Week 11 - Part 1 Flashcards
Renal Disorders
1
Q
What are (7) roles of the kidneys?
A
- Filtration of the blood
- Removes wastes
- Maintains appropriate
concentrations of
electrolytes - Maintains acid base
balance - Regulation of blood volume
and blood pressure - Activation of vitamin D
- Production of erythropoietin
2
Q
What is the functional unit of the kidneys?
A
Nephron
3
Q
Each nephron contains what (3) things?
A
- Glomerulus
- Tubule
- Collecting duct
4
Q
What has a bunch of capillaries and filtration surfaces for filtering blood?
A
Glomerulus
5
Q
What is responsible for reabsorption and secretion of various ions and
molecules?
A
Tubule
6
Q
What are the (3) tubules?
A
- Proximal tubule
- Loop of Henle
- Distal convoluted
tubule
7
Q
What is responsible for more reabsorption/secretion and delivery of urine to bladder?
A
Collecting duct
8
Q
What are (4) things that happen if kidneys fail?
A
- Increase of metabolic wastes in the circulation
- pH imbalance
- Decreased activation of vitamin D
- Decreased erythropoietin
9
Q
What happens when there is a decrease in activation of vitamin D?
A
Results in decreased calcium absorption and then hypocalcemia
10
Q
Decreased erythropoietin leads to?
A
Anemia
11
Q
What are (3) General Types of Kidney Failure?
A
- Pre-renal failure
- Intrinsic failure (intrarenal)
- Post renal failure
12
Q
What type of kidney failure has a problem that is outside the kidney?
A
Pre-renal
13
Q
What is the cause of pre-renal failure?
A
Decrease in blood supply to the kidneys
-> Ischemia to the kidney
14
Q
What type of kidney failure has a problem within the kidneys?
A
Intrinsic failure (intrarenal)
15
Q
What type of kidney failure has a problem with the collecting system outside of the kidneys (ureters/bladder/urethra)?
A
Post renal failure
16
Q
What are (3) lab tests of kidney function?
A
- GFR (Glomerular filtration rate)
- BUN (Blood urea nitrogen)
- Creatinine (blood)
17
Q
What lab test estimates how much blood passes through the glomeruli each minute?
A
GFR - Glomerular filtration rate
18
Q
As GFR goes down, what do we see a decrease in?
A
Decrease in the functional filtration rate of the kidney
19
Q
What lab test measures urea level in blood which indicates retention of nitrogenous products?
A
BUN - Blood urea nitrogen
20
Q
What is a by-product of muscle metabolism?
A
Creatinine
21
Q
The more creatinine that is retained (goes up) in the blood, what happens?
A
GFR decreases
22
Q
Decreased filtration function (GFR) leads to imbalances in what?
A
Electrolytes
23
Q
Prolonged disruption of blood flow in kidneys will lead to?
A
Permanent ischemic damage (tubular epithelial cells)
24
Q
Impaired perfusion in pre-renal failure can be caused by what (5) things?
A
- Dehydration
- Shock
- Heart failure
- Burns
- Drugs - nephrotoxins
25
What drugs are nephrotoxins?
Drugs that dilate peripheral blood vessels
26
What is a substance that can damage the kidneys and cause nephrotoxicity (Poisoned) referred to as?
Nephrotoxin(s)
27
Intrinsic renal failure includes diseases of what (2) things?
Diseases of the glomeruli and tubes
28
What type of conditions cause sclerosis of the functional units of the kidney?
Acute or chronic conditions
29
What are immunologic causes of glomerular injury?
Primary and secondary glomerular disease
30
What are (4) non-immunologic causes of glomerular injury?
- Diabetes - MAIN
- Hypertension - MAIN
- Drugs
- Chemicals
31
What are heredity mechanisms causes of glomerular injury?
Alport syndrome
32
What syndrome is a rare genetic disorder that causes kidney disease, hearing loss, and eye abnormalities?
Alport syndrome
33
What type of renal failure is caused by obstruction of urine outflow from the
ureter, bladder, or urethra?
Post renal failure
34
What substance in post renal failure backs up into the kidneys from bladder and causes damage to the functional units of the kidney?
Urine
35
What are the causes of post renal failure by the ureters? (2)
- Calculi (kidney stones)
- Strictures (narrowing)
36
What are the causes of post renal failure by the bladder? (2)
- Tumors
- Neurogenic bladder
37
What is the cause of post renal failure by the urethra?
Prostatic hyperplasia (enlarged prostrate)
38
What is the #1 common cause of post renal failure?
Prostatic hyperplasia (enlarged prostrate)
39
What disease is abrupt in onset, and usually reversible?
Acute renal failure (ARF)
40
Acute renal failure (ARF) is rapid decline in kidney function marked by (3)?
- Inability to maintain fluid balance
- Inability to maintain electrolyte
balance
- Inability to excrete nitrogenous wastes (Azotemia)
41
What is the gold standard manifestation of renal failure?
Azotemia
42
What condition occurs when your kidneys can't get rid of enough nitrogen waste?
Azotemia
43
Azotemia is accumulation of what (4) nitrogenous wastes in the blood?
- Urea
- Nitrogen
- Uric acid
- Creatinine
44
An increase in nitrogenous waste in the blood means what for the GFR?
It means the GFR is decreased/decreasing
45
What are ways we can prevent and early diagnosis acute renal failure?
* Identifying patients at risk
* Recording of urine output
* Urine tests (proteinuria)
* Blood tests (BUN, creatinine)
* Identifying and correcting cause
* Monitoring and treating infections
* Hemodialysis or continuous renal replacement therapy (CRRT)
46
What is ATN?
Acute tubular necrosis
47
What is the most vulnerable part of the functional unit of the kidney?
The tubular structures
48
ATN describes an acute destruction of what cells?
Tubular epithelial cells with acute
impairment of renal function.
49
What are (5) etiological factors of acute tubular necrosis (ATN)?
* Ischemia
* Sepsis
* Nephrotoxic effects of drugs
* Tubular obstruction
* Toxins from massive infection
50
What is the onset or initiating phase of ATN?
It is the time of onset of the precipitating event until tubular injury occurs
51
What is the maintenance phase of ATN?
Marked decrease in GFR, with sudden retention of metabolites and low urine output
52
In the maintenance phase of ATN, what are examples of metabolites that are retained? (2)
- Potassium
- Creatine
53
In the maintenance phase of ATN, the fluid retention results in what problem?
Edema; pulmonary congestion
54
What (3) things happen in the recovery phase of ATN?
- Repair of renal tissue occurs
- Urine output increases
- Serum creatinine falls.
55
Does acute or chronic renal failure cause nephrosclerosis?
Chronic
56
Is polycystic kidney disease seen chronic or acute kidney failure?
Chronic
57
Is oliguria with increased serum urea an early sign of acute or chronic kidney failure?
Acute
58
Is polyurea with dilate urine is an early sign of acute or chronic kidney failure?
Chronic
59
Do burns cause acute or chronic renal failure?
Acute
60
What disease is a progressive decline in kidney function due to permanent loss
of nephrons?
Chronic kidney disease (CKD)
61
CKD can result from multiple etiologies however most common are those that are extrinsic or intrinsic in nature?
Intrinsic
62
Examples (4) of etiologic diseases that lead to CKD?
- Hypertension
- Diabetes
- Glomerulonephritis
- Autoimmune
63
In CKD, there is a decreased GFR greater
than how many months?
3+ months
64
What units in the kidney are fewer in CKD?
Nephrons
65
In CKD, the remaining nephrons must
filter more, this leads to?
Hypertrophy (growing)
66
If your GFR is less than 15 mL/min, what does this mean?
Kidney failure and/or dialysis
67
What are (6) Clinical Manifestations of CKD?
1. Fluid, electrolyte and acid-base balance
2. Calcium and phosphorous balance and bone disease
3. Hematologic function
4. Cardiovascular function
5. Accumulation of nitrogenous wastes
6. Drug elimination
68
What is hyponatremia?
Low serum sodium
69
Loss of ability to reabsorb Sodium in tubules and inability to concentrate urine (polyuria) refers to what manifestation?
Hyponatremia
70
How much of potassium is excreted through kidneys?
90%
71
What manifestation is associated with inability to remove potassium with severe kidney impairment?
Hyperkalemia (High serum potassium)
72
Low serum pH is AKA?
Metabolic Acidosis
73
What manifestation causes loss of ability to eliminate hydrogen ions (acidic) and to reabsorb bicarbonate (buffer of acid)?
Metabolic acidosis (Low serum pH)
74
What manifestation directly results in a
demineralization of bone?
Metabolic acidosis (Low serum pH)
75
What manifestation which describes inability to eliminate phosphate results in rising serum phosphate?
Hyperphosphatemia (high serum phosphate)
76
How does phosphate work with calcium inversely?
They balance each other out
77
With high phosphate levels, calcium is excreted at higher amounts leading to high or low serum levels?
Low serum levels
78
Hypocalcemia triggers what kind of response?
A parathyroid response
79
Kidneys activate which vitamin that is absorbed through the GI tract?
Vitamin D
80
Inability to activate Vitamin D occurs with progressing kidney impairment, which leads to?
Vitamin D deficiency
81
Does low Vitamin D lead to a increased or decreased absorption of Calcium in GI?
Decreased
82
Low Calcium results in stimulation of Parathyroid gland leading to?
Reabsorption (decay) of bone
83
Decay of bone replaces serum Calcium and acts as?
a buffer of acidosis
84
What are (6) Manifestations of disorders of Calcium, Phosphate & Bone?
* Bone pain and muscle weakness
* Develop gait abnormalities
* Spontaneous fractures
* Impaired healing of fractures
* Metastatic calcifications (occurring in healthy tissue)
* Hyperparathyroidism
85
Treatment of Disorders of Calcium & Phosphate? (4)
- Dietary restrictions of foods high in phosphorus content (milk)
- Phosphate binding antacids: Ca carbonate
- Activated vitamin D supplement
- Hyperparathyroidism medications
86
Renal failure erythropoietin production is insufficient to stimulate RBCs which causes what disease?
Anemia
87
What are manifestations of anemia? (8) name a few
- Weakness
- Fatigue
- Depression
- Insomnia
- Decreased cognitive functioning
- Increased Heart Rate
- Can worsen patients with angina
- Spontaneous bleeding
88
Why do patients manifest increased heart rate with anemia?
Due to decreased blood viscosity
89
Treatment for anemia?
Iron supplement
90
Cardiovascular disease is worsened or
develops due to what disease?
CKD
91
What are some common cardiovascular diseases associated with CKD?
* Hypertension
* Left ventricular hypertrophy
* CHF
* Pericarditis
92
Progressive failure of kidney function drugs leads to accumulation of?
Active drug and/or metabolites
93
What are (5) ways that pts can slow the progression of the disease (loss of kidney function)?
1. Prompt treatment of UTIs
2. Blood pressure control
3. Glycemic control in diabetics
4. Smoking Cessation
5. Dietary management
94
What are (5) CKD dietary management goals?
- Restriction of dietary proteins.
- Restriction of Sodium intake
- Restriction of Potassium
- Restriction of Phosphorus
- Adequate calories in the form of carbohydrates and fats.
95
(3) overall management of CKD?
* Hemodialysis
* Peritoneal dialysis
* Transplantation
