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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