - catabolism (stress, fever, burns), high protein diet, GI bleed, hemolysis and malignancy Decreased renal perfusion/low flow states: Hypotension/shock CHF (congestive heart failure) Dehydration Renal vein thrombosis
40
Mechanism of how BUN increases
The appropriate renal response in low flow states is to activate the renin-angiotensin system, which causes efferent arteriole constriction, and increases Na and water reabsorption Urea is passively reabsorbed along with Na and water; when there is increased reabsorption in low perfusion states, the serum BUN increases out of proportion to any change in the GFR
41
Post-renal increase in BUN
``` Urinary tract obstruction: Benign prostatic hypertrophy Prostatic carcinoma Tumor of bladder or ureter Retroperitoneal mass Urinary calculi ```
42
Renal increase in BUN
Glomerular disease ATN Interstitial disease
43
Decrease in BUN
Decreased synthesis: low protein intake, androgen use and liver disease Hemodilution: overhydration problems Usually not useful
44
Creatinine
Waste product formed by the spontaneous dehydration of body creatine Most creatinine is found in muscle: Serves as energy storage reservoir for conversion to ATP Excretion relatively constant per day in a given individual Normal is 0.7 – 1.5 mg/dL Slightly better estimate of glomerular function than BUN Less affected by kidney perfusion (not reabsorbed) Secreted in tubules
45
Pre-renal increase in Cr
``` Increased synthesis: - Muscle hypertrophy - Muscle necrosis - Anabolic steroid use - High meat diet - Intense exercise Decreased renal perfusion: - CHF, hypotension/shock, etc. ```
46
Post-renal increase in Cr
Urinary tract obstruction
47
BUN:Cr ratio
Normal ratio is 10-20:1 | Due to disproportionate increase in proximal urea reabsorption which accompanies the reabsorption of water
48
Fraction of excreted Sodium (FeNa)
Help for differential diagnosis of pre-renal vs renal disease (ATN) Fe Na = Urine Na x plasma Cr x 100/Urine Cr x plasma Na FeNa 2.0 % favors ATN Normally Na retention is the renal response to renal ischemia (pre-renal), but this is impaired with ATN; the tubules fail and the urine Na concentration is high (>40mEq/L)
49
Proteinuria
Normal urine it can be up to 50mg/24 hours | 1/3 albumin, 1/3 small globulins, 1/2 tamm-horsfall protein (tubular secretion)
50
Urine dipstick test (protein detection)
Sensitive only to albumin pH dependent (false + in alkaline urine) False + with gross hematuria or dilute urine
51
Acid precipitation test (protein detection)
Detects albumin and globulins (ie-light chains) | False + with gross hematuria and some meds
52
Proteinuria without renal disease
- Postural (orthostatic): 3 - 5% of young adults - Transiently - Functional: Heavy exercise, cold exposure, fever
53
Proteinuria with Renal disease
Can get a glomerular pattern or tubular pattern - glomerular it'd be high like in the nephrotic range= > 3.5 g - tubular has B2 microglobulins

CRRAB 2 Week 3 (4 decks)

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