Pathophysiology-Chapter 21

Front 1

What secretes ADH? What effect does it elicit?

Back 1

Posterior Pituitary Gland ; increases water reabsorption in distal convoluted tubules and collecting ducts

Front 2

Where is aldosterone secreted? What effect does it elicit?

Back 2

Adrenal cortex
Sodium reabsorption in exchange for potassium or hydrogen

Front 3

Functions of the urinary system

Back 3

- remove metabolic wastes (nitrogenous and acidic)
- remove hormones, drugs, and acid-base balance in the body
-secrete erythropoietin
-activate Vitamin D
- regulate blood pressure through the renin-angiotensin-aldosterone system (RAS)

Front 4

Where are the kidneys located?

Back 4

Retroperitoneally on the posterior abdonminal wall

Front 5

What protects the kidneys from injury?

Back 5

Fibrous capsule
Fat that surrounds it
Lower ribs

Front 6

What is the outer layer of the kidney called? Inner layer?

Back 6

Cortex
Medulla

Front 7

which layer is the renal pelvis in?

Back 7

Medulla

Front 8

Which layer is the calyces in?

Back 8

Medulla

Front 9

What is the functional unit of the kidney?

Back 9

Nephron

Front 10

What is superior to the kidney?

Back 10

Adrenal gland

Front 11

Two types of nephrons

Back 11

Cortical and Juxtamedullary

Front 12

blind end of the proximal convulated tubule

Back 12

Bowman's capsule

Front 13

During filtration, what passes from the blood into the tubule? What stays in the blood?

Back 13

Large volume of fluid (wastes, nutrients, electrolytes, and other dissolved substance);
CELLS AND PROTEIN REMAIN IN THE BLOOD

Front 14

Where does reabsorption of essential nutrients, water, and electrolyes occur?

Back 14

Proximal convoluted tubule (has brush border of microvilli)
does most reabsorption. Glucose, AAs, water, Na+ (and Cl-)

loop of Henle (especially the long loops in JG
produces hypertonic urine by reabsorbing water from the filtrate (due to high osmotic pressure)

Distal convoluted tubule:
Actively reabsorbs sodium ions (aldosteron effect) and excretes hydrogen, potassium ions, and drugs into the filtrate

Collecting ducts:
reabsorb water (ADH effect)

Front 15

What transports urine to the renal pelvis?

Back 15

Collecting ducts

Front 16

Reabsorption of nutrients and electrolytes involves the use of __________ transport

Back 16

Active

Front 17

Sodium reabsorption may be linked to the ____________ of the molecules, such as _________ and amino acids. There is a limit on reabsorption, called the _________ or ___________ maximum. What is this max for glucose?

Back 17

Cotransport
glucose
transport or tubular maximum 310 mg/min for glucose

Front 18

What causes glucosuria? What is it an indication of?

Back 18

Excess quantity of glucose in the filtrate, with inadequate carrier molecules for reabsorption (so glucose gets peed out);
indication of hyperglycemia associated with diabetes mellitus

Front 19

How is water reabsorbed?

Back 19

Osmosis

Front 20

What controls the reabsorption of fluid and electrolytes?

Back 20

Hormones

Front 21

How does ADH control reabsorption of water?

Back 21

By increasing the permeability of the distal convoluted tubule and collecting ducts

Front 22

Where does atrial natriuretic hormone come from? What is its effect?

Back 22

Heart ; reduces sodium and fluid reabsorption in the kidneys

Front 23

How much of the CO enters the renal artery from the aorta?

Back 23

20-25% (hence, the kidneys are always processing a very large volume of blood at any given time)

Front 24

What is the alternative blood supply available to a lobe of the kidney deprived of oxygen supply? What would happen in the case of an embolus?

Back 24

NONE. Anastomoses between the interlobar and arcuate arteries are NOT present.

In the case of an embolus (or any obstruction of blood flow) that lobe would undergo necrosis and infarction

Front 25

Is there regeneration of the nephrons?

Back 25

NO

Front 26

What is the vasa recta?

Back 26

Peritubular capillaries

Front 27

How many arterioles and how many capillaries are assocciated with each nephron?

Back 27

Two arterioles and two capillaries

Front 28

Summarize the blood flow through the kidney

Back 28

Renal artery --> interlobar artery --> arcuate artery --> interlobular artery--> afferent arteriole --> glomerulus --> efferent arteriole --> peritubular capillaries--> interlobular vein --> arcuate vein --> interlobar vein--> renal vein

Front 29

What is the purpose of the dual arteries of Bowman's capsule?

Back 29

To control the pressure in the glomerular capillaries (GFR)

Front 30

If the afferent arteriole is dilated and the effernt arteriole is constricted, what will happen to the hydrostatic pressure in the glomerular capillaries? GFR?

Back 30

increase; increase

Front 31

Loss of voluntary control of the bladder

Back 31

Incontinence

Front 32

Involuntary urination by a child age 4+ years. What is the often related to?

Back 32

Enuresis
Often related to developmental delay, sleep pattern, psychosocial aspect

Front 33

What is stress incontinence? Who is it most common in? What are the "triggers"?

Back 33

When increased intra-abdominal presure forces urine through the sphincter.

Most common in pregnant (esp multiparity)

triggers= coughing.lifting, laughing

Front 34

What are JG cells? Where are they? What do they secrete?

Back 34

Juxtaglomerular cells;
Modified smooth muscle cells in the wall of the afferent arteriole, just before it enters Bowman's capsule;
Renin

Front 35

What makes up the juxtglomerular apparatus?

Back 35

JG cells and macula densa.

Front 36

What are the macula densa? Where are they located? what is their function?

Back 36

A group of modified distal convoluted tubule cells;
Right next to the JG cells near the vascular pole;
Act as baroreceptors and chemoreceptors- JG cells respond to changes in systemic blood pressure and macula densa responds to changes in sodium chloride concentration

Front 37

What stimulates the release of renin from the JG cells?

Back 37

decrease in systemic blood pressure (blood volume) or decrease in sodium concentration in the filtrate.

Front 38

What does renin do?

Back 38

Converts angiotensinogen (plasma protein) to angiotensinogen I, which is then converted to angiotensinogen II by the ACE enzyme in the endothelial cells of the lung capillaries

Front 39

What effect does angiotensinogen II elicit?

Back 39

Powerful vasoconstrictor;
Stimulates the release of aldosterone from the adrenal gland cortex (increases water reabsorption by increasing sodium reabsorption)

Front 40

The RAS system causes (vasoconstriction / vasodilation)? What effect does this have of the GFR?

Back 40

Vasoconstriction
Increases GFR

Front 41

In the absence of ADH, the collecting tubules remain (permeable / impermeable) to water. What is the result of this?

Back 41

Impermeable
Increased volume of water in the urine

Front 42

Autoregulation, SNS innervation, and RAS system are all mechanism for _______________.

Back 42

Vasoconstriction

Front 43

What are the "renin-blocking" drugs?

Back 43

beta-adrenergic blocking drugs

Front 44

Where does "filtrate" become "urine"?

Back 44

In the collecting ducts

Front 45

Explain the pathway urine takes during excretion

Back 45

Collecting ducts --> renal calyces --> renal pelvis --> ureter --> urinary bladder --> urethra

Front 46

What assists movement of urine from the ureters to the urinary bladder?

Back 46

Peristaltic movement by smooth muscles

Front 47

The urinary bladder is surrounded in ___________, with _______ for expansion

Back 47

Smooth muscle
Rugae

Front 48

The urinary bladder and two ureters make up the ____________.

Back 48

trigone

Front 49

what effect does hypertrophy of the prostate gland (common in older men) have on urine flow?

Back 49

Decreases it (due to obstruction)

Front 50

What is micturition? What stimulates it?

Back 50

Urination, voiding;
Stimulated by the increased pressure as the bladder distends, PNS innervation

Front 51

______________________ results from an incompetent bladder sphincter. What causes this in older people?

Back 51

Overflow incontinence;
A weakedn detrusor muscle (prevents complete emptying of the bladder, leading to frequency and incontinence)

Front 52

Overflow incontinence results from ...

Back 52

... an incompetent bladder sphincter.

Front 53

What causes neurogenic bladder?

Back 53

interference with the CNS and ANS(for example, by injury)

Front 54

What are the two types of neurogenic bladder?

Back 54

Spastic or flaccid

Front 55

Inability to empty the bladder?

Back 55

Retention

Front 56

What is retention typically accompanied by?

Back 56

Overflow incontinence

Front 57

Spinal cord injury at the ______ level blocks the micturation reflex. This leads to _______ .

Back 57

sacral; retention

Front 58

What urinary defect might occur after anethesia? Does this occur during general or spinal?

Back 58

Retention ; can be both

Front 59

Describe normal urine in terms of color, odor, and specific gravity

Back 59

Clear
straw-colored
mild odor
sp gr 1.010 - 1.050

Front 60

What does "cloudy" urine indicate?

Back 60

Presence of large amounts of protein, blood, bacteria, and pus

Front 61

How would you expect urine that has large amounts of protein, blood, bacteria, and pus to look?

Back 61

Cloudy

Front 62

What might dark, "coca-cola or tea-colored" urine indicate?

Back 62

hematuria
excessive bilirubin
highly concentrated urine

Front 63

How would you expect urine that contained blood or excessive bilirubin to look?

Back 63

dark, "coca-cola or tea-colored"

Front 64

Unpleasant or unusual odor of urine may result from...

Back 64

...infection or result from certain dietary components or medication

Front 65

What would small amount of hematuria indicate?

Back 65

infection, inflammation, or tumors in the urinary tract

Front 66

What would large amounts of hematuria indicate?

Back 66

increased glomerular permeability (as in glomerulonephritis or nephrosis) or hemorrhage

Front 67

What does hematuria mean in men?

Back 67

Cancer

Front 68

Leakage of albumin into filtrate

Back 68

Albuminuria

Front 69

Leakage of mixed plasma proteins into filtrate

Back 69

Proteinuria

Front 70

Presence of bacteria in urine? What does this indicate?

Back 70

Bacteriuria ; infection in the urinary tract

Front 71

Another name for small amounts of blood in the urine? Another name for large amounts of blood in the urine?

Back 71

Microscopic hematuria
Gross hematuria

Front 72

Infection in the urinary tract is indicated by the presence of ___________ and __________ organisms in the urine

Back 72

gram + and gram -

Front 73

What is this a picture of? What does it indicate?

Back 73

Urinary casts (microscopic molds of tubules consisting of one or more cells)

Indicates inflammation in the kidney tubules

Front 74

What does specific gravity of urine indicate?

Back 74

The ability of tubules to concentrate urine

Front 75

What type of specific gravity (high, low) would dilute urine with normal hydration have? What might this indicate?

Back 75

low ; renal failure

Front 76

What type of specific gravity (high, low) would concentrated urine with normal hydration have?

Back 76

High

Front 77

What would be found in the urine when diabete mellitus is not well controlled?

Back 77

Glucose and ketones

Front 78

Another name for ketoacids?

Back 78

Ketones

Front 79

What blood test would you expect to be elevated if your kidney fails to excrete nitrogen wastes during protein metabolism?

Back 79

Elevated serum urea (BUA) and elevated serum creatinine or nitrogen (BUN) ;
also, metabolic acidosis possibly because nitrogen will bind with H ions

Front 80

What would elevated BUA and BUN serum levels indicate? What is this due to?

Back 80

Failure to excrete nitrogen wastes during protein metabolism;
decreased GFR

Front 81

What does metabolic acidosis indicate?

Back 81

decreased GFR;
failure of the tubules to control acid-base balance

Front 82

Decreased serum pH would indicate

Back 82

Metabolic acidosis

Front 83

decreased serum bicarbonate would indicate

Back 83

metabolic acidosis

Front 84

A low hemoglobin level would indicate? This would suggest that production of ___________ has (increased / decreased) or depression of the _________________.

Back 84

Anemia ; erythropoietin ; bone marrow

Front 85

A blood test that depends on related fluid balance

Back 85

Serum electrolytes

Front 86

A test to diagnose poststreptococcal glomerulonephritits

Back 86

Antibody level- ASO titer (antistreptolysin O) or ASK titer (antistreptokinase O)

Front 87

What test could prove that the kidney was the cause of hypertension?

Back 87

Elevated levels of renin

Front 88

Why might you perform a culture and sensitivity test on the urine?

Back 88

-to identify the causative organism of infection
- select the appropriate treatment

Front 89

Why would you perform a radiological test (such as radionuleotide imaging, angiography, ultrasound, CT, MRI, or intravenous pyelography)?

Back 89

To visualize structures and possible abnormalities, flow patterns, and filtration rates

Front 90

What is are two examples of clearance tests? What do they assess?

Back 90

Creatin or inulin clearance ; Used to assess GFR

Front 91

What is a test that could be used to assess GFR?

Back 91

Clearance test (creatine or inulin)
**inulin is the best test, because our body cannot use inulin, so ALL of it should be excreted out-- it it's not there's a problem

Front 92

Test that visualizes the lower urinary tract? When might this be used?

Back 92

Cystoscopy ; could be used during biopsy or to remove kidney stones

Front 93

Test that is used to acquire tissue specimens ?

Back 93

Biopsy

Front 94

What do diuretics remove from the body?

Back 94

Electrolytes and water

Front 95

What drug could you give to increase excretion of water through the kidneys?

Back 95

Diuretic

Front 96

Name some disorders for which a duretic might be utlized

Back 96

Pulmonary edema (or just edema in general)
Hypertension
Renal failure
Liver disease
Congestive heart failure

Front 97

What do "loop diuretics" do?

Back 97

Inhibit reabsorption of NaCl in the renal tubules

Front 98

What is the major side effect of using a diuretic? what might this cause?

Back 98

Hypokalemia ; cardiac arrythmias and muscle weakness

Front 99

What should a patient eat while on a diuretic?

Back 99

Bananas

Front 100

Which diuretic spares potassium?

Back 100

Aldactone (Spiranolactone)

Front 101

What are the two types of dialysis?

Back 101

Hemodialysis and peritoneal dialysis

Front 102

Which type of dialysis can only be perfomed at a hospital, dialysis center, or home with special equipment and training?

Back 102

Hemodialysis

Front 103

Dialysis provides __________ and __________ across a semipermeable membrane

Back 103

filtration ; reabsorption

Front 104

Process that sustains life during kidney failure. Name two situations in which this would be used

Back 104

Dialysis ;
1. Acute renal failure (until problem is reversed)
2. End stage renal failure (until transplant organ becomes available)

Front 105

Which type of dialysis is required for a patient with chronic renal failure?

Back 105

Hemodialysis

Front 106

What device does blood move through during to hemodialysis to reach the machine

Back 106

Shunt or catheter

Front 107

What is dialysis fluid called?

Back 107

Dialysate

Front 108

Explain what happens with wastes, electrolyes, blood cells, proteins, and bicarbonate ions during dialysis

Back 108

Blood --> dialysate
wastes
electrolytes

dialysate--> blood
bicarbonate

stays in blood
blood cells
proteins

Front 109

How often is hemodialysis required and how long does it typically last? What are the potential complications?

Back 109

Every three weeks and lasts for 3-4 hours

complications
Blood clots
Infection of shunt
Blood vessels involved in the shunt become sclerosed or damaged (have to find new site)
Increased risk of parenteral infections (Hep B, Hep C, HIV)

Front 110

which type of dialysis is typically done on an outpatient basis?

Back 110

Peritoneal dialysis

Front 111

In peritoneal dialysis, the ___________ serves as the semipermeable membrane

Back 111

Peritoneal membrane

Front 112

During peritoneal dialysis, dialysate is instilled into the ____________ and drained via ___________ .

Back 112

peritoneal cavity ; gravity

Front 113

Which type of dialysis takes longer? What is a major complication of this type?

Back 113

Peritoneal dialysis ; Infection leading to peritonitis

Front 114

Since transient bacteremia is a risk in dialysis. To prevent this risk _____________ are given.

Back 114

prophylactic antibiotics

Front 115

What is the major concern we have as pharmacists in drug administration to a patient on dialysis?

Back 115

Caution with dosage because toxic-level buildup can occur

Front 116

Why are UTIs so common?

Back 116

-urine is excellent growth medium
- E coli is common causative agent

Front 117

Examples of lower urinary tract infections?

Back 117

Cystitis (inflammation of the urinary bladder) and Urethritis (inflammation of the urethra)

Front 118

example of upper urinary tract infection?

Back 118

Pyelonephritis

Front 119

Examples of lower urinary tract infections

Back 119

Urethritis and cystitis

Front 120

Example of upper UTI

Back 120

pyelonephritis, glomerulonephritis

Front 121

Most common to develop UTI?

Back 121

Women (chocolate factory so close to the water factory)

Older men (Prostatic hypertrophy and urine retention- any problem with the reproductive system poses risks to urniary system in men since they're shared)

Front 122

Congenital abonormalities, incontinence, retention of urine, or direct contamination with fecal matter could cause

Back 122

UTI

Front 123

Inflammation of the bladder wall and urethra

Back 123

Cystitis

Front 124

Cystitis

Back 124

Inflammation of the bladder wall and urethra

Front 125

Painful urination

Back 125

Dysuria

Front 126

Dysuria

Back 126

Painful urination

Front 127

Nocturia

Back 127

Need for urination during sleep period

Front 128

How does the urine look with cystitis?

Back 128

Cloudy and unusual odor

Front 129

what is most likely to cause hyperactive bladder and reduced capacity?

Back 129

Cystitis

Front 130

Where is the infection in pyelonephritis?

Back 130

From the ureter into the kidney (including the renal pelvis and the medullary area)

Front 131

In pyelonephritis, what fills the renal pevis and calyces? If the infection is severe, how does this effect the renal artery and vein and urine flow?

Back 131

Purulent exudate ; Sever infection could compress the renal artery and vein, obstruct urine flow to the ureter

Front 132

What are the signs and symptoms of pyelonephritis?

Back 132

Same as cystitis because infection will also be present in the bladder wall and urethra, but in addition:

Dull, aching, flank pain (in the lower back)
FEVER

Front 133

Diagnose.
Urinary casts found during urinalysis.

What does this presence reflect?

Back 133

Pyelonephritis ;
Presence of renal casts reflect tubule involvement

Front 134

Why does flank pain occur in pyelonephritis?

Back 134

The inflammation streches the renal capsule

Front 135

What is hydronephrosis?

Back 135

An enlargement of the kidney due to the accumulation of urine

Front 136

What are complications of pyelonephritis?

Back 136

- Loss of tubule function (due to medullary involvement)
- Hydronephrosis (due to obstruction of urine flow, which leads to collection of filtrate)
- Chronic renal failure (due to excessive scar tissue and necrosis if it is left untreated)

Front 137

How would you treat pyelonephritis?

Back 137

Antibacterials

Front 138

What does APSGN stand for?

Back 138

Acute poststreptococcal glomerulonephritis

Front 139

Diagnose.
Kidney Disorder in which antigen-antibody complexes are formed, leading to an inflammatory response.

Back 139

APSGN (a form of glomerulonephritis)

Front 140

Explain the inflammatory response associated with APSGN

Back 140

Presence of anti-streptococcal (ASO) antibodies form complexes with the antigens, then are deposited into the lumen of the glomerulus, causing an inflammatory response. This causes increased capillary permeability --> leakage of proteins and rbcs

Front 141

What causes the negative effect of strept on the kidney and the heatr?

Back 141

strong exotoxin produced by strept organism causes antigen-antibody complex formation and DEPOSITION INTO THE TISSUE--> SEVERE INFLAMMATION and NECROSIS

Front 142

What the the effect of glomerulonephritis on GFR?

Back 142

Decreased

Front 143

Where would you find congestion and cell proliferation in the glomerulus?

Back 143

Severe inflammatory response associated with glomerulonephritis

Front 144

How would you expect the urine to look in glomerulonephritis? What about the quantity?

Back 144

Dark and cloudy (due to blood and proteins);
Oliguria, due to decreased GFR

Front 145

Diagnose.
Facial and periorbital edema and flank pain with fever.

Back 145

glomerulonephritis

Front 146

explain the effects of glomerulonephritis on blood pressure

Back 146

Because of edema, the macula densa cells are not detecting a high blood volume, therefore, the JG cells will release increased levels of renin, leading to further edema because increased hydrostatic pressure, but with limited osmotic pressure. This increases the blood pressure. eventually, as kidney fails, renin secretion will slow and blood pressure will drop.

Front 147

What do you expect to see in renal failure?

Back 147

Anemia (decreased erythropoietin secretion)

Front 148

glomerulonephritis would cause metabolic (acidosis / alkalosis)

Back 148

acidosis

Front 149

What might be wrong with a a person whose urinalysis showed proteinuria, hematuria, and erythrocyte casts with no evidence of infection?

Back 149

glomerulonephritis

Front 150

What might treatment for glomerulonephritis include?

Back 150

Sodium restriction and antihypertensives (to lessen the workload of the kidney)
Glucocorticoids (to reduce inflammation)
Decrease fluid and protein intake (in severe cases)

Front 151

1 tsp = _____ mL

Back 151

5

Front 152

What does the abnormality in nephrosis cause?

Back 152

Escape of large amounts of plasma proteins to escape into the filtrate

Front 153

What causes nephrosis?

Back 153

In children 2-6 usually idiopathic

in adults, usually secondary to an autoimmune disease (such as SLE) or to exposure of nephrotoxins or drugs

Front 154

What would you expect in nephrotic syndrome, hypo or hyperalbuminemia? What does this cause?

Back 154

Hypoalbuminemia
Decreased osmotic pressure and increased edema

Front 155

What effect would you expect nephrotic syndrome to have on blood pressure?

Back 155

Low or normal (due to extreme fluid loss... may be elevated depending on angiotensin II levels)

Front 156

What hormone secretions would you expect to see in nephrosis?

Back 156

Aldosterone (to increase sodium reabsorption and increase blood volume)

Maybe renin (to vasoconstrict)

Front 157

Why is lipiduria associated with nephrosis?

Back 157

Not totally clear- probably a response of the liver to high protein loss

Front 158

Diagnose.
proteinuria, lipiduria, casts, massive edema, sudden increase in girth

Back 158

Nephrosis

Front 159

How would you treat nephrosis?

Back 159

All treatments aimed at decreasing inflammation
-Glucocorticoids
- decreasing sodium reabsorption
- ACE inhibitors (to decrease hydrostatic pressure and to decrease aldosterone secretion)

Front 160

Another name for a stone?

Back 160

Calculi

Front 161

Where can calculi form in the urinary tract?

Back 161

anywhere

Front 162

What do you call a large calculi that forms in the renal pelvis and calyces?

Back 162

"Staghorn" calculi (because looks like deer antlers)

Front 163

Under which conditions do urinary calculi form?

Back 163

- Insufficient fluid intake
-When there is excessive amounts of solutes in the filtrate
-urinary tract infection

Front 164

Calculi themselves are not dangerous.... what causes the manifestations? what can it cause?

Back 164

Obstruction of urine flow;

Causes:
Infection
Hydronephrosis with dilation of the calyces
Atrophy of renal tissue (if located in the kidney or ureter)

Front 165

What is the formation of calculi in the urinary system called?

Back 165

Urolithiasis

Front 166

What are common components of calculi? What does stone formation depend on?

Back 166

Calcium (due to alkaline urine)

Uric acid stones (Due to acidic urine and hyperuricemia associated with gout, high-purine diets [red meats], and cancer chemotherapy)

Struvite

Cysteine

Stone formations depend on Predisposing factors (diet, genetics, etc)

Front 167

What type of stone would a person who eats a diet rich in red meats likely form?

Back 167

Uric acid

Front 168

Diagnose.
Renal colic

Back 168

Urolithiasis

Front 169

Intense spasms of pain in flank area that radiates into the groin area

Back 169

Renal colic (associated with urolithiasis)

Front 170

what is ESWL? When is it used?

Back 170

Extracorporeal shock-wave lithotripsy ;
Used to break up calculi

Front 171

What can a person do to prevent urolithiasis?

Back 171

Maintaint high fluid intake
Adjustment of urine pH through dietary modifications (cranberry juice, vitamins, antioxidants)