Unit 10 Chapters 32-34 Flashcards by Lani Manners

how many mL of filtrate is formed each minute

125mL

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what is GFR

glomerular filtration rate

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GFR is what

amount of filtrate formed in each minute

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only ___mL of the 125mL formed each minute is excreted in urine

1mL

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what happens to the rest of the 124mL

reabsorbed in tubules

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what is the average urine output

60mL/hr

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what is the bare minimum of urine output

30mL/hr

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what percent of all reabsorptive and secretory processed occur in the proximal tubule

65%

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renal threshold

plasma level at which the substance appears in urine

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sometimes the renal threshold exceeds the ___________ ____________

transport mechanism

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an example of renal threshold exceeding transport mechanism is in diabetics when _____mg/minute spills into urine

320

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where do loop diuretics work

loop of Henle

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ADH maintains _____________ volume by returning water to vascular compartment

extracellular

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ADH is associated with what system

RAA

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_________________ in hypothalamus sense increase in osmolality of extracellular fluids and stimulates the release of _____ from the posterior pituitary

osmoreceptors, ADH

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where are osmoreceptors located at

hypothalamus

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ADH is also known as

vasopressin

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without ADH _________ channels are closed, tubular cells lose water permeability and dilute urine is formed

water

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what innervates renal

SNS

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if you are in hypovolemic shock will there be any flow to the kidneys

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what 3 substances produce vasoconstriction of renal vessels

Angiotensin II, ADH, endothelins

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what 3 substances dilate renal vessels

dopamine, nitric oxide, prostaglandins

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_______________ __________ represents feedback control system linking GFR with renal blood flow

juxtaglomerular complex

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juxtaglomerular complex controls the release of

renin

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what does the juxtaglomerular complex link

GFR with renal blood flow

what are three values that measures kidneys function

GFR, creatine, BUN

creatinine is a product of

creatine metabolism in muscles

is the release of creatinine constant or not

constant

creatinine is freely filtered in glomeruli and is it or is it not reabsorbed from tubules

not reabsorbed from tubules

creatinine serum levels depend closely on

GFR

creatinine is used as a measure of

renal function

regulation of NA and K

- aldosterone - atrial natriuretic peptide - ADH

atrial natriuretic peptide

synthesized in the muscle cells of atria and released with atria are stretched; vasodilatation of arterioles, inhibits NA reabsorption

regulation of pH in kidney conserves and eliminates what

conserves HCO3 eliminates H+

kidney uric acid elimination. what drug competes and what drugs affect

ASA competes, diuretics affect

urea elimination is a product of ____________ metabolism

protein

normal urea production by an adult

25-30 G/day

urea qualities rises with increased intake, tissue breakdown and

GI bleeding

RAA: renin is released in response to

- decrease in renal blood flow - change in composition of distal tubular fluid - SNS stimulation

erythropoietin is what kind of hormone

polypeptide

what does erythropoietin regulate

differentiation of RBC in bone marrow

where is erythropoietin majority produced

kidney (89-95%)

WHAT IS THE STIMULUS FOR PRODUCTION OF ERYTHROPOEITIN

TISSUE HYPOXIA

why is tissue hypoxia the stimulus for production

to produce more red blood cells in the chance to get more oxygen

if your kidney is not functioning will it still produce erythropoietin

where does the activation of Vitamin D occur

in kidney

vitamin D is needed to increase ______ absorption from GI tract

does vitamin D need to be activated before it is used

yes

what is the preferred type of urine sample

first voided and fresh

Casts

molds of distal nephron lumen

specific gravity valuable index of

hydration status and functional status of kidney

use of urine and what else is used to calculate GFR

blood

serum creatinine level

0.6-1.2

BUN normal level

8-20 mg

what does BUN stand for

blood urea nitrogen

BUN is influenced by

- protein intake - GI bleeidng - hydration status

normal BUN to creatinine ratio

10:1

what ratio do we start to get suspected of pre renal conditions such as CHF or GI bleed

15:1

casts are formed when

cells are packed together in the tubule lumen

Dysgenesis

failure of an organ to develop normally

agenesis

complete failure of an organ to develop

hypoplasia

failure of an organ to reach normal size

Potters syndrome is what type of failure of organ development

agenesis

when you see the prefix A what does that mean

without

Pottersyndrome is characteristic facial features of newborns with _________ agenesis

renal

renal agenesis name

Potter Syndrome

Polycystic kidney disease can be what autosomal

both (dominant and recessive)

if you have cysts in kidney you may also have them where

liver, pancreas

cysts of kidney may also present with mitral valve

prolapse

cysts of the kidney may have a 10-30% chance of ___________ aneurysm

cerebral

cysts of the kidney may also have chronic colonic ___________

diverticula

cysts of the kidney will present with

pain, hematuria, infection, hypertension

is the process of cysts in the kidney fast or slow

slow

hematuria

blood in urine

causes of urinary tract obstruction

developmental defects pregnancy benign prostatic hyperplasia scar tissue inflammation tumors neurological disorders

stasis of urine predisposing to

infection and stone formation

development of back pressure interfere with

renal blood flow and destroys kidney tissue

what is back pressure in renal system

urine from bladder pushes on ureter and kidney

manifestations of urinary obstruction depend on

site of obstruction the cause the rapidity with which the condition developed

common symptoms of urinary obstruction

pain signs and symptoms of UTI manifestations of renal dysfunction

hydronephrosis

refers to urine filled dilation of renal pelvis and chalices with accompanying atrophy of renal tissues caused by obstruction of urine flow

hydronephrosis causes

congenital, stones, tumors, inflammatory

kidney stones definition

crystalline structures that form from components of the urine

kidney stones are also alled

renal calculi

kidney stones happen when the filtrate is extremely saturated or unsaturated

saturated

what is the prevention of kidney stones/renal calculi

FLUID INTAKE PLUS CORRECTING CAUSE WITH DIET/MEDS

you have a patient who is frequently having kidney stones what is one preventative measure you can tell them to further prevent kidney stones

increased fluid intake

why would you want to increase fluid intake if you have kidney stones

makes the filtrate less saturated

why are women more at risk for UTI

shorter urethra

lower UTIs are just your basic

cystitis

lower UTI is the normal or abnormal UTI

normal

what is infected with lower UTI

bladder and urethra

how would someone present with a lower UTI/cystitis

urgency, pain, frequent bathroom

a women comes in a claims she was sexually active a few days ago and after that encounter she has had pain with urination and has to use the bathroom frequently. what does she have

lower UTI, cystitis

in an upper UTI what is infected

kidneys

upper UTI may lead to

sepsis, renal abscess, chronic pyelonephritis, chronic renal failure

pyelonephritis

kidney infection

how would someone present with a upper UTI

head ache, fever, chills, pain over kidneys

what UTI is more systemic

upper

a patient comes in and claims she was just in the hospital and had a catheter in, she claims she now has a fever and chills and she is having back pain, what does she have

upper UTI

why would someone with an upper UTI have back pain

kidneys are retroperitoneal so they are closest organ to the back

what is the most common bacteria to cause UTI

e. coli

what makes you more at risk for UTI

prior UTI, urinary obstruction/reflux, neurogenic bladder, sexually active women, disease of prostate, elderly, instrumentation, changes in vaginal flora, static urine flow

what is neurogenic bladder

loss of control of bladder

an elderly patient just had a catheter in for a week, they are now not hungry (when they normally are) and are also acting confused, what could they have

UTI

characteristics of acute episode of cystitis

frequency of urination lower abdominal or back discomfort burning and pain on urination cloudy and foul smelling urine on occasion

elderly with UTI may present with

vague symptoms such as anorexia, fatigue, CONFUSION

glomerulonephritis

inflammatory process involving the globular structures

what is the second leading cause of kidney failure

glomerulonephritis

glomerulonephritis can either be

primary or secondary

primary glomerulonephritis

condition in which glomerular abnormality is the only disease present

secondary glomerulonephritis

secondary condition such as DM or SLE

triggers for glomerulonephritis

immunologic, nonimmunologic (hypertension, drugs, chemicals, DM) and hereditary

glomerulonephritis injury results from __________ reacting with fixed glomerular antigens OR circulation _________-__________ __________ trapped in glomerular membrane

anitbodies, antigen-anitbody complexes

glomerulonephritis causes

disease that provoke proliferative inflammatory response

inflammatory process of glomerulonephritis

damages the capillary wall permits red blood cells to escape into the urine produces hemodynamic changes that decrease the GFR

glomerulonephritis presents with hematuria with

red cell casts

glomerulonephritis may present with coke color urine, why?

the longer the blood is there the darker it gets and since it is coming from the kidneys it will be dark

glomerulonephritis will have normal or diminished GFR

diminished

glomerulonephritis will present with azotemia which is?

presence of nitrogenous wastes in blood

why would a patient with glomerulonephritis have azotemia

because the GFR is decreased which means the kidney is not filtering out nitrogen so it stays in the blood

glomerulonephritis will present with oliguria which is?

less urine

glomerulonephritis will present with hyper or hypo tension

hypertesion

glomerulonephritis is a disorder of

glomerular function

types of glomerular disease

acute nephritic syndrome nephrotic syndrome

is acute nephritic syndrome a disease or not

yes it is a disease

acute nephritic syndrome, what type of inflammation

acute proliferative inflammation

acute nephritic syndrome will have an onset of oliguria why?

GFR is decreased

will acute nephritic syndrome have casts, hematuria, and proteinuria

yes

since acute nephritic syndrome has a decreased GFR this will lead to

hypertension and edma

since acute nephritic syndrome has a decreased GFR this will lead to

hypertension and edema

acute nephritic syndrome could develop how long after someone has pharyngitis (strep) or impetigo

7-12 days

what may be the first sign of acute nephritic syndrome

cola colored urine due to RBC breakdown

is nephrotic syndrome a disease

NO NOT A SPECIFIC DISEASE

what is nephrotic syndrome

constellation of clinical findings that results from increased glomerular permeability to plasma proteins

nephrotic syndrome is either a primary or a secondary disorder, a secondary disorder is changes of systemic diseases such as DM or

systemic lupus erythematosus

nephrotic syndrome presents like

massive amounts of proteinuria, lipiduria, hypoalbuminemia, generalized edema and hyperlipidemia

nephrotic syndrome could present with edema of the

face

why might a person with nephrotic syndrome have generalized edema

since they have hypoalbuminemia they have decreased colloidal osmotic pressure and the fluid is not being kept in intravascular space

since nephrotic syndrome have hypoproteinemia they will have decreased plasma oncotic pressure which leads to

fluid escaping into tissues and causing edema

nephrotic syndrome hypoproteinemia will be compensated by the liver in synthesizing ____________ and will also lead to hyper____________

proteins, lipidemia

diseases associated with glomerular lesions associated with systemic disease

systemic lupus erythematosus diabetic glomerulosclerosis hypertensive glomerular disease

what type does diabetic glomerulosclerosis occur in

type 1 and 2

diabetic glomerulosclerosis is a widespread thickening of the glomerular capillary ____________ ___________

basement membrane

can diabetic glomerulosclerosis occur without proteinuria

yes

hypertensive glomerular disease: mild to moderate hypertension causes __________ changes in renal arterioles in 15%

sclerotic

what race is majority affected by hypertensive glomerular disease

african americans

Tubulointerstital disorders are damage to the ________, ______, or ______ portion of the nephron could be caused by

proximal, loop, distal

Tubulointerstital disorders

actue tubular necrosis renal tubular acidosis pyelonephritis drugs and toxins

if an individual with a low GFR has pain and is requesting pain medication what type would you give them and why would you not give them the one you did not chose

you would give they Tylenol, NOT ibprophen. You would not want to give them ibprophen because it is nephrotoxic

pyelonephritis

inflammation of parenchyma and pelvis

what type of infection is acute pyelonephritis

bacterial

acute pyelonephritis

bacterial infection of upper urinary tract

the source of infection for acute pyelonephritis is

lower urinary tract, blood stream

is the infection of acute pyelonephritis systemic or not

systemic

signs of acute pyelonephritis

shaking chills, fever, headache, pain over costovertebral angle

would you have CVA tenderness with acute pyelonephritis

yes

where do you tap to asses for CVA tenderness

back

chronic pyelonephritis is progressive with _________ and _____________ of the renal chalices and pelvis

scarring, deformation

what are some examples of drugs that cause decrease in renal blood flow

diuretics, contrast, NSAID, immunosuppressive drugs

what do NSAIDS do to the kidney

decrease renal blood flow

what drugs obstruct urine flow

vit c and sulfonamides

renal neoplasm disease

Wilms tumor, renal cell carcinoma

Wilms tumor is a mass in any part of the kidney, is it solid or soft mass

solid

what is the median age diagnosis for a Wilms tumor

Wilms tumor presents

asymptomatic abdominal mass hypertension microscopic and gross hematuria

gross hematuria

visible blood

renal cell carcinoma is a silent disorder so if you have symptoms this may denote

advanced disease

renal cell carcinoma cause

unclear, smoking, obesity, occupational, asbestos

renal cell carcinoma age

55-84

why might in renal cell carcinoma the BUN and creatine be normal

because remaining kidney works well to compensate

renal failure definition

condition in which the kidney fail to remove metabolic end product from the blood and regulate the fluid, electrolyte, and pH balance of the extracellular fluids

renal failure underlying causes

renal disease systemic disease urologic defects of non renal origin

acute and chronic kidney injury is a rapid decline in renal function sufficient to increase _______ and impair _______ and electrolyte _________

wastes, fluid, imbalance

kidney injury threatens ____ patient

ICU

prerenal

leading up to kidney

intrinsic

within kidney

post renal

after kidney

where does majority of renal failure occur

pre renal

is contrast nephrotoxic

yes

if someone who has decrease GFR and we use contrast we might have to go to

dialysis

pre renal causes of acute renal failure

hypovolemia decreased vascular filling heart failure and cariogenic shock decreased renal perfusion due to sepsis, vasoactive mediators, drugs, diagnostic agents

hypovolemia cause pre renal failure

not enough fluid going to kidneys

prerenal failure will have a decrease or increase in urine called

olyuriga

prerenal failure disproportionate elevation of _____ in relation serum ____________

BUN, creatinine

is prerenal failure reversible with treatment

yes

intrinsic

- prolonged renal ischemia - exposure to nephrotoxic drugs - intratubular obstruction - acute renal disease

sepsis produces ischemia by provoking

- systemic vasodilatation - infrarenal hypo perfusion - generation of toxins that sensitize tubules to ischemia

postrenal

- results from obstruction of urine outflow - ureter - bladder - urethra

post renal ureter

calculi and strictures

post renal bladder

tumors or neurogenic bladder

post renal urethra

BPH

hypovolemic is prerenal, postrenal or intrinsic

prerenal

decreased vascular filling prerenal, postrenal or intrinsic

prerenal

prolonged exposure to renal ischemia prerenal, postrenal or intrinsic

intrinsic

obstruction of urine outflow prerenal, postrenal or intrinsic

post renal

neurogenic bladder prerenal, postrenal or intrinsic

post

benign prostatic hyperplasia prerenal, postrenal or intrinsic

postrenal

sepsis prerenal, postrenal or intrinsic

prerenal

acute renal disease (glomerulonephritis) prerenal, postrenal or intrinsic

intrinsic

heart failure prerenal, postrenal or intrinsic

prerenal

why would congestive heart failure be a prerenal cause of renal failure

low blood flow to kidneys

which type of acute renal failure would be most likely to accompany benign prostatic hypertrophy

postrenal

trauma would cause renal failure why

crush injuries release creatinine and myoglobin

Rhabdomyolysis

renal failure caused by tissue damage

SCENARIO a man developed acute renal failure after emergency surgery for a severed left leg... he came in with a serum creatinine of 1.2 but it is now 5.6 mg/dL his BUN is 86 mg/dL why would leg damage cause renal failure

Rhabdomyolysis - muscle breakdown from trauma would cause increase in creatinine going to the kidneys and it is too much for the kidneys to handle

rhabdo myelysis presents with what abnormal test used to determine GFR

creatinine

onset or initiating phase

lasts hours or days from onset of precipitating event until tubular injury occurs

maintenance phase

marked decrease in GFR, sudden retention of urea, K, and creatinine low urine output, edema, pulmonary congestion may be non oliguric

recovery or convalescent phase

renal tissue repair occurs, diuresis may begin before renal function has fully returned to normal BUN and creatinine begin to return to normal

in chronic kidney disease as kidney structures are destroyed the remaining nephrons undergo

structural and functional hypertrophy, each increasing function as a means of compensation

regardless of cause of chronic kidney failure results in progressive deterioration of

glomerular filtration tubular reabsorption capacity endocrine function

what are the 3 most common causes of chronic renal disease

hypertension diabetes mellitus polycystic kidney disease

what are the stages of the progression of chronic renal failure

diminished renal reserve renal insufficiency renal failure end stage renal disease

why would a manifestation of chronic renal failure be accumulation of nitrogenous wastes (early)

kidney is not filtering out of the blood so it will stay in the blood

why would a manifestation of chronic renal failure be anemia

kidney is not making erythropoietin

what are the electrolyte imbalances associated with chronic renal failure

Metabolic acidosis, hyperkalemia, decrease calcium, increase phosphorus

stage 1 chronic kidney disease

kidney damage with normal or increased GFR (GFR >90)

stage 2 chronic kidney disease

kidney damage with mild decrease in GFR (GFR 60-89)

stage 3 chronic kidney disease

moderate decrease in GFR (GFR 30-59)

stage 4 chronic kidney disease

severe decrease in GFR (GFR 15-29)

stage 5 chronic kidney disease

kidney failure (GFR <15 or dialysis)

GFR below 60 represents a loss of

one half or more of normal adult kidney

which of the following renal disorders is characterized by an increase BUN and creatinine levels - ARF -CRF -uremia

ALL OF THE ABOVE

SCENARIO a man has chronic renal failure he has high creatinine and BUN, hyperkalemia, acidosis with normal pCO2, and severe anemia his blood glucose has reached 340 mg/dL one hour after his hospital meal he complains of having broken two toes in the last few weeks, even though he eats a lot of daily products for calcium why does he have hyperkalemia

kidney not able to eliminate potassium

kidney cannot hold onto bicarb and eliminate H+

kidney cannot produce erythropoietin

diabetes

he does not have kidneys to convert vit d which helps aid in the process of calcium absorption so the body is using osteoclasts to breakdown bones for calcium which causes fragile bones

uremia

urine in the blood

what is the first clinical manifestations of end stage renal disease

BUN may rise as high as 800mg/dL; with creatinine levels of 10 mg or more it is assumed that 90% of renal function is loss

what clinical manifestations may present later with end stage renal disease

disorders of water, electrolyte and acid base balance mineral metabolism and skeletal disorders hematologic disorders

with end stage renal disease patients will be chronic anemia due to

erythropoietin deficiency

with end stage renal disease what might be common

pruritus

what is the long term treatment for renal failure

dialysis

as renal failure progresses and the GFR falls below 50 mL/min which change occurs - metabolic acidosis - hypokalemia - hypercalcemia - hypophosphatemia

metabolic acidosis (HYPERkalemia, HYPOcalcemia, HYPERphosphatemia)

T/F: hypercalcemia is the most life threatening of the fluid and electrolyte changes that occur in patients with renal disturbances

FALSE, HYPERPOTASSIUM

Unit 10 Chapters 32-34 Flashcards

(237 cards)