Renal patho-Josh Flashcards Preview

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Flashcards in Renal patho-Josh Deck (56):
1


GFR and erythyopoetin are what?


linear as GFR decreases you get anemic

2


Normal GFR


125-140 mL/min

3


GFR decereases ___% per decade after the age of 20

1%

4


what is considered the best measurment of renal funtion


GFR

5

Clinical manifestation of uremia generally appear when GFR is less than what

15mL/min

6


Serum Creatinine:

what is the normal values


0.6-1.0 men

0.8-1.3 men

7


Serum Creatinine:

what is it


waste product of muscle metabolism

8


Serum Creatinine:

is is reabsorbed by the kidneys?


Nope

9


Serum Creatinine:

T/F

it can be low in the presence of decreased GFR?


yeppers

10


BUN:

normal values?


5-20 mg/dL

11


BUN:

BUn can be potentially misleading due to confounding factors  b/c urea is the end product of protein digestion. so what can cause false levels?

  • high protein diet
  • Upper Gi bleed
  • Dehydration

12


Specific Gravity:

what is teh normal Specific gravity

 


1.005-1.030

13


Urine protein:

what is the normal Value


0-8 mg/dL

or

< 150mg/24hrs

14


Cystine C:

what is teh normal values

 


0.52-0.98 mg/dL

15


Cystine C:

what is a con of this test vs creatine?


it cost 2-3 dollars vs 2-15 cents for Creatinine

16


Cystine C:

Cystine C is produced by all ______ _____ in the human body- not influenced by muscle mass, gender or age


nucleated cells

17

what is a blanket term that can be applied to almost any acute renal disease


Acute Kidney disease

18


what is a term that covers diseases that involve inflammation of the nephrons


Nephritic

19


AKI:

may be oliguric which is UOP < _____ml/day, or non-oliguric which is a UOP > _____mL/day

 

400

400

20


AKI:

is divided into what 3 etiological categories?

 

  • prerenal
  • Intrarenal
  • Postrenal

21


AKI: Prerenal Azotemia

what is it?


the root of the problem lies somwwhere upstream or proximal the kidneys

the kidneys themselfs are ok

22



AKI: Prerenal Azotemia

If left untreated it is the most common factor that predispposes the pt to what?


ischemic-induced Acute Tubular Necrosis

23



AKI: Prerenal Azotemia

what are some causes?

 

  • hemorrhage
  • GI fluid loss
  • trauma
  • sx
  • Burns
  • Cardiogenoic shock
  • SepsisHepatic failure
  • Aortic or Renal artery clamping
  • Thromboembolism

24



AKI: Intrarenal Azotemia

what is it?

 


as the name implies it lies within the parenchyma of the kidney itself

25


AKI: Intrarenal Azotemia

Intrinsic (intrarenal) kidney disease that results in AKI are categorized according to the site of injury! what are the 4 categories?

 

  1. Glomerulus
  2. Renal tubules
  3. interstitium
  4. Renal Vasculature

26


AKI: Intrarenal Azotemia

injury to the tubules is most often due to what?

Ischemia (prerenal) or the administration of nephrotoxins)

27


AKI: Intrarenal Azotemia

AKI resulting from acute INTERSTITIAL NEPHRITIS is most often caused by what?

allergic reactions to drugs

28


AKI: Intrarenal Azotemia

what are other causes (besides allergic reations) to drugs


Glomerulonephritis

Pyelonephritis

Renal artery emboli

Renal vein thrombosis

vasculitis

ATN

Heavy metals

Radiographic dyes

Myoglobinuria

ischemia

Solvents

29

AKI: Postrenal Azotemia

what is it


AKI that happens when outflow tracts are obstructed

30


AKI:

what are S/S

 

  • general malaise
  • Evidence of Fluid Overload (SOB, edema, HTN)
  • Lethargy
  • nausea
  • HyperKalemia
  • Encephalopathy
  • Hypotension
  • Jaundice
  • hematuria
  • urinary retention

31


AKI:

How is Oliguria defined?


less than 0.5 mL/kg/hr or less than 400 mL/day

32

AKI:

Anuria is defined as what?


less than 100mL/day

33


AKI:

AKI manifest complications in various systems. what are the systems it causes s/s to?


CNS

CV

Hematological

GI

34


AKI:

what are it's effects on the CNS

 

  • Confusion
  • Asterixis (tremor of the hand)
  • Somnolemce
  • Seizures
  • polyneuropathy

35


AKI:

S/S on CV system

 

  • Systemic HTN
  • CHF
  • Pulm Edema
  • Uremic pericarditis
  • Peaked T-waves
  • Dysrhythmias

36


AKI:

complications on hematological

 

  • Anemia
  • Coagulopathy

37


AKI:

Complications on the GI system?

 

  • Anorexia
  • Nausea
  • Vomiting
  • Paralytic ileus
  • GI bleed (1/3 of pts)
  • Gastroporesis

38


AKI:

how can all of the complications listed be ameliorated?


Dialysis

39


AKI:

treatment for AKI

 

  • no specific treatments
  • management aimed at emlimiting further renal injury, and correcting cpmplications (ex electrolytes, acid-base balance)
  • Underlying cause should be corrected
  • Keep MAP of 65
  • Fluid resuscitation
  • Vasopressors
  •  

40


AKI:

why is NS prefered?


it lacks K+

41


AKI:

Although NS is preferred, what is the down side of too much?


hyperchloremic metabolic acidosis (which will cause hyperkalemia)

42


AKI:

what does the evidence say about the use of colloids over crytalloids for AKI?


no evidence and Voluven has been shown to exacerbate renal injury

43


AKI: Treatment:

Vasopressors cause concern why?


vasoconstriction may exacerbate tubular injury

44


AKI: Treatment:

What are the benefits of Levophed?


reduces renal blood flow in healthy volunteers, BUT sytemic pressures cause LESS SYMPATHETIC TONE IN THE KIDNEYS AND BY EXTENSION MORE RENAL VASODILATION

45


AKI: Treatment:

why is vasopressin good?


tends to selectivly constrict renal efferent arterioles

may preserve GFR and UOP better than Alpha agonist

46


AKI: Treatment:

 why/whynot?should you give diuretic?


Nope

 

  • increase mortality
  • Increase risk of permanent injury

47


What is the progressive, irreversible deterioration of renal function that may result from a variety of diseases?


Chronic Kidney Disease

(CKD)

48


CKD:

symptoms are typically independent of the origional insult abd reflect the inability of the kidneys to excrete _____ ___, regulate  ____, and ____ _____, and ______ ______

 

  • Nitrogenous waste
  • fluid
  • electrolyte balance
  • secrete hormones

49



CKD:

in most pt's regardless of the cause a decrease in the GFR to less than ____ mL/min eventually requires dialysis or renal transplantation


25

50


what is an autoimmune d/o caused by the manufacture of antibodies to vasular collagen or can be caused by cross reactivity of deposited antigen-antibody complexes in teh glomeruli- can occur after essentially any infection, but most commonly after strep pyogenes


Acute Glomerulonephritis

51


Acute glomerulounephritis:

what are the clinical manifestations?

 

  • hematuria
  • Proteinuria
  • HTN
  • Edema
  • Increased creatine concentration
  • Presence of urinary RBC
  • proteinuria

52


Acute Glomerulonephritis:

what are the 2 patterns that exist?

 

  • NephRITIC
  • NephROTIC

53


Acute Glomerulonephritis:

which pattern is characterized by- inflammation and an active urine sediment containing red and white blood cells, and a varible amount of proteinuria


NephRITIC

54


Acute Glomerulonephritis:

which pattern is characterized by marked Protenuria and a relatively inactive urine sediment?


NephROTIC

55


what is a parachymal disease caused by infection by organisms usually found un the digestive tract? (AKA E.coli)


Pyelonephritis

56


done next on to anesthesia complications?


yeah