Pathophysiology Exam 7 Renal & Bladder

Front 1

What is the breakdown of mm fibers that leads to the release of mm fiber (myoglobin) into the bloodstream?

Back 1

rhabdomyolysis

Front 2

What are increased levels of nitrogens waste products, especially urea nitrogen, in the blood indicative of impaired renal clearance?

Back 2

azotemia

Front 3

What is it called when blood is present in the urine?

Back 3

hematuria

Front 4

What is it called when protein is present in the urine?

Back 4

proteinuria

Front 5

What is severe decrease or lack of urine output of less than 100ml/day?

Back 5

anuria

Front 6

What is urine output less than 500ml/day?

Back 6

oliguria

Front 7

What are tiny tube-shaped particles made up of WBC, RBC, or kidney cells? They are held together by a protein released by the kidney.

Back 7

urine casts

Front 8

What is point or place at which something originates, accumulates, or develops, as the center around which calculi form?

Back 8

nidus

Front 9

What is the prescence of a stone or calculus anywhere in the urinary tract?

Back 9

nephrolithiasis

Front 10

What is concretion of crystals of material (uric acid, calcium phosphate) that initially from in the calices or pelvis of the kidneys?

Back 10

renal calculi

Front 11

What is distention of a ureter with urine , usually resulting from an obstruction process?

Back 11

hydroureter

Front 12

What is it called when swelling of one kidney due to a backup of urine?

Back 12

hydronephrosis

Front 13

What is it called when a healthcare provider taps on the area over the kidneys and it produces pain?

Back 13

CVA tenderness

Front 14

What is it called when a patient abnormally needs to urinate in the middle of the night?

Back 14

nocturia

Front 15

What is a strong and immediate urge to void brought about by involuntary detrusor overactivity?

Back 15

urgency

Front 16

What is the term used to describe how often a patient is urinating?

Back 16

frequency

Front 17

What is known as pus in the urine?

Back 17

pyuria

Front 18

What is also known as painful urination?

Back 18

dysuria

Front 19

What is the condition where urinary calculi are formed or located anywhere in the urinary system?

Back 19

urolithiasis

Front 20

What is bladder dysfunction caused by a lesion at any level in the nervous system?

Back 20

neurogenic bladder

Front 21

What is the ability to retain a bodily discharge voluntarily?

Back 21

continence

Front 22

What is also known as urination?

Back 22

micturition

Front 23

What is an infection of the kidney medulla or cortex?

Back 23

pyelonephritis

Front 24

What is inflammation of the urothelium (lining of the bladder) resulting from infection, irritation, presence of a foreign body, or trauma?

Back 24

cystitis

Front 25

What are the clinical manifestations of Benign Prostatic Hyperplasia/Hypertrophy (BPH)?

Back 25

-weak urinary stream
-abdominal "pushing" to move urine
-urinary hesitancy
-incomplete bladder emptying
-urgency, frequency

Front 26

What is Benign Prostatic Hyperplasia/Hypertrophy (BPH)?

Back 26

enlargement of the prostate (result of age, exogenous drugs testosterone) that puts pressure on the urethra

Front 27

What are the 2 major causes of chronic renal failure (CRF)?

Back 27

-HTN
-DM

Front 28

What determines end-stage renal disease (ESRD)?

Back 28

when GFR is decreased by 90% with GFR <10ml/min

Front 29

What are the levels of GFR with chronic renal failure (CRF)?

Back 29

decreased by 75%

Front 30

How does mental status change with post renal acute renal failure (ARF)?

Back 30

hyponatremia

Front 31

What are the clinical manifestations of post renal acute renal failure (ARF)?

Back 31

-oliguria/anuria
-back/flank pain
-change in mental status (hyponatremia)

Front 32

What is post renal acute renal failure (ARF)?

Back 32

"beyond the bladder" <5% of all ARF

Front 33

What are the three stages of acute renal failure (ARF)?

Back 33

1. oliguria- volume overload, increase K+, metabolic acidosis
2.diuretic-retention of tubular patency
3. recovery

Front 34

What are the causes acute tubular necrosis (ATN)?

Back 34

-antibiotics
-chemicals
-heavy metal poisons
-rhabdomyelosis (mm injury)
-x-ray contrast media*

Front 35

What is the most frequent manifestation on intrarenal acute renal failure (ARF)?

Back 35

acute tubular necrosis

Front 36

What is intrarenal acute renal failure (ARF) typically caused by?

Back 36

exposure to toxins, drugs, or autoimmune

Front 37

What is acute tubular necrosis (ATN)?

Back 37

decrease GFR to hypoxia/ischemia & tubular cell injury

Front 38

What is intrarenal acute renal failure (ARF)?

Back 38

intrinsic to the kidney itself

Front 39

What are the clinical manifestations of pre-renal acute renal failure (ARF)?

Back 39

-decreased GFR
-increased BUN & creatinine
-hyperkalemia
-tachycardia
-decreased urine output
-lethargy (confusion)

Front 40

What role does chronic NSAID use have in the potential development of pre-renal ARF?

Back 40

renal PG maintains vasodilation of the renal artery/afferent arteriole. NSAIDS till inhibit this & cause vasoconstriction & hypoperfusion

Front 41

What might cause pre-renal acute renal failure (ARF)?

Back 41

-decrease in renal perfusion
-no tubular damage but decreased GFR

Front 42

What is pre-renal acute renal failure (ARF)?

Back 42

"before" the kidney (50% of all ARF)

Front 43

In acute renal failure (ARF) what are 2 major problems that can kill your patient quickly?

Back 43

-hyperkalemia (high K+)
-metabolic acidosis (high H+)

Front 44

What is chronic renal failure (CRF)?

Back 44

slow onset renal failure

Front 45

What is acute renal failure (ARF)?

Back 45

rapid onset renal failure

Front 46

What are the clinical manifestations of polycystic kidney disease?

Back 46

-abdominal pain
-hematuria
-proteinuria
-oliguria
-anuria
-HTN (fluid retention)

Front 47

What causes extreme pain in polycystic kidney disease?

Back 47

the cysts swell and press against the renal capsule

Front 48

Where do the cysts develop in polycystic kidney disease?

Back 48

-develop throughout cortex & medulla

Front 49

What do the cysts do in polycystic kidney disease?

Back 49

-destroys normal nephrons

Front 50

How is polycystic kidney disease received?

Back 50

-genetic
-defective gene on short arm of chromosome 16
-autosomal dominant pattern

Front 51

What type of casts are typical in pyelonephritis?

Back 51

WBC cast

Front 52

Why do casts for in pyelonephritis?

Back 52

inflammation of the kidney

Front 53

What type of casts form in glomerulonephritis?

Back 53

RBC cast

Front 54

Why do casts form in glomerulonephritis?

Back 54

leakage of RBC from glomerulus or severe tubular damage

Front 55

Where do casts form?

Back 55

only in DCT or collecting ducts

Front 56

What is the hallmark syndrome of nephrotic syndrome?

Back 56

urinary casts

Front 57

What are the clinical manifestations of nephrotic syndrome?

Back 57

-hypovolemia
-edema formation* (lack of oncotic pressure)
-protein malnutrition
-HTN

Front 58

What is nephrotic syndrome?

Back 58

loss of protein in the urine of >3-5gm/day

Front 59

What is chronic glomerulonephritis?

Back 59

fibrotic tissue development in the glomerulus leading to permanent decrease in GFR

Front 60

Why does HTN happen with glomerulonephritis?

Back 60

-increases protein loss
-hypovolemia
-RAA kicks in
-Na+ & H₂O are retained

Front 61

Why is there increased serum lipids with glomerulonephritis?

Back 61

-decreased albumin
-liver overproduces to compensate

Front 62

Why does edema happen with glomerulonephritis?

Back 62

-protein loss
-less colloid osmotic pressure

Front 63

What are the clinical manifestations of glomerulonephritis?

Back 63

-typically 7-10 days after strep throat
-hematuria & proteinuria
-oliguria from lowered GFR (<400mL/24 hrs)
-RBC casts
-edema
-increased lipids
-HTN

Front 64

The glomerular "leakiness" in glomerulonephritis allows what to happen?

Back 64

RBC, WBC & protein into the urine

Front 65

What is the mechanism of acute glomerulonephritis?

Back 65

-type III hypersensitivity
-Ab/Ag complex trapped in glomerulus
-inflammatory response
-glomerulus is compromised & damaged
-the damage allows RBC, WBC & protein into the urine

Front 66

What is the cause of acute glomerulonephritis?

Back 66

strep

Front 67

Glomerulonephritis is always accompanied by ________GFR and ____________ creatinine

Back 67

-decreased
-increased

Front 68

What is glomerulonephritis?

Back 68

inflammation of the glomerulus

Front 69

What is a staghorn calculus?

Back 69

-a stone formed in the renal pelvis shaped like a horn
-made from magnesium-ammonium-phosphate mix

Front 70

What characteristic of urine with favor supersaturation and stone formation in uric acid stone?

Back 70

acidic urine

Front 71

What is the significance of a high purine diet with uric acid stones?

Back 71

increase purine metabolism from high protein intake produces more uric acid (rich in meats, liver)

Front 72

What is hyperuricemia?

Back 72

uric acid stones

Front 73

What characteristic of urine will favor calcium oxalate stone formation?

Back 73

alkaline urine

Front 74

What are the risk factors for hypercalciuria?

Back 74

-increased GI absorption of Ca++
-increased demineralization of Ca++ from bone
-defect in tubular secretion from kidneys
-high levels of uric acid

Front 75

What is hypercalciuria?

Back 75

calcium oxalate stone

Front 76

Where do stones form?

Back 76

they can form anywhere but typically in the ureters

Front 77

they can form anywhere but typically in the ureters

Back 77

there can be back pressure into the kidney, which can decrease GFR, leading to renal failure.

Front 78

What is hydroureter?

Back 78

complete obstruction of ureter; accumulation of urine, ureter distended

Front 79

What is hydronephrosis?

Back 79

enlarged, swollen kidney from backed up urine

Front 80

What is any interference with urine flow at any site along the urinary tract leading to accumulation of urine behind the obstruction?

Back 80

UT obstruction

Front 81

What is the HALLMARK symptoms of pyelonephritis?

Back 81

CVA tenderness (costovertebral angle tenderness)

Front 82

What are the s/s of pyelonephritis?

Back 82

-pt looks sick
-chills
-fever
-back pain
-HA

Front 83

What is pyelonephritis?

Back 83

infection of the renal pelvis, calices, parenchyma

Front 84

What are the s/s of a UTI?

Back 84

-cystitis (inflammation of bladder lining)
-dysuria
-frequency
-fever
-low back pain
-cloudy and/or strong odor urine
-pyuria (WBC in urine)

Front 85

What risk factor for UTI's are nurses capable of preventing?

Back 85

catheterization

Front 86

What are some risk factors for UTI's?

Back 86

-women: failure to void after sexual activity
-pregnancy
-men: rectal sex (no condom)
-BPH
-kidney stones
-diabetes
-catheter
-neurobenic bladder (voiding dysfunction)

Front 87

Compare gender anatomical differences for risk of UTI's?

Back 87

women have a shorter urethra then men therefore women are more at risk than men.

Front 88

What are the protective mechanisms associated with urine?

Back 88

-voiding flushes out pathogens
-pH (acidic)
-osmolarity
-high concentration of UREA

Front 89

What are the characteristics of urine?

Back 89

-sterile
-specific gravity 1.010-1.030

Front 90

What is the only anatomic part of voiding that is under somatic/voluntary control?

Back 90

external sphincter

Front 91

What is the PSNS control on the bladder?

Back 91

"void" (Ach)
-contracts detrusor mm
-relaxes internal sphincter

Front 92

What is the SNS control of the bladder?

Back 92

"hold it" (NE)
-relaxes detrusor mm
-contracts external sphincter

Front 93

What is the triangle shape located in bladder that has openings from ureters. usually referring to the bladder mm?

Back 93

trigone

Front 94

What is the smooth mm of the bladder body?

Back 94

Detrusor Muscle

Front 95

What is located at base of urethra. controlled voluntarily?

Back 95

External Sphincter

Front 96

What is located at base of bladder, top of urethra. controlled involuntary?

Back 96

Internal Sphincter

Front 97

Discuss the process of voiding (micturition).
Most is under ANS and some is under Somatic

Back 97

1. bladder fills
2.fullness felt (trigone stretched)
3. afferent signal to the brain
4. contraction of detrusor (muscarinic)
5. relaxation of internal sphincter (muscarinic)

Front 98

What is the capillary tuft at beginning of every nephron. it is the site of fluid filtration from the blood to the nephron tubule. it is what prevents passing of WBC, RBC, platelets?

Back 98

glomerulus

Front 99

What is the cup-like sac that surrounds the golmerulus. it drains the glomerular filtrate directly into the PCT?

Back 99

bowman's capsule

Front 100

What are located in the DCT. they sample the filtrate for NaCl content and send signals to the glomerulus to adjust GFR?

Back 100

macula densa

Front 101

What is the endocrine gland that regulates the function of each nephron. the apparatus is made up of the macula densa cells, extraglomerular mesangial cells, and JG cells?

Back 101

juxtaglomerular apparatus

Front 102

What is it called when proteins are negatively charged and attract ions which then attract H₂O?

Back 102

capillary osmotic/oncotic pressure

Front 103

What opposes filtration by holding H₂O & ions in capillaries?

Back 103

oncotic pressure

Front 104

What is the enzyme that is produced & released mainly by the liver. known as renin substrate. AI is formed when renin acts on angiotensinogen?

Back 104

angiotensinogen

Front 105

What is the enzyme that converts AI to AII?

Back 105

ACE

Front 106

What is the RAAS pathway?

Back 106

1. JG cells sense decreased BP
2. JG cells secrete renin
3. renin causes angiotensinogen to be converted to A1
4. AI circulates the lung and ACE converts it to AII
5. AII circulates to adrenal cortex & stimulates secretion of aldosterone
6. aldosterone increases reabsorption of Na+
7. therefore, water is retained & blood volume increases

Front 107

What is the role of aldosterone in the RAAS pathway and where is it secreted from?

Back 107

-aldosterone increases reabsorption of Na+ (DCT)
-secreted from adrenal cortex

Front 108

On which part of the tubular system does aldosterone act on?

Back 108

-distal convoluted tubule Na+ is reabsorbed(DCT)
-collecting duct K+ is excreted

Front 109

What is the role of ADH in blood volume maintenance?

Back 109

-ADH is a vasopressin
-it is secreted from posterior pituitary in response to increased osmolality by the osmoreceptors in the hypothalamus

Front 110

On which part of the tubular system does ADH act on?

Back 110

collecting duct where it stimulates water reabsorption

Front 111

What is the significance of HPO₄?
(handbook pg. 619-620)

Back 111

this is used for an important buffer system. the excretion of H+ will be bound to a filtered phosphate and excreted in the urine. this excretes acid and gain bicarbonate

Front 112

What is the significance of NH₄?

Back 112

excess H+ is attached to NH₃ to make NH₄ and excrete it through the kidneys.

Front 113

How does the kidneys excrete metabolic wastes?

Back 113

it can excrete H+ attached to a NH₃ if the body is to acidic

Front 114

In the arterial blood, what is the best indicator of how well the kidneys are excreting metabolic wastes?

Back 114

HCO₃ in the blood

Front 115

In arterial blood, what is the best indicator of how well the lungs are excreting metabolic wastes?

Back 115

PaCO₂ in the blood

Front 116

Renin causes the conversion of what?

Back 116

AI to AII which leads to potent vasoconstriction

Front 117

What is the role of the macula densa?

Back 117

-sense changes in osmolality (NaCl)
-stimulate renin release from JG cells

Front 118

What is the role of the JG cells?

Back 118

-they are baroreceptors
-they synthesize, store, and secrete renin
-smooth mm cells in walls of afferent arteriole

Front 119

What happens if the GFR is too high?

Back 119

-all filtrate would be lost to urine (good & bad)

Front 120

What happens if the GFR is too low?

Back 120

-too much tubular filtrate is reabsorbed
-glucose & waste products would be out of balance

Front 121

How does each individual nephron regulate GFR?

Back 121

the macula densa in the DCT sense changes in the NaCl delivery

Front 122

What does not get filtered in the glomerulus?

Back 122

negatively charged particles (protein) or particles too large to pass (RBC, WBC, platelets)

Front 123

What gets filtered in the glomerulus?

Back 123

-water
-electrolytes (H+, K+)
-solutes (creatinine, urea, glucose)
-organic acids
-phosphates

Front 124

The driving force of filtration in the glomerulus is why?

Back 124

hydrostatic pressure

Front 125

What vasoconstricts to keep GFR constant?

Back 125

afferent arterioles

Front 126

How does systemic BP affect GFR?

Back 126

if there is an increase in BP it will in turn increase GFR

Front 127

What is the goal of GFR?

Back 127

to generate enough pressure for urine formation

Front 128

How much Na+ & H₂O absorption occurs at the collecting duct?

Back 128

3%

Front 129

How much Na+ & H₂O absorption occurs at the distal convoluted tubule (DCT)?

Back 129

7%

Front 130

How much Na+ & H₂O absorption occurs at the Ascending Loop of Henle?

Back 130

30%

Front 131

How much Na+ & H₂O absorption occurs at the proximal convoluted tubule (PCT)?

Back 131

60%

Front 132

What is normal GFR?

Back 132

125 ml/min

Front 133

What are efferent arterioles?

Back 133

they transport blood out of the glomerulus

Front 134

What are afferent arterioles?

Back 134

they transport blood into the glomerulus

Front 135

What are the functions of the nephron?

Back 135

-filter water soluble substances from blood
-reabsorption of filtered nutrients, water, and electrolytes.
-secretion/excretion of wastes or excess substances into filtrate

Front 136

What is the function of the kidneys?

Back 136

-maintains fluid & electrolyte balance
-disposal of water-soluble wastes
-EPO production
-vitamin D activation
-20% total glucose production