Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
505 Cards in this Set
- Front
- Back
what is the average amount of blood that passes through the kidney in 24 hours?
|
180 liters
|
|
what are the top 3 functions of the kidneys?
|
-extra cellular fluid volume control
-electrolyte balance -excretes waste |
|
what are other random kidney functions?
|
-drug/hormone-elimination/metabolism
-BP regulation -hct regulation (erythropoeitin) -regulation of Ca++/phosphate balance -vit D metabolism |
|
which kidney is easier to remove, and why?
|
the left renal vein/artery are longer, so the left kidney is easier to remove
|
|
the ureter is recognizable anatomically in the abd/pelvis, why?
|
-most superficial structure in the pelvis
-shows peristalsis -sticks to post. surface of the peritoneum -enters the bladder at the level of the pubic tubercle on a plain x-ray |
|
what anatomically passes underneath the ureter?
|
vas deferens
uterine artery |
|
What does "water under the bridge" represent?
|
the ureters are POSTERIOR to the ovarian/testicular artery.
|
|
What is a common surgical error in regards to the ureter?
|
to cut the ureter instead of ovarian artery when removing the uterus.
|
|
What is the best "screening" test in regards to urology?
-"the best bang for the buck" |
UA
|
|
Name 3 methods of screening for renal function.
|
1-serum crt (but must lose approx 70% of fcn before elevation)
2-eGFR (best measure) 3-Urine testing *urine dipstick *urine micro exam *urine microalbumin (test for diabetes, that should be done every 6-12 months) |
|
Which lab level is NOT used for screening of renal function?
|
BUN
|
|
What is the hallmark of kidney disease?
|
proteinuria
|
|
T/F
If the creatinine is normal means the kidney's are normal. |
False
|
|
T/F
Almost all early renal failure patients are asymptomatic. |
True
|
|
T/F
A patient needs to lose approx. 50-70% of their nephrons before it will show up on their creatinine level. |
True
|
|
__ creatinine is a poor reflection of early renal disease/failure.
|
serum
|
|
What is the role of the kidney?
Hint: REEM |
R-regulates: fluid/acid base, and electrolyte balance.
E-endocrine: erythropoietin/prostaglandins E-exocrine: waste products/drugs M-metabolic |
|
Prostaglandins cause renal ___
|
vasodialation
|
|
What is the effect do NSAID's have on renal blood flow?
|
vasoconstriction
|
|
NSAID's are prostaglandin __
|
inhibitors
|
|
The process by which water and middle sized molecules (>5000 daltons) move across a membrane, is called __
|
filtration
|
|
Filtration moves "stuff" across membranes of the kidney by __ pressure, NOT concentration gradient.
|
hydrostatic
|
|
T/F
At any given time, 50% of nephrons are in "downtime". |
False-it is 20%
|
|
A network of blood capillaries in the nephron is more specifically called the __.
|
glomerulus
|
|
the loop of henle is located in the renal __ (medulla/cortex)
|
medulla
|
|
__ __leads to renal pelvis
|
collecting ducts
|
|
hydrostatic pressure is produced by __?
|
cardiac output
|
|
blood enterst the glomerulus thru the ___ and exits thru the ___
|
afferent arteriole and exits the efferent arteriole
|
|
fluid movement from capillary to filtrate is governed by __ forces and intrinsic membrane properties.
|
Starling's forces
|
|
the 3 properties of Starling's forces include...
|
-hydrostatic pressure
-oncotic pressure -membrane properties |
|
What are 3 properties of the glomerular capillary?
|
-increased hydrostatic pressure
-increased permeability -location between 2 arteriolar beds (afferent and efferent) |
|
Blood enters the glomerulus via the __ arteriole
|
afferent
|
|
What are the 3 top functions of the kidney?
|
-filtration
-secretion -absorption |
|
__ of a substance is the volume of plasma from which that substance is completely removed by the kidney per unit of time.
|
Clearance
|
|
___ is becoming a very important screening tool in regards to kidney function
|
GFR
|
|
a crt clearance is difficult to obtain why???
|
requires a timed urine collection, inconvient for the pts.
|
|
the __ nervous system is the nerve supply of the glomerulus.
|
sympathetic
|
|
Renin is produced in the __ __
|
macula densa
|
|
the release of renin is controlled by the __ arteriole
|
afferent
|
|
renin release causes __
|
HTN
|
|
intrarenal __ sense a fall in blood pressure in the afferent arteriole when they are stretched to a lesser degree.
|
baroreceptor
|
|
when the baroreceptors are stretched to a lesser degree, what happens next?
|
renin secretion
|
|
renal __ nerves increase their tone once blood pressure falls.
|
sympathetic
|
|
Sympathetic nerves directly and indirectly lead to the release of __
|
renin
|
|
how does the sympathetic nervous system directly affect the release of renin?
|
activate b1 receptors on granular cells
|
|
how does the sympathetic nervous system indirectly affect the release of renin?
|
leads to the constriction of afferent arterioles, which leads to decreased stretch of JG cells and renin release
|
|
how else does the sympathetic nervous system affect the GFR?
|
reduces it, lowering the NaCl delivery to the macula densa to trigger renin release
|
|
the __ __ monitors the amount of NaCl contained in tubular fluid
|
macula densa
|
|
a decrease in NaCl delivery tothe diestal nephron results in the release of __ 12, which stimulates the release of __ from granular cells.
|
prostaglandin 12
renin |
|
___, a substrate for renin, also inhibits renin release by negative feedback.
|
angiotensin II
|
|
renin causes __ of the arterioles
|
constriction
|
|
angiotensinogen is released by the __ which joins up with renin from the kidney to form__
|
liver
angiotensin I |
|
angiotensin I goes to the __
|
lungs
|
|
what converts Angio I into Angio II?
|
ACE
|
|
ACE is produced where?
|
in the lungs
|
|
When angiotensin I is converted in the lungs via ACE to __ it causes constriction of the arterioles
|
angiotensin II
|
|
you will find increased serum ACE levels and increased Ca++ in what __ (not a kidney dx per se)
|
sarcoidosis
|
|
ADH is released from the__ __
|
posterior pituitary
|
|
how does angiotensin II affect the brain?
|
signals the post. pit to secrete ADH
|
|
what does ADH control?
|
the release of H2O, it adds hydration
|
|
ADH causes the release of __ from the kidney
|
renin
|
|
does anyone else here feel like we are going in __
|
circles
|
|
The adrenal cortex layers control what hormones?
-glomerulosa= -fasiculata= -reticularis= |
glomerulosa=salt
fasiculata=sugar reticularis=sex |
|
when angiotensin II goes to the adrenal glands, the adrenals release __.
|
aldosterone
|
|
aldosterone released from the adrenal glands goes to the kidneys which in turn release__
|
renin
|
|
the release of aldosterone from the adrenal cortex results in __ sodium absorption and __ potassium excretion
|
increased
increased |
|
the increased sodium absorption and increased potassium excretion results in an __ blood volume and __BP
|
increased
increased |
|
Primary aldosteronism causes __ HTN
|
secondary
|
|
the HTN of primary aldosteronism occurs secondary to __ sodium, low potassium and __ BP
|
high sodium
increased BP |
|
Aldosterone functions to maintain an adequate ___by regulating the amount of sodium reabsorbed in the tubule.
|
extracellular volume (ECV)
|
|
Aldosterone is a __ hormone produced in the glomerulosa cells of the __ cortex.
|
steroid hormone
adrenal cortex |
|
aldosterone increases the number of open __ channels in the apical surface of principal cells.
|
sodium
|
|
aldosterone release is dependent upon two primary stimuli...what are they?
|
1-increase in angiotensin II concentration
2-increase in plasma K+ which leads to the release of aldosterone into the circulation. |
|
the 1/2 life of aldosterone is __ minutes while its peak action is at about __minutes.
|
20
30 |
|
__ will result in decreased sodium uptake in the collecting ducts causing a decrease in the ECV..
|
hypoaldosteronism
|
|
hyperaldosteronism results in __sodium uptake causing an increased in ECV
|
increased
|
|
you cannot correct a pt's K+ without appropriate levels of __
|
magnesium
|
|
a low magnesium level may cause the cardiac arrythmia of __
|
torsade de pointe
|
|
the effects of aldosterone on K+ within the DCT is __?
|
hypokalemia
|
|
the effects of aldosterone on Na+ is __
|
increased Na+
|
|
low sodium results in the release of __ from the adrenal gland, which then stimulates sodium reabsorption.
|
aldosterone
|
|
high levels of aldosterone causes a __K+ level
|
low
|
|
catecholamine release causes __K+
|
low
|
|
high insulin levels cause __K+
|
low
|
|
the 2 actions of ADH are...?
|
1-water absorption-adds hydration
2-vasoconstriction |
|
insulin forces __ into the cells
|
potassium
|
|
name some causes of hypokalemia...
|
high aldosterone
alkalosis catecholamines high levels of insulin vomiting low mag levels |
|
in kids with bedwetting you could give them DDAVP which is a ___
|
ADH
|
|
if serum osmolarity is up, then urine osmolarity goes __
|
down
|
|
if serum osmolarity goes down, then urine osmolarity goes __
|
up
|
|
SIADH causes __retentin
|
water
|
|
without ADH a pt. could develop diabetes __
|
insipidous
|
|
name 2 functions of ADH.
|
-keeps h2o in the system
-vasoconstriction |
|
a high osmolarity means __
|
dehydration
|
|
a low osmolarity means __
|
overhydration
|
|
a high osmolarity __ ADH release which in turn causes renal __ of free water to lower osmolarity
|
increases
retention |
|
__ controls serum osmolarity
|
ADH
|
|
This disease is seen when the pituitary gland is unable to secrete ADH...
|
central diabetes insipidous
|
|
this disease is seen when the collecting ducts are unable to respond to ADH due to a mutation inth e v2 receptor. (the kidney's do not have ADH receptors)
|
nephrogenic diabetes insipidous
|
|
this disease is seen when drugs or tumors result in continued secretion of ADH or increased action of ADH on the collecting ducts.
|
SIADH
|
|
Name the 3 malfunctions of the ADH system that result in noticeable disease.
|
central diabetes insipidous
nephrogenic diabetes insipidous SIADH |
|
Name the disease which is often related to CA's or disease involving the lungs, the pt. retains too much water related to too much ADH.
|
SIADH
|
|
a popular synthetic ADH medication often used to treat kids with bedwetting is called __?
|
DDAVP/desmopressin
|
|
Desmopressin releases the __ factor stored in the lining of blood vessels.
|
von Willebrand factor
|
|
von Willebrand factor is also used in the treatment of __ A.
|
hemophilia A
|
|
constriction of the afferent arteriole causes a __GFR.
|
decreased
|
|
Constriction of the afferent arteriole causes a decreased pressure in the __ capillary.
|
glomerular
|
|
NSAID's cause blood vessel __
|
constriction
|
|
constriction of the efferent arteriole will __GFR
|
increase
|
|
prostaglands __the afferent and efferent arterioles.
|
dialate
|
|
NSAID's block __ release
|
prostaglandin
|
|
Relaxation of the afferent arteriole will __GFR.
|
increase
|
|
Relaxation of the afferent arteriole increases GFR, more blood goes in, and you will see a increase of __ __ and increased GFR
|
hydrostatic pressure
|
|
dialation of the efferent arteriole will __GFR.
|
decrease
|
|
The glomerular capillary will see a __ hydrostatic pressure if the efferent arteriole is relaxed.
|
reduced
|
|
A increased sympathetic tone within the glomerulus will __ everything.
|
constrict
|
|
You will see the effects of increased sympathetic tone, contraction of everything is what kind of conditions?
|
fight or flight...hemorrage, the body is trying to conserve its fluids
|
|
What is the effect of prostaglandins on the afferent and efferent arterioles?
|
dialate both
|
|
Where are prostaglandings produced?
|
in the kidney
|
|
Prostaglandin effects include, vasoconstriction, mesangial cell constriction of sympathetic nerves and __.
|
Angiotensin II
|
|
Angiotensin II effects on the glomerular arterioles is?
|
constricts everything
|
|
Where in the nephron is acid/base balance maintained?
|
PCT
|
|
what is the purpose of the 'curves' in the convoluted tubules?
|
to slow everything down: secretion/reabsorption/retention has greater time to process.
|
|
of the 3 types of buffers..how long do they take to work in the case of acidosis?
-blood is the __ -kidney's work in __ -lungs work in __ |
blood-fastest (minutes)
kidney's work in hours to days lungs work in minutes to hours |
|
Reabsorption of bicarb, K+, and sugar occurs where in the nephron?
|
PCT
|
|
The PCT is located in the renal__
|
cortex
|
|
Reabsorption of NA, K+, H2O, Mg, and Ca++ occurs in the __
|
descending LOH
|
|
The descending LOH is located in the renal __
|
medulla
|
|
Reabsorption of electrolytes in the descending LOH occurs via __
|
osmosis
|
|
K+ sparing diuretics work within which parts of the nephron?
|
DCT and collecting ducts
|
|
What type of diuretics work within the PCT?
|
osmotic
|
|
Carbonic anhydase and Mannitol are examples of __ diuretics.
|
osmotic
|
|
relaxation of the efferent arteriole will cause the GFR to __
|
decrease
|
|
Increased sympathetic output will contract__, the __arteriole will dominate the __arteriole.
|
everything
afferent dominates efferent |
|
What diuretics work in the Loop of Henle?
|
Loop diuretics
|
|
T/F
Lasix has a sulfa group attached so you must be careful with pt's with a sulfa allergy. |
True
|
|
What is secreted in the LOH?
|
nothing!
|
|
What is reabsorbed in the LOH?
|
-sodium chloride
-potassium -water -magnesium -calcium |
|
Which diurectics work in the DCT?
|
-thiazides
-osmotic -potassium sparing |
|
There is reabsorption of what in the DCT?
|
-sodium chloride
-water -calcium -ammonia |
|
What is secreted in the DCT?
|
-potassium
-hydrogen |
|
Reabsorption of water is under the effects of __?
|
ADH
|
|
What is secreted from the DCT?
|
nada!!
|
|
What is the effect of Angiotensin II?
|
-vasoconstriction of arterioles (inc. BP)
-Brain, causes release of ADH from stores in post. pit. -zona glomerulosa, releases aldosterone (Na retention, H20 retention) inc. BP |
|
effects of angiotensin II
|
-increased ADH
-increased Aldosterone -vasoconstriction of arterioles |
|
What are the regulatory mechanisms that maintain pH?
|
-buffers of the blood
concentration of carbonic acid controlled by the lungs -concentration of bicarb controlled by the kidneys |
|
What is the most important intravascular buffer?
|
bicarb
|
|
What is the most important intracellular buffer?
|
hgb
|
|
How do the kidney's control bicarb (2)?
|
-can reabsorb bicarb
-can synthesize bicarb |
|
How is carbonic acid controlled by the lungs?
|
is in equilibrium with carbon dioxide in the pulmonary alveoli
|
|
__ is the passage of particles thru a semipermable membrane
|
diffusion
|
|
__ is the movement of fluid across a semipermeable membrane from a lower concentration of solutes to a higher concentration of solutes.
|
osmosis
|
|
T/F
Diffusion and osmosis cannot occur at the same time. |
False, yes they can
|
|
What are the structures that cannot be easily filtered thru the glomerulus?
|
albumin and large molecules
|
|
__ is a metabolite excreted thru the kidney and is a metabolite of protein.
|
BUN
|
|
Protein metabolites make __
|
ammonia (NH3)
|
|
__is a rough estimate lab value and should not be used for screening.
|
BUN
|
|
__ is a toxic metabolite that effects the brain and can cause confusion.
|
NH3 (ammonia)
|
|
what happens to ammonia in the kidney's?
|
it is filtered into urine and eliminated
|
|
Pt's with what type of organ failure can cause increased ammonia levels?
|
liver disease
|
|
__ is a fantastic measure of kidney function, and that your pt's need to know their #'s.
|
GFR
|
|
A diet high in __ will increase BUN
|
protein
|
|
Hemorrage can cause an increased BUN, but how?
|
secondary to protein degradation
|
|
BUN is a measurement of urea concentration in serum that is used to mainly screen for __ GFR.
|
decreased
|
|
Urea is secreted by the (4)?
|
-kidneys
-intestines -saliva -sweat |
|
Concentrations of BUN are dependent upon (2) things?
|
-hepatic urea production
-renal tubular flow rate |
|
The rate of urea production is dependent on hepatic function and digestion and catabolism of protein, is called __?
|
hepatic urea production
|
|
Urea is freely filtered through the glomerulus and passively diffuses out of the tubules at a rate dependen on flow rate thru the tubules, is called__?
|
renal tubular flow rate
|
|
Hypovolemic patients may have as high as 60% of their urea __
|
reabsorbed
|
|
Why is creatinine not a good measure of kidney function?
|
you have to have big losses before the crt level will ever reflect the loss.
|
|
the concentration of crt in the plasma depends upon two factors...what are they?
|
the rate of its production from muscle and the GFR
|
|
what is the normal adult plasma creatinine level?
|
60-110 mmol/L
|
|
If the GFR falls by half, the plasma crt will __
|
double
|
|
If the plasma crt is 5 times the normal, then the GFR is __of normal.
|
1/5
|
|
Both urea and crt are filtered from __ at the glomerulus.
|
blood
|
|
__ is the best, routinely available, direct measurement of GFR and is therefore a more sensitvie and specific meausre of early renal disease then either BUN or crt.
|
crt clearance
|
|
For every doubling of you blood creatinine, the filtration rate of the kidney's is ___
|
cut in half
|
|
the amount of urea and crt excreated in urine is dependent on the ___
|
GFR
|
|
Creatinine clearance measures the volume of blood plasma which is cleared of __during passage through the kidneys in one minute.
|
creatinine
|
|
Urea is a byproduct of __
|
protein
|
|
a decrease in the GFR means a __ of BUN
|
increase
|
|
a decrease in liver function means a __of BUN
|
decrease as the liver is not producing urea
|
|
__is formed at a constant rate by dehydration of muscle creatine
|
creatinine
|
|
normally __% of muscle creatine is broken into creatinine
|
1-2%
|
|
Creatinine is freely filtered by the __ and is not reabsorbed
|
glomerulii
|
|
normal serum creatinine level is
|
1-2mg/dl
|
|
children, females, elderly, spinal cord injured have __ serum and urine creatinine
|
low
|
|
What is the normal BUN/crt ratio?
|
10:1
|
|
A BUN/crt ratio of >20 indicates __or__
|
dehydration
pre-renal failure |
|
Are hyaline casts in the urine normal or abnormal?
|
normal
|
|
vomiting causes metabolic __
|
alkalosis
|
|
diarrhea causes metabolic __
|
acidosis
|
|
osmolality is controlled by __
|
sodium
|
|
Another name for bicarb is__?
|
total C02
|
|
Renin secretion is from the __
|
macula densa
|
|
Renin is secreted from the macula densa in the __
|
JGT
|
|
Anemia is always seen in __ patients
|
CRF=chronic renal failure
|
|
Why do pt's with CRF have low levels of Vitamin D?
|
because Vit D is processed in the DCT, so CRF pts. have low vit D and Ca++ with high phosphate levels
|
|
What does FeNa stand for?
|
fractional excretion of filtered Sodium
|
|
A FeNa of <1% means?
|
pre-renal failure r/t dehydration/hypovolemia
|
|
If your serum creatinine goes from 1 to 2 means your filtration goes from___.
|
120 to 60
|
|
What is 30/20/10 rule?
|
A BUN of 30=CRF, start to worry, 20=prepare for dialysis
10=start dialysis |
|
hypohydration does what to the serum osmolarity?
|
decreases it
|
|
On a BMP, what does carbon dioxide tell you?
|
gives you the buffering capacity of the plasma
|
|
With metabolic acidosis you will see what happen to the bicarb?
|
lowering of bicarb
|
|
You will see an increased lactic acid levels, decreased bicarb level, and increased CRP in what medical condition?
|
sepsis
|
|
What is a normal anion gap?
|
8-12
|
|
What are the 5 causes of an increased anion gap.
|
-acidosis (lactic)
-salicylates -intoxication -DKA -ethylene glycol (antifreeze) |
|
In diarrhea, the anion gap will be __
|
negative
|
|
__% of O2 is carried in the plasma.
|
3%
|
|
__give information on ventilation (oxygen/carbon dioxide exchange) and acid/base status.
|
ABG's
|
|
What does Pa02 stand for and what are the normal levels?
|
partial pressure oxygen
normal 60-90mm Hg this is information on the percent of oxygen bound to hemoglobin |
|
hyperventilation will __C02 levels?
|
decrease
|
|
hypoventilation will __ C02 levels?
|
increase
|
|
If the GFR is reduced the BUN and crt will be__ ?
|
increased
|
|
The glomerulus filtration rate depends on what 3 factors?
|
-rate at which the blood to be filtered is presented to the filter
-patency of the filter (blocked?) -any opposing pressure on the other side of the filter, reducing filtration rate |
|
Low GFR due to reduced blood volume being presented to the glomerulus for filtration is what type of renal failure?
|
pre-renal
|
|
Low GFR due to damage to the filter is what type of renal failure?
|
renal disease (intrinsic)
|
|
Low GFR due to the blockage on the distal side of the glomerulus opposing filtration pressure is what type of renal failure?
|
post-renal
|
|
nephrons that haven't died yet and that are working hard without time to rest is a description of __?
|
CRF
|
|
__provides an excellent measure of the filtering capacity of the kidneys.
|
GFR
|
|
A decrease in GFR preceds kidney failure in __forms of prgressive kidney disease.
|
all forms
|
|
What are the labs included in a BMP?
|
-glucose, random
-BUN -crt -sodium -potassium -chloride -calcium -total C02 |
|
what is the normal levels for a random glucose?
|
70-100mg/dl
|
|
what is the normal BUN levels?
|
8-18
|
|
what is the normal adult serum creatinine level?
|
0.5-1.2mg/dL
|
|
What is a normal serum total C02 level?
|
22-30mmol/L
|
|
what is the normal sodium level?
|
135-145mmol/L
|
|
what is the normal potassium level?
|
3.5-5.0mmol/L
|
|
What is the normal calcium serum level?
|
8.8-10.2 mg/dL
|
|
What is the normal serum total protein level?
|
6-8
|
|
What is a normal serum albumin level?
|
3.5-5.0g/dL
|
|
What is the nromal serum total bilirubin level?
|
<1.20 mg/dL
|
|
With dilute urine, what happens to the sodium level in the blood?
|
hyponatremia-the urine is too dilute
|
|
With dehydration what will happen to serum sodium levels?
|
hypernatremia-too concentrated
|
|
Electrolytes are measured in terms of their __ within a fluid, not their content.
|
concentration
|
|
If serum osmolarity is high, what will the urine osmolarity do?
|
go low
|
|
hypernatremia=
|
dehydration
|
|
hyponaturemia=
|
overhydration
|
|
What is the most common cause of hyponatremia?
|
iatrogenic-we give too much IVF
|
|
Which fluid compartment in the body contains the most amount of water?
|
intracellular=66%
|
|
Extracellular fluid is broken into 2 compartments, what are they?
|
Extracellular compartment total =34%
-plasma 8% -interstitial 26% |
|
the average human body is approximately __% water.
|
55%
|
|
Why do females generally have lower water contents then men?
|
women have greater fat content and lower muscle mass.
|
|
The kidney is primarily concerned with regulation of the rapidly diffusing substances in the __.
|
ECF
|
|
The most important of the ECF cations is __.
|
sodium
|
|
The major ICF cation is __.
|
potassium
|
|
Is magnesium intracellular or extracellular?
|
intracellular
|
|
Is sodium intracellular or extracellular?
|
extracellular
|
|
The major ECF anion is __.
|
chloride
|
|
The most significant ICF anions are __.
|
proteins
|
|
The __ is a major regulator of the volume of the plasma compartment. This is achieved by variation of the __ and water content.
|
kidney
sodium |
|
The peripheral resistance is regulated by the __.
|
autonomic nervous system
|
|
Pressure regulation is determined by __ and __ of the arterioles.
|
cardiac output
PVR |
|
Other than the ANS, what else regulates PVR?
|
angiotensin and prostaglandins produced directly or indirectly by the kidney.
|
|
What is the "best friend" in renal imaging?
|
renal ultrasound
|
|
US is the first line investigation in __that relates to probable renal parenchymal disease.
|
hematuria
|
|
Renal ultrasound is the 1st line test of choice for __disease.
|
PKD
|
|
US is primarily useful in visualizing kidney __, hydronephrosis, __, and renal cysts.
|
size
renal masses |
|
What are the advantages of renal ultrasound over other diagnostic testing?
|
-noninvasive
-no need for dye or radiation -little preparation |
|
What are the disadvantages of renal ultrasound?
|
-doesn't show ureters
-quality may be reduced due to obesity, bowel gas, or patient cooperation -not good for vesicoureteral reflux |
|
KUB is really only helpful in screening for what type of stones?
|
radioopaque
|
|
A pt. may have a __ reaction to IVP dye.
|
anaphylactoid
|
|
What is the 1st test of choice for diagnosis of stones?
|
CT
|
|
An IVP is very good in showing the __ and __.
|
calyxes and ureters
|
|
What must you know before ordering an IVP?
|
the pt's GFR
|
|
What medication must be stopped for 24 hours prior to an IVP?
|
metformin
|
|
Why must metformin be stopped before an IVP?
|
the binding of metformin and IVP dye causes a lactic acid buildup.
|
|
CRF pt's have chronic __.
|
acidosis
|
|
Name the test in which a catheter is passed up the ureter and dye is injected to delineate the precise level of obstruction.
|
retrograde pyelography
|
|
Retrograde pylography can be use when there is an __ to IVP dye.
|
allergy
|
|
About 90% of kidney stones are __ stones.
|
calcium oxalate
|
|
Approximately __% of kidney stones can be diagnosed by KUB as most stones contain calcium.
|
85%
|
|
An exam of the bladder using a cystoscope is called?
|
a cystoscopy
|
|
Why are cystoscopes usually done?
|
looking for bladder cancer usually.
|
|
Samples of renal parenchymal tissues can be obtained via __
|
a renal biopsy done by a nephrologist
|
|
Does sprinolactone contain a sulfa component?
|
NOPE-SURE DONT
|
|
does thiazide contain a sulfa component?
|
sure does...
|
|
__ failure usually means not enough blood is getting to the kidney's due to dec. cardiac output, hypohydration, or hypovolemia.
|
pre-renal failure
|
|
What is the most common post renal failure caused by?
|
BPH
|
|
__ failure is when the nephron itself is involved, such as tubular necrosis (ATN).
|
Intra-renal (intrinsic)
|
|
What drug should men with BPH never take?
|
benadryl (anticholinergics)
|
|
A decreased Vitamin D makes decreased Calcium levels secondary to __
|
hypoparathyroidism
|
|
Renal failure will cause a decreased __ level.
|
calcium
|
|
name 5 causes of pre-renal failure
|
-hypovolemia
-low cardiac output -inc. SVR -drugs (COX inhibitors) -ACE inhibitors |
|
Name some common causes of renal (intrinsic) failure.
|
-GN
-renovesicular obstruction -TTP -DIC -SLE -ATN -interstitial nephritis |
|
Name 5 causes of post-renal failure
|
-bilateral ureteral obstruction
-BPH -bladder neck obstruction -stricture -phimosis |
|
An acute rise in BUN and crt measured over hours to days is___
|
ARF
|
|
elevated BUN not froman intrinsic renal disease is...?
|
azotemia
|
|
urine output less than 500cc/24 hours is __?
|
oliguria
|
|
urine output greater than 500cc/24 hrs is ?
|
nonoliguria
|
|
urine output less than 50cc/24hrs is __?
|
anuria--and that my friends is bad.
|
|
__renal failure is usually reversible.
|
acute
|
|
__renal failure is usually not reversible.
|
chronic
|
|
End stage renal disease due to gradual loss of renal fcn or sudden onset of repidly progressive disease is the definition of __?
|
CKD (crf)
|
|
Injurey or obstruction of the nephron, most commonly caused by intrinsic ARF often due to ischmic injury or nephrotoxins...is ?
|
ATN
|
|
What are the 3 etiologies of ARF?
|
-ATN/GN
-circulatory dysfcn (shock, hypovolemia, sepsis, cardiogenic) -urinary outflow obstruction |
|
what is the most common cause of intrinsic acute renal failure?
|
injury or obstruction of the nephron often due to ischemic injury or nephrotoxins
|
|
What drugs can commonly cause ARF?
|
-NSAID's
-ACE inhibitors -ARB's |
|
volume depeletion can cause ARF, where do some of these losses come from?
|
-GI losses: vomiting/diarrhea
-Skin losses: burns, sweat -Renal losses: DKA, DI, Addison's dx, Na wasting |
|
Elevated blood levels of nitrogenous waste products is called __?
|
azotemia
|
|
When azotemia progresses to confusion and drowsiness this is called __?
|
uremia
|
|
What are 6 pivotal 'bedside' tests to perform in ARF?
|
-othrostatic VS
-H & P -fluid challenge -foley placement -labs -ultrasound |
|
Urinary casts are only formed in the __ or the collecting ducts.
|
DCT
|
|
__ is usually a compound protein or bacteria that takes on the shape of the DCT or collecting duct.
|
cast
|
|
What type of casts will you see in glomerulonephritis?
|
red blood cell cast
|
|
__casts are composed primarily of mucoproteins.
|
hyaline
|
|
Are hyaline casts normal or abnormal
|
can be normal
|
|
Hyaline casts are most commonly seen in...
|
exercise, dehydration, heat exposure or stress.
|
|
WBC's seen in the urine are in response to...?
|
infection
|
|
Granular/waxy casts are seen in __?
|
ARF
|
|
Broad casts are seen in __?
|
CRF
|
|
Maltese cross casts are seen in __?
|
nephrotic syndrome
|
|
__ is the presence of abnormal numbers of red cells in urine.
|
hematuria
|
|
hematuria in the elderly is __ until proven otherwise
|
cancer
|
|
__ presence of abnormal numbers of leukocytes that may appear with infxn in either the upper or lower urinary tract or with GN.
|
pyuria
|
|
__cells from the skin surface or from the outer urethra can normally appear in the urine, but over 25 means a poor sample.
|
epithelial cells
|
|
An elevated specific gravity means...?
|
hypohydration
|
|
A FeNa of <1% means __failure.
|
pre-renal
|
|
ARF is frequently defined as an acute increase of the serum crt level by __% from baseline.
|
25%
|
|
What is the mainstay of treatment pre-renal ARF?
|
IV hydration
|
|
Half of pts with acute renal failure are __.
|
septic
|
|
What lab should you check for status of your patients sepsis?
|
lactate level!!
|
|
What lab do you watch for CHF progression?
|
BNP
|
|
Toxic wastes can be divided into 2 categories..what are they?
|
endogenous and exogenous
|
|
__ wastes are produced by normal body metabolism,ie: creatinine
|
Endogenous
|
|
__ wastes are produced from environmental sources (drug metabolites)
|
Exogenous
|
|
What is the minimal volume needed to excrete daily production of metabolites and waste products.
|
400cc/day
|
|
NSAID's usually do not cause interstitial nephritis, but by inhibiting prostaglandin synthesis they decrease __.
|
GFR
|
|
Most common cause of ARF is __.
|
ATN
|
|
Which type of renal failure is most common?
|
pre-renal
|
|
What is usually the first sign of renal failure?
|
oliguria
|
|
__ is an irreversible, substantial, long standing loss of renal function.
|
CRF
|
|
What are common causes of CRF? Mneumonic is ACID/BASE.
|
A-analgesic nephropathy (ASA)
C-cystic dx (polycystic) I-interstitial nephritis D-diabetes B-BP A-renal Artery athermanous dx S-stones E-enlarged prostate |
|
What are common complications of CRF? Mneumonic is RESIN & 8P's
|
R-retinopathy
E-excoriations S-skin is yellow I-inc. BP, inc. K+ N-nails are brown P-pallor r/t chr. anemia P-purpura and bruises P-pericarditis P-pleural effusions P-peripheral edema P-prox. myopathy P-peripheral neuropathy P-phosphates, increased |
|
__ is accepted as the best overall measure of kidney fcn in health and disease.
|
GFR
|
|
Comorbidities of CRF (ckd) are ? list 5.
|
-htn
-anemia -bone disease -metabolic acidosis -protein malnutrition |
|
What type of diuretics are the best in the tx of CRF?
|
Loop diuretics
|
|
The anemia of CRF has several potential causes, but the overwhelming reason is lack of __.
|
erythropoeitin
|
|
What type of diet should you consider for all CRF patients.
|
low protein diet.
|
|
What are the 4 goals of CKD therapy?
|
-delay onset of ESRD
-Dec. cardiovascular risk -Empower/educate patients -Improve overall quality of life |
|
What are the recommended screening tests for patients at risk for CRF/CKD?
Name 5 |
-serum crt for est. GFR
-BP -glucose -UA -microalbuminuria/proteinuria |
|
__is a physiological, transient condition that occurs when strenuous activity that is followed by a release of hyaline and granular casts in the urine.
|
athletic pseudo-nephritis
|
|
What is the tx of athletic pseudo-nephritis?
|
stop exercising stupid
|
|
Modest edema, htn, oliguria, hematuria, RBC casts, and proteinuria are indicative of __?
|
nephritic syndrome
|
|
Massive edema, normotension, and massive proteinuria are indicative of __?
|
nephrotic syndrome
|
|
__syndrome is assoc. with a non-inflammatory but "leaky" glomerular lesion which allows protein to drift into the filtrate.
|
nephrotic
|
|
__syndrome describes a condition assoc. wtih inflammatory and exudative lesions of the glomeruli.
|
nephritic
|
|
__syndrome can be seen in CRF patients.
|
uremic syndrome
|
|
__is a syndrome assoc. with chronic renal failure that affects multiple organ systems.
|
Uremic syndrome
|
|
__ is the inability of the kidney to concentrate urine; fixing specific gravity at 1.010.
|
uremic syndrome,
the kidney cant concentrate the urine any longer |
|
What are some s/s of uremic syndrome?
There are lots.... |
pale complexion, wasting, purpura, pruritis, polydipsia, nausea, anorexia, vomiting, proteinuria, isosthenuria, abn. sediment, tubular casts
|
|
Uremic syndrome can effect what other body systems?
|
All of them, if it can happen-it will happen
|
|
What metabolic abnormalities are seen with uremic syndrome?
|
elevated triglycerides
insulin resistance with impaired glucose tolerance |
|
If your patient looks like the Michelin Man, what should you think of?
|
nephrotic syndrome
|
|
Glomerular lesion causing proteinuria >3 g/day is indicative of __?
|
Nephrotic syndrome
|
|
Name 5 pathophysiologic factors seen with Nephrotic Syndrome.
|
-loss of glomerular impermeability to plasma proteins
-proteinuria -severe dec. in serum proteins and oncotic pressure -edema and serosal effusions -hypercholesterolemia |
|
__crosses are seen in nephrotic syndrome.
|
maltese crosses
|
|
Clinical findings with Nephrotic Syndrome are..?
mneumonic is LEAC |
L-lipids up, r/t protein loss
E-edema, r/t 3rd spacing A-albumin down r/t protein loss C-coagulapathy r/t loss of protein S & C |
|
Complications of nephrotic syndrome are?
mneumonic is SALT |
S-susceptible to infxns r/t loss of complement
A-ARF L-lipidemia, loss of proteins T-thromboembolism |
|
Nephrotic Syndrome is also known as __ disease.
|
Nil's
|
|
One more time...the complications of Nephrotic Syndrome include?
mneumonic is NAPLES. |
N-nephrotic syndrome
A-albumin decreases P-proteinuria L-lipidemia E-edema S-sequelae or complications |
|
Nephrotic syndrome, proteinuria is greater than__?
|
>3.5 g/day
|
|
Hypoalbuminemia in Nephrotic syndrome means less than..?
|
<3gr/dL
|
|
Glomerular diseases are either __ or __?
|
inflammatory or leaky
|
|
UA's in Nephrotic Syndrome will show what commonly?
|
high proteinuria
fatty casts free fat droplets, oval fat bodies may or may not have hematuria |
|
UA's in Nephritic Syndrome will commonly show?
|
high hematuria
RBC's and WBC's RBC and granular casts may or may not have proteinuria |
|
UA in CRF may show?
|
waxy and pigmented granular casts.
May or may not have proteins, hematuria, or cells |
|
An inflammed glomerlus is indicative of __syndrome.
|
nephritic
|
|
With Nephritic syndrome, the amount of __ filtered is reduced and the amount is reabsorbed in inappropriately large-expanding the ECF.
|
sodium
|
|
Post streptococcal glomerular
nephritis is a classic example of __ syndrome. |
nephritic
|
|
PSGN is an example of when the glomerulus is __.
|
swollen
|
|
__involves abrupt onset hematuria with RBC casts, mild proteinuria, often HTN, edema and azotemia.
|
Nephritic syndrome
|
|
__is elevated BUN and crt.
|
azotemia
|
|
What is the hallmark sign of PSGN?
|
asymptomatic hematuria
|
|
T/F
Steroids are the #1 treatment of PSGN. |
False, they do NOT work at all and may even worsen the condition
|
|
What is the 1st sign of PSGN?
|
hematuria
|
|
"Broad" casts are also called...?
|
renal failure casts
|
|
Broad casts occur when the flow of urine in the lumen of the tubules becomes...?
|
very compromised
|
|
Minimal change disease is a cause of __syndrome and is known as a kids disease.
|
nephrotic
|
|
-lipoid nephrosis
-nil lesion disease -foot process disease -minimal change nephrotic syndrome All are also called what? |
minimal change disease
|
|
MCD is observed most often in kids with 80% of cases occurring before __years of age, and is more often found in males.
|
8 years old
|
|
What are 2 therapies for the treatment of MCD?
|
-low sodium diet
-steriod sensitive |
|
What 3 immunizations should all renal patients receive?
|
-flu
-pneumonia -prevnar |
|
What is the classic triad of nephrotic syndrome?
|
-proteinuria
-hyperlipidemia -edema |
|
What is the normal urine specific gravity?
|
1.005-1.035
|
|
What is the normal urine pH range?
|
4.5-8
|
|
What is the normal amount of RBC's seen in urine?
|
0-5/hpf
|
|
What is the normal level of WBC's seen in urine?
|
0-4/hpf
|
|
What is the normal amount of casts seen in urine?
|
1-2 hyalines are ok, but anything else is abnormal.
|
|
T/F
crystals seen in urine are always indicative of a problem. |
false, it is ok for some to present
|
|
Even trace amounts of __ in the urine are clinically significant.
|
bilirubin
|
|
It is normal to have how much protein in the urine.
|
none, but over 0.3g/L is clinically significant
|
|
Is urobilinogen abnormal in the urine?
|
yes and no. normal range is 3-17mmol/L, but over 34 is the point where it becomes abnormal.
Disclaimer-these were Dr. Hakemi's words not mine..I have no idea what this means. |
|
__is dependent on the conversion of dietary nitrate to nitrite by gram negative bacteria.
|
nitrite
|
|
Positive nitrites results may indicate the presense of greater than 10-5 __cells per mL.
|
bacterial cells
|
|
T/F
If the nitrites on the UA are negative then there is no UTI |
false, can still have a UTI
|
|
How many leukocytes are normal to see in a urine?
|
none, any are clinically significant.
|
|
Hematuria, proteinuria, hypoalbuminemia, oliguria, edema, and htn indicate what syndrome?
|
nephritic syndrome
|
|
proteinuria, hypoalbuminemia, edema, hyperlipidemia, and lipiduria are indicative of what syndrome?
|
nephrotic syndrome
|
|
You will see classic maltese crosses with __syndrome.
|
nephrotic
|
|
complicated uti's include:
|
involving the upper urinary tract
chilren men pregnancy structural neurological abnormalities |
|
Uncomplicated __ involves bacteria that adhere to urothelium, typically by e.coli or staph.
|
cystitis
|
|
Bugs that cause UTI's...
mneumonic is SEEKS PP |
S-s. saprophyticus
E-e.coli E-enterobacter (most serious) K-klebsiella S-serritia P-proteus P-pseudomonas |
|
What bug would most likely give a hospitalized pt a UTI?
|
pseudomonas
|
|
__ is an infection of the renal pelvis and parenchyma.
|
acute pylonephritis
|
|
What bugs are most commonly responsible for acute pylo's?
|
e.coli, proteus, klebsiella, and enterobacter (the worst)
|
|
What are s/s of pylonephritis?
|
-fever, chills, urinary frequency and urgency, dysuria, CVA tenderness
|
|
what lab findings will you see in a pt with pylonephritis?
|
UA= L.E., and nitrates
bacturia, pyuria, and ? hematuria. cultures will show heavy growth, blood cultures may be positive. |
|
What type of abx's are usually number one for the tx of pylonephritis?
|
FQ's
|
|
If you suspect bacterial prostatitis, would should you NOT do?
|
prostate exam
|
|
__ is the inflammation of the prostate due to bacteria ascending the urethra and then passing into the prostate thru the prostatic ducts.
|
bacterial prostatitis
|
|
What are the most common pathogens assoc. with bacterial prostatitis?
|
e.coli
pseudomonas |
|
What are the s/s of bacterial prostatitis?
|
-perineal and suprapubic pain
-dysuria and urinary frequency -fever -tender prostate on PE |
|
What will a UA show with bacterial prostatitis?
|
bacteruria and pyuria
|
|
What is the tx of outpatient bacterial prostatitis?
|
TMP-SZM or cipro for at least 21 days
|
|
__ is an inflammatory process in the prostate from and unknown etiology.
|
non-bacterial prostatitis
|
|
What are the symptom's of nonbacterial prostatitis?
|
urinary frequency and dysuria
nontender, enlarged prostate on PE |
|
What will lab studies show with nonbacterial prostatitis?
|
UA and C/S are negative
leukocytes can be seen in prostatic secretions |
|
What is the tx of nonbacterial prostatitis?
|
anti-inflammatories for sx relief
abx for 4 weeks is controversial |
|
What is urolithisis?
|
renal stones
|
|
__ typically radiates from the loin around to the lower quadrant of the aabdomen and upper medial thigh on the same side.
|
renal colic
|
|
What type of kidney stone is the most common?
|
calcium oxalate
|
|
What type of stone does the bacteria proteus cause?
|
infectious
|
|
T/F
urate stones can be easily identified on x-ray |
false, calcium stones are seen on x-ray
|
|
high uric acid levels will cause what type of stones to develop?
|
urate stones
|
|
__ is a metabolic end-product excreted in the urine.
|
oxalate
|
|
staghorn stones are caused by __ stones
|
infectious
|
|
__ is a calculi in the urogenital system
|
urolithiasis
|
|
Are men more apt to get stones than women?
|
yes by 3:1
there is a familial tendency also whites>AA |
|
Another name for infectious stones is?
|
Struvite stones
|
|
T/F
The same patient may have more than one type of stone concurrently. |
true
|
|
What is the key common denominator in all types of stones?
|
hypohydration
|
|
The causative factors of calcium oxalate stones are ?
|
underlying metabolic abnormality
|
|
The causative factor of struvite (infectious) stones are?
|
infection
|
|
The causative factors of uric acid stones are?
|
hyperuricaemia and hyperuricosuria
|
|
In a male pt that has flank pain that radiates to his groin you must think of?
|
kidney stones
|
|
What are 3 common s/s of kidney stones other than pain?
|
hematuria
nausea vomiting |
|
What is the gold standard for the diagnosis of kidney stones?
|
spiral CT
|
|
A urine pH of <5 is indicative of what type of stone?
|
uric acid stones (note the low pH) high acid environment
|
|
A urine pH of >6 suggests what type of stone?
|
struvite/proteus (infectious)
|
|
Why is renal ultrasound not good for the diagnosis of stones?
|
misses small stones, and doesn't do ureters
|
|
KUB is a __ test, not a __ test
|
screening not a diagnostic test
|
|
What is the tx of renal stones?
|
-toradol
-no hydration more than normal |
|
What is the 1st line tx of stones?
|
NSAID's
|
|
What are some DD that you should not miss when you suspect a renal stone?
|
ectopic pregnancy
AAA bleeding renal cell CA GI obstruction malingering |
|
The KUB will miss what type of stone?
|
radiolucent uric acid stones, stones over bone or obstruction
|
|
What is the medication tx of calcium stones? They decrease the amount of calcium in the urine.
|
thiazide diurectics
|
|
How do you treat struvite stones? prevention?
|
treat the infection
lower the urine pH |
|
Who do you tx uric acid stones? prevent?
|
Allopurinol
raise the urine pH |
|
Recent evidence shows that the formation of stones is a result of a nanobacterial dx akin to __ and PUD
|
h. pylori
|
|
What are dietary recommendations you should make for pt's with calcium oxalate stones?
|
low sodium
low animal protein |
|
Most ureteral stones under __mm, pass spontaneously?
|
5mm
|
|
Name 6 general measures to prevent recurrent stone formation.
|
-inc. fluid intake
-dec. intake of animal protein -restrict salt intake -normal calcium intake -dec. dietary oxalate -cranberry juice |
|
If your patient has an elevated calcium level, what should you check next?
|
PTH
|
|
You should urgently consult urology when..?
|
urosepsis
ARF or anuria unremitting pain if fails to pass stone in 2-4 wks stone >5mm |
|
T/F
In a pt with a calcium stone you should restrict their calcium intake. |
false, restrict salt and animal protein intake but calcium intake will not help
|
|
__ nephropathy is characterized by gross or microscopic hematuria without other symptoms.
|
IgA
|
|
When evaluating hematuria, what should you be looking for?
mneumonic is I PEE RBC'S |
infection
pseudohematuria (menses) exercise external trauma renal dx benign prostatic hypertrophy cancer stones |
|
What 3 things are included in a basic hematuria workup?
|
H & P
labs imaging |
|
T/F
coumadin could be a cause of hematuria. |
false, not a cause but an indication of underlying process
|
|
In pt's with hematuria, what are 4 risk factors for cancer?
|
age>50
smoker exposure to aniline dyes (leather, dye, rubber, tires) cyclophosphamide (chemo drug) |
|
A lab workup for hematuria includes what 3 things?
|
UA
CBC BMP |
|
If the patient's problem arises from the kidney, ureter, or a stone you should consult?
|
urology
|
|
If the pt's problem arises from the glomerulus you should consult?
|
nephrology
|
|
What are the 3 top causes of hematuria in pt's under age 20?
|
UTI
GN congenital abnormalities |
|
What are the 3 most common causes of hematuria in pt's 20-60 years old?
|
UTI
stones cancer |
|
Hematuria in a pt over age 60 is __ until proven otherwise.
|
cancer
|
|
What are the 4 top causes of hematuria in pt's over 60.
|
UTI
cancer BPH systemic vasculitis |
|
Name 6 reasons for false positive proteinuria.
|
UTI
sepsis heart failure strenuous exercise heavy protein content menses |
|
Persistent proteinuria is broken into what 2 categories?
|
primary renal dx
secondary renal dx |
|
What does primary renal disease mean in regards to proteinuria?
|
glomerular or tubular
|
|
What does secondary renal disease mean in regards to proteinuria?
|
diabetes mellitus, CHF, HTN
|
|
Proteinuria is a dominant risk factor for deterioration of __ and a marker of increased risk for __ mortality/morbitity.
|
renal failure
cardiovascular |
|
What is a autosomal dominant kidney disease?
|
polycystic kidney disease
|
|
What are the initial s/s of PKD?
|
htn
flank pain gross hematuria renal infxn renal insufficiency |
|
What is the 1st screening test for PKD?
|
renal ultrasound
|
|
What are the tx's of PKD?
|
ace inhibitors
transplantation hemodialysis *screen for occult cerebral hemorrages |
|
PSA is a tumor marker used for __ not screening.
|
diagnosis
|
|
When should men begin having their PSA's checked?
|
>50 for whites
age 40 for AA |
|
False positive PSA's can result from what 3 things?
|
-DRE
-BPH -infection |
|
What are 3 big risk factors for prostate ca?
|
-family hx
-inc. animal fat consumption -age |
|
false negatives can come from?
|
-NSAID's
-proscar/avodart -propecia (smaller dose of proscar) |
|
Furosemide and Bumex are examples of what type of diuretics?
|
loop diuretics
|
|
what are some indications for loop diuretics?
|
fluid overload
htn hypercalcemia |
|
What must we watch for when using loop diuretics?
|
lyte imbalances
volume depletion tinnitus |
|
Name some indications for thiazide diuretics.
|
-htn especially when combined with an ACEi
-with loop for profound edema |
|
What do NSAID's do to the kidney's?
|
interfere with prostaglandin production
disrupt regulation of renal medullary bld flow and salt water balance |
|
NSAID's and CRF can be exacerbated by what other drugs?
|
ACE inhibitors
|
|
Why meds should you not give to CRF patients?
|
aminoglycosides
tobramycin they are nephrotoxic |
|
If you have to prescribe aminoglycosides, how should you go about it?
|
load dose does not change,
maintance dose dose change once daily dosing watch peaks and troughs |
|
Spironolactone is what type of diuretic?
|
potassium sparing
|
|
Amphotericin B is what class of drug?
|
anti-fungal
|
|
The __ is the structural unit of the kidney?
|
nephron
|
|
The __ is responsible for the formation of urine.
|
nephron
|
|
T/F
The number of nephrons does not increase after birth. |
true
|
|
T/F
Filtrate is the same as urine. |
false
|
|
__ arterioles feed into the glomerular capillary bed.
|
Afferent
|
|
__ arterioles carry the newly filtered blood away from the glomerulus.
|
Efferent
|
|
__ is a cup shaped structure that encloses the glomerulus.
|
Bowman's capsule
|
|
__ extends off of Bowman's capsule, it is formed by a single layer of cuboidal epithelium.
|
PCT
|
|
__ the proximal portion that is connected to the proximal tubule.
|
LOH
|
|
__collects urine from several nephrons distal tubules and carries it through the medulla pyramids to the minor calyces.
|
Collecting ducts
|
|
__is a measurement of how well the kidneys are processing wasts.
|
GFR
|
|
The __ determines the stage of chronic renal disease.
|
GFR
|