Reading...
Play button
Play button
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;
88 Cards in this Set
- Front
- Back
|
What labs reflect glomerular function?
|
protein content in urine
GFR |
|
|
What labs reflect tubular reabsorption?
|
specific gravity of urine
|
|
|
What are the two main causes of renal failure?
|
DM
HTN |
|
|
What is BUN, and how is it made?
|
this is excess nitrogen in the body, which is disposed in Urea.
Urea is filted from the blood and excreted in urine. |
|
|
What happens to the high BUN in people with renal disease?
|
the urea can be cleaved in the gut into ammonia by bacteria- and reabasorbed. which is bad
|
|
|
What happens to the BUN in kidney disease?
|
it is elevated, often before creatinine
|
|
|
What things can increase the BUN?
|
kidney disease
GI bleed catabolic states dehydration |
|
|
What is Creatinine?
|
this is the end product of creatine in skeletal muscle that made ATP
|
|
|
When is Creatinine increased?
|
decreased GFR
|
|
|
When do you get Hyponatremia in kidney disease?
|
renal tubular defect with salt wasting
|
|
|
When do you get Hyperkalemia in kidney disease?
|
decreased renal excretion, end stage disease
|
|
|
When do you metabolic Acidosis in kidney disease?
|
tubular loss of bicarbonate (low bicarb, and low CO2)
decreased tubular excretion of organic/inorganic acids |
|
|
What does all glomerular disease result in?
|
proteinuria
|
|
|
What does specific gravity measure?
|
the ability to concentrate urine
|
|
|
What are the signs of acute nephRITIC syndrome?
|
gross hematuria
mild/moderate proteinuria HTN |
|
|
What are the signs of nephROTIC syndrome?
|
3.5gm/24hrs in urine**
hypo albumin edema high lipids GFR increased* at first...but then Decreased over time*** Normal BUN/Creatinine** |
|
|
What are the consequences of poorly selective proteinuira (pissing out all kinds of proteins)
|
infections
clotting |
|
|
What is the best measure for renal function?
|
the GFR
|
|
|
What is the normal GFR ?
|
125ml/min/1.73m2
|
|
|
What defines stage 1 CKD?
|
GFR is greater than 90ml/min/1.72m
AND has proteinuria |
|
|
What defines stage 2 CKD?
|
GFR of only 60-89ml/min/1.72m
azotemia (elevated BUN and Creatinine) |
|
|
What defines stage 3 CKD?
|
GFR 30-59
|
|
|
What defines stage 4 CKD?
|
GFR 15-29
|
|
|
What defines stage 5 CKD?
|
GFR Less than 15
|
|
|
Other than GFR, what are the signs of Renal insufficiency stages 3-4
|
Azotemia
Anemia- low epo/iron HTN poyluria/nocturia |
|
|
Other than GFR what are the signs of renal failure stages 4-5
|
Edema
metabolic acidosis hypocalcemia |
|
|
What is Azotemia?
|
elevated BUN and Creatinine levels due to decreased GFR
|
|
|
What are is the BUN to Creatinine ratio common in Azotemia?
|
12:1 to 20:1 BUN:Creatinine
|
|
|
What is Prerenal Azotemia?
|
this is due to hypoperfusion of the kidneys
due to hemorrhage, shock, volume depletion, CHF |
|
|
What is the BUN: Creatinine ratio in Prerenal Azotemia?
|
20:1 or greater
|
|
|
What is Postreanl azotemia?
|
this is kidney problems due to urinary outflow obstruction
|
|
|
How does Uremia affect Calcium, Phosphate, and Bone?
|
Hyperphosphatemia
Hypocalcemia Hyperparathyroidim- elevated PTH (to try and bring the Ca back up) Renal Osteodystrophy |
|
|
How does Uremia affect the Blood?
|
Burr Cells
Low EPO Low Iron Bleeding diathesis due to platelet dysfunction |
|
|
How does Uremia affect the CV system?
|
platelet dysfunction
Burr cells HTN Fibrinous pericarditis |
|
|
How does Uremia affect the eyes?
|
causes bother atherosclerotic retinopathy and hypertensive retinopathy
|
|
|
How does Uremia affect the lungs?
|
Hilar pneumonitis, gives it a "BAT WING" opacity on xray
Deep Sighing (KUssmaul) breathing breath smells like urea |
|
|
What are the GI manifestations of Uremia?
|
N/V
GI bleeding Esophagitis, Gastritis Colitis with ulcers |
|
|
What are the Neuromusclar manifestation of Uremia?
|
myopathy
peripheral neuropathy encephalopahy |
|
|
What are the dermatologic manifestations of Uremia?
|
Sallow color (gray-yellow)
pruritus dermatitis Excoriations (flaked off areas) |
|
|
What causes Uremia?
|
Azotemia
|
|
|
What is Potters syndrome?
|
bilateral total renal agenesis- kid dies
|
|
|
What is unilateral renal agenesis cause?
|
hypertrophied functional kidney
may develop glomerular sclerosis |
|
|
What does bilateral kidney hypoplasia lead to?
|
childhood renal failure
|
|
|
Where are ectopic kidneys usually located?
|
in the pelvis or just above the pelvic brim
|
|
|
What are the risks associated ectopic kidneys?
|
UTI's
obstruction due to tortuosity of ureter |
|
|
What is a horseshoe kidney?
|
the kidneys fuse across the midline of the body
|
|
|
What is the histology of Multicystic renal dysplasia?
|
Cartilage, undifferentiated mesenchyme
immature collecting ductles abnormal lobular organization |
|
|
What are the clinical findings with Multicystic renal dysplasia?
|
enlarged cystic kidney or flank mass, present at birth
|
|
|
How is adult polycystic kidney disease transmitted?
|
autosomal dominant
|
|
|
what gene is implicated in adult polycystic kidney disease?
|
PKD1 on chromosome 16
|
|
|
What are the typical clinical symptoms of adult polycystic kidney disease?
|
asymptomatic till older about 53
renal colic pain from bleeding bilateral abdominal masses polyuria proteinuria HTN |
|
|
What three things are often associated with adult polycystic kidney disease?
|
Polycystic Liver Disease
Berry Aneurysm Circle of Willis Mitral Valve Prolapse |
|
|
What is the course of adult polycystic kidney disease?
|
slow progression to azotemia
eventual death due to HTN |
|
|
How is Childhood Polycystic disease transmitted?
|
this is an autosomal recessive disease
|
|
|
What gene is mutated in Childhood Polycystic disease?
|
PKHD1- codes for fibrocystin
|
|
|
What does the PKD1 gene in Adult polycystic kidney disease code for?
|
this codes for polycystin
|
|
|
What do Preinatal and neonatal Childhood Polycystic disease usually result in?
|
rapid renal failure and death
|
|
|
What do infantile and juvenile Childhood Polycystic disease usually result in?
|
hepatic fibrosis, and liver disease that kills you later on
|
|
|
What is the morphology of Childhood Polycystic disease?
|
parallel cylindrical cysts in the cortex and medulla at right angles to coritcal surface
|
|
|
What is the morphology of Medullary sponge kidney?
|
multiple cystic dilation of the collecting ducts in the medulla of adults
these have a cuboidal/transitional** cell lining |
|
|
What are the complications of Medullary sponge kidney?
|
calcifications in dilated ducts
hematuria |
|
|
What are the characteristic of Juvenile Nephronophthisis
|
cysts in medulla at corticomedullary junction
cortical tubular atrophy interstitial fibrosis |
|
|
What is the geneotype of Juvenile Nephronophthisis ?
|
autosomal recessive
|
|
|
When does autosomal dominant nephronophthisis occur?
|
in adults
|
|
|
What are the clinical signs of Medullary Cystic Disease (Juvenile Nephronophthisis )
|
Pallor
hyperparathyroidism deminilaized bone Aztoemia low CA2+, high phos Uremia Anemia Polyuria Salt wasting |
|
|
What causes acquired cystic disease?
|
prolonged dialysis, causes tubules to become obstructed with fibrosis or oxalate crystals
|
|
|
How much of the cardiac output do the kidneys get?
|
25%, wow!
|
|
|
What do infacts of the kidney look like?
|
white/ anemic segments
|
|
|
What is the morphology of benign nephrosclerosis?
|
hyaline arteriolosclerosis- narrow lumen with thick walls
patchy ischemic atrophy finely granular surface of kidney |
|
|
What are the clinical findings in benign nephrosclerosis
|
maybe slightly reduced GFR
maybe proteinuria |
|
|
What causes accelerated nephrosclerosis?
|
malignant HTN
|
|
|
Who is most at risk for accelerated nephrosclerosis
|
young black men with HTN
|
|
|
What are the physical findings of accelerated nephrosclerosis?
|
scleroderma with nephropathy
|
|
|
How does renal ischemia lead to malignant HTN?
|
can cause hyper-reninemia
|
|
|
What are some physical findings of accelerated nephrosclerosis/malginant nephrosclerosis?
|
fibrinoid necrosis of arteries
onionskin hyperplasia of arterioles focal hemorrhages on kidney surface |
|
|
What are the 3 causes of HTN with hypokalemia?
|
primary hyperaldosteronism
secondary hyperaldosteronism due to renal disease cushing syndrome |
|
|
IS unilateral renal artery stenosis curable?
|
yes it is
|
|
|
How does renal artery stenosis cause HTN?
|
excessive renin secretion from the ischemic kidney
|
|
|
What is a goldblatt kidney?
|
a shrunken kidney due to unilateral renal artery stenosis
|
|
|
What are the common causes of renal artery stenosis?
|
atherosclerosis
fibromusclar dysplasia |
|
|
what does the other kidney look like in renal artery steonosis?
|
contralateral kidney has hyaline arteriolosclerosis
|
|
|
What is the morphology of Thrombotic microangiopathies?
|
**Eosinophilic hyaline thrombi
platelet or fibrin clots in small arteries or glomeruli |
|
|
What is the most common cause of HUS?
|
E coli infection
|
|
|
What does HUS look like?
|
Sudden onset
-severe oliguria with hematuria microangiopathic hemolytic anemia neruo disease |
|
|
What is deficient in TTP?
|
ADAMTS-13
|
|
|
What is the presentation of TTP?
|
fever, anemia, microangiopathic hemolyic thrombocytopenic purpura
renal failure |
|
|
What causes Papillary necrosis of the kidney?
|
sickle cell disease
|
|
|
What causes diffuse cortical necrosis?
|
shock, septic shock
|
