Clinical Medicine Ii - Renal Disorders

Front 1

Basic Functional Unit of the Kidney

Back 1

The Nephrons

Front 2

Basic Anatomical Facts about the Kidneys

Back 2

• They are retro-peritoneal (behind peritoneal lining)
• There is typically one main artery to each kidney
• Each kidney normally contains about 1 million nephrons
  

Front 3

In Normal Kidneys the amount of filtrate we start with as blood passes through the glomerulus into the proximal tubules is:

Back 3

120 ml/minute

Front 4

The amount of urine output resulting from the above filtrate of blood per minute is approximately:

Back 4

1-2ml/minute

Front 5

The primary function of the glomerulus is

Back 5

To filter blood, removing wastes

Front 6

The primary function of the Loop of Henley is:

Back 6

to concentrate the urine

Front 7

True statements about the Juxtaglomerular apparatus include:

Back 7

• It helps regulate blood pressure
• Maintains constant glomerular filtration rate (GFR) with range of blood pressures
• Is the source of renin from kidneys, regulates blood pressure via renin-angiotensin system

NOTE - does NOT control the amount of toxins excreted in the urine.

Front 8

The primary function of the Collecting ducts is

Back 8

To control the re-absorption of water molecules via responding to vasopressin (ADH) thereby "fine tuning" the final diluteness or concentration of the urine.

Front 9

Basic tests of kidney function include

Back 9

• Urinalysis
• Creatinine Level
• BUN (blood urea nitrogen) level
  

Front 10

Uremia is characterized by all of the following:

Back 10

• Profoundly abnormal renal function tests
• Neurological symptoms such as sterixis (flap)
• Stupor and coma

NOTE - Does NOT cause Acute flank pain

Front 11

True statements about Acute tubular necrosis (ATN) include:

Back 11

• It can be reversible if recognized and treated
• Its mechanism involves sloughing of the cells lining the renal tubules
• It can be preceded by "prerenal azotmeia" where the kidney fxn tests become abnormal before acute tubular necrosis occurs.

NOT result of longstanding illnesses eg. diabetes

Front 12

People with chronic renal failure need

Back 12

Need either dialysis or a kidney transplant - or they will die!

Front 13

In chronic renal failure you have

Back 13

• Kidneys get smaller
• Cardiovascular effects
• Destruction of nephrons, leading to hyperfiltration and more destruction of nephrons.
• Reduced red cell counts in the blood
  

Front 14

Chronic renal failure commonly results from:

Back 14

• Diabetes
• Systemic Lupus Erythematosis and other autoimmune diseases
• Hyptertension

NOT Hemorrhagic shock - that would be ATN

Front 15

Diseases which primarily affect the function of the glomerulus:

Back 15

• Glomerulonephritis
• Nephrotic Syndrom

NOT Kidney Stones

Front 16

In glomerulonephritis, there is

Back 16

• Leakage of blood cells and protein into urine
• Deposition of immune complexes into the structures of the glomerular walls
• In cases involving vasculitis, such as Systemic Lupis, often progression to renal failure.
  

Front 17

The nephrotic syndrome is characterized by

Back 17

• Massive protein loss in the urine
• Low serum albumin levels
• Fat globules in the urine
  

Front 18

Because of the protein loss in the nephrotic syndrome, you may have all of the following:

Back 18

• Fainting due to low blood volume
• Increased infection risk, due to loss of IGG in the urine
• A hypercoabualable state, due to loss of clot busters like protein C and antithrombin in the urine
• Low levels of albumin
  

Front 19

A patient with Nephrolithiasis (kidney stones) will probably

Back 19

• Have no pain if the stone is in the renal pelvis and not the ureter
• Have SEVERE, "waves" of flank pain and be unable to get comfortable in any position due to stretching of the walls of the ureter if the stone is lodged there.
• Have blood in the urine.
  

Front 20

Kidney stones are most often made of:

Back 20

Calcium oxalate