Pbd 2 Renal Disorders Exam 3 Katovich

Front 1

In order for the kidney to function normally, what 3 things must occur?

Back 1

There must be adequate blood flow thru the GC. The glomerulus must be intact, and tubules must be able to reabsorb & excrete normally

Front 2

a condition in which the kidneys fail to remove the metabolic end products from the blood and to regulate fluid, electrolyte, and pH balance of the extracellular fluids.

Back 2

Renal failure

Front 3

What are some underlying causes of renal failure?

Back 3

Renal or systemic dz

Front 4

progressive, slow development of renal failure – course of years

Back 4

Chronic

Front 5

Chronic renal dz can affect w/c areas of the kidney?

Back 5

Glomerulus, renal tubules, blood perfusion

Front 6

T/F: many of the chronic renal disorders are reversible?

Back 6

False: they are usually NOT reversible

Front 7

As renal dz progresses, how can we find the origin of the dz?

Back 7

Although renal dz can start in any area of the kidney, as the dz progresses it’s often difficult to determine the original cause since all of the kidney can become destroyed or scarred.

Front 8

Name a kidney dz that involves the glomerulus?

Back 8

Glomerulonephiritis

Front 9

Name 2 kidney dzs that inolve the renal tubules?

Back 9

Pyelonephritis & polycystic kidney dz

Front 10

Name a dz that interferes w/ blood perfusion of the kidneys?

Back 10

nephrosclerosis

Front 11

a rapid decline in kidney function, resulting in an inability to maintain fluid and electrolyte homeostasis and failure to excrete nitrogenous wastes.

Back 11

Acute renal failure

Front 12

Acute renal failure is characterized by a sudden drop in __________ & fall in ______________?

Back 12

Urine output & fall in GFR

Front 13

T/F: Acute renal failure is considered a reversible dz?

Back 13

True

Front 14

In acute renal failure, dysfunction can be in w/c 3 places?

Back 14

Dysfunction can be pre-renal (blood flow), Post-renal (obstruction), or renal (acute tubular necrosis)

Front 15

What is a common indicator of ARF?

Back 15

Azotemia

Front 16

What are the 3 characteristics of ARF?

Back 16

1) Is associated w/ an increased morbidity & mortality 2) more susceptible in the elderly, 3) more common in seriously ill pts in ICU

Front 17

This refers to retention of nitrogenous wastes, either through inability of the kidney to excrete them or through their failure to be delivered to the kidney?

Back 17

Azotemia

Front 18

Azotemia is reflected by an increase in __________?

Back 18

BUN

Front 19

Complex syndrome characterized by variable and biochemical and clinical changes that occurs when azotemia becomes symptomatic- all organs affected?

Back 19

Uremia

Front 20

In uremia, what changes are seen in the body?

Back 20

Volume derangements, acid/base problems, electrolyte imbalances, endocrine changes

Front 21

T/F: uremia can lead to metabolic alkalosis?

Back 21

False: metabolic acidosis

Front 22

What electrolyte imbalances are seen in uremia? This can cause what?

Back 22

Hyperkalemia & hypocalcemia w/c can cause arrhythmias & mm weakness

Front 23

What endocrine changes are seen in uremia?

Back 23

Renal osteodystrophy due to calcium disturbances/2° hyperparathyriodism, anemia

Front 24

What other things can be seen w/ uremia?

Back 24

Anorexia, pericarditis, uremic encephalopathy, inflammation, atherosclerosis

Front 25

What are the leading causes of CKD?

Back 25

DM & HTN

Front 26

What is the mortality rate of ARF?

Back 26

>50%

Front 27

Number of Americans that suffer from kidney stones?

Back 27

One million between 20-40 yrs of age

Front 28

Number of pts suffering from CKD? # that die?

Back 28

26 million w/ 90,000 die each yr

Front 29

As many as ______% of the nephrons may need to be destroyed before significant functional impairment (clinical) is seen?

Back 29

90%

Front 30

A person is generally asymptomatic until how much of the renal function is lost?

Back 30

>60%

Front 31

What needs to be done for Dx?

Back 31

Must ID subclinical diagnostics by different testing procedures such as urine analysis or renal biopsy & others.

Front 32

What are 6 biochemical assessments that can be done to assess renal fxn?

Back 32

1. Proteinuria ( a problem if >150mg/day)
2.hematuria
3. H ion [ ] (normal is 4.5-8
4.specific gravity
5. GFR
6. Tubular fxn test

Front 33

What does it mean if there is hematuria? How do u test for it?

Back 33

Suggestive of dzs of lower urinary tract or renal dz. Can test for it by dipstick test or microscopic exam

Front 34

What does it mean to have proteinuria? How do u test for it?

Back 34

Suggestive of glomerular problem. Can test by dipstick

Front 35

What is normal urine pH? How do u test?

Back 35

4.5-8. Tested by dipstick

Front 36

Changes in pH occur in w/c cases?

Back 36

Increases after a meal (alkaline tide) & decreases during sleep (hypoventilation) & fever (metabolic acidosis)

Front 37

In what condition is there an acidic urine? Alkaline?

Back 37

Uric acid in gout & alakaline w/ phosphate stone w/c is suggestive of UTI

Front 38

What is the normal specific gravity?

Back 38

1.010-1.025

Front 39

What is specific gravity in dehydration?

Back 39

Could go up to 1.040

Front 40

Specific gravity is a measurement of what?

Back 40

Osmolarity

Front 41

What happens to specific gravity in CKD? What is a sign of this?

Back 41

Kidney loses ability to [ ] urine first in chronic renal disease, then lose ability to dilute urine. Nocturia is one of the 1st signs to be seen w/ this

Front 42

Relate BUN to GFR?

Back 42

As GFR decreases, BUN will increase

Front 43

[ ] & dilution tests measure what?

Back 43

Specific gravity

Front 44

What is the [Na] test?

Back 44

restrict Na in diet – urine should be free of Na. If loss more than ingest – problem.

Front 45

What is the urine acidication test?

Back 45

5 day test – control testing – challenge with NH4Cl check pH.

Front 46

What is the most common abnormal microscopic examinations?

Back 46

RBC >1-2/field, WBC 3-4/field, bacteria, & cast (these are muco protein matrix w/ cells & debris

Front 47

What are the 5 types of casts?

Back 47

Hyaline, RBC, WBC, fatty, broad or ganular

Front 48

These casts are devoid of cells; they are clear cylinders of protein?

Back 48

Hyaline

Front 49

These casts come from leaking glomeruli

Back 49

RBC casts

Front 50

These casts come from infection & often seen in pylonephritis?

Back 50

WBC casts

Front 51

These casts are seen in nephrotic syndrome?

Back 51

Fatty casts

Front 52

These casts contain dead cells, they are formed in the collecting ducts & are typical of ESRF?

Back 52

Broad or granular casts

Front 53

What is IVP & what can it show?

Back 53

Intravenous pyelogram w/c is a contrast media given IV & then x rays are taken. It can show cortex of kidney & can also establish size, shape & location of kidneys

Front 54

What pathology can IVPs show?

Back 54

Presence of cysts, lesions or obstruction & cortex thinness & thickness

Front 55

If cortex is thin on IVP, what does it mean? If cortex has moth eaten appearance?

Back 55

Thin: indicates glomerulonephritis. If moth eaten appearance: indicates pylonephritis or ischemia

Front 56

What is a retrograde pyelogram?

Back 56

A catheter is advanced up the ureter & a contrast media is injected into the renal pelvis

Front 57

w/c radiologic test is useful for transplantations?

Back 57

Renal angiography

Front 58

What is the renal angiography?

Back 58

A catheter is advanced via the femoral artery to the level of the renal artery

Front 59

What pathology can a renal angiography detect?

Back 59

Areterial stenosis, presence of neoplasms, & arrangement of arteries & veins

Front 60

This is a way to Dx diffuse renal dz?

Back 60

Renal biopsy

Front 61

This can see problems w/ intrarenal bleeding?

Back 61

Renal biopsy

Front 62

This type of ARF usually reflect abnormal renal blood flow or myocardial dysfunction?

Back 62

Pre-renal

Front 63

This type of ARF is from a parenchymal injury?

Back 63

Renal

Front 64

This type of ARF is usually some type of tubular obstruction that interferes w/ elimination of urine from the kidney?

Back 64

Post renal

Front 65

What is the most common cases in ARF?

Back 65

80-95% are pre-renal or renal in nature

Front 66

ARF is usually manifested by a fall in urine output to < ________. The clinical syndrome is characterized by a sudden __________ in GFR.

Back 66

400ml/day, decrease

Front 67

Causes of ARF?

Back 67

Ischemia & nephrotoxic injury

Front 68

In order for the kidney to excrete the daily load of metabolic wastes three conditions must prevail?

Back 68

1.The Kidney must be adequately perfused with blood. 2. The kidney must function normally. 3. Urine formed must be able to leave the body

Front 69

Autoregulation can be overcome in conditions of ________ __________ ________if pressure to the kidney < ___mmHg.

Back 69

severe volume depletion, <65mmHg

Front 70

What are the causes of severe volume depletion?

Back 70

Hemorrhage, GI or renal losses (loss of lytes), excessive diuretics, burns, & heat prostration, dehydration

Front 71

What happens to the kidneys when there is volume loss?

Back 71

kidney vessels vasoconstrict (NE, AngII, etc) and renal blood flow and GFR fall (whether CO falls or not) and this results in a “pre-renal” state.

Front 72

Pre-renal azotemia is commonly caused by loss of what?

Back 72

ECF; Fluid doesn’t actually have to be lost – this could occur due to a volume shift of fluid out of the extracellular spaces (decrease in vascular filling).

Front 73

What happens to the kidneys w/ vasodilating drugs?

Back 73

the volume of fluid is constant but the volume of distribution is expanded – less to kidney.

Front 74

Give 3 examples of edematous states that can lead to ARF?

Back 74

CHF, nephrotic syndrome, & cirrhosis

Front 75

How does CHF contribute to ARF?

Back 75

There will be a decrease in CO & therefore a decrease in GFR

Front 76

How does cirrhosis contribute to ARF?

Back 76

There is a drop in vascular volume & increase in interstitial volume

Front 77

T/F:The drop in vasuclar volume in cirrhosis is d/t the hyperprotenemia?

Back 77

False it’s hYPOprtenemia

Front 78

What is the normal ratio of BUN: creatinine? What is the ratio in ARF?

Back 78

Normal: 10:1 but w/ ARF it’s 20:1. Since GFR has decreased, more urea is not being excreted therefore it increases BUN

Front 79

W/ pre-renal ARF, there is a marked decrease in GFR, what does this do to Na & water?

Back 79

The kidney will conserve salt & water so there will be low excretion of sodium (<1%) so it can maintain BP.

Front 80

T/F: w/ pre-renal ARF, u will find protein in the urine?

Back 80

FALSE; since the kidneys are normal, there won’t be any protein in the urine

Front 81

What 2 signs will be seen in pre-renal ARF?

Back 81

1)rapid pulse, 2) low BP,

Front 82

What meds should be avoided in ARF? Why?

Back 82

NSAIDS b/c they inhibit PG synthesis. PG is a vasodilator & when u inhibit it w/ NSAIDS, ischemia is potentiated & PX worsened.

Front 83

What is the best treatment for ARF?

Back 83

Restore the adequate volume w/ whole blood or isotonic fluids

Front 84

What is the Px for oliguria as a result of CHF or cirrhosis?

Back 84

It implies a severe dz w/ poor px

Front 85

How can u differentiate pre-renal azotemia from tubular necrosis? What is seen?

Back 85

Urine osmolarity fractional excretion of Na. In pre-renal azotemia reabsorption capacity of tubules are maintained while necrosis this fxn is lost & therefore unable to [ ] urine

Front 86

What are 4 potential causes of pre-renal conditions leading to ARF?

Back 86

1) hypovolemia, 2) decreased vascular filling, 3) HF & cardiogenic shock, 4) decreased renal perfusion d/t vasoactive mediators, drugs or diagnostic agents

Front 87

This is caused by an acute obstruction that affects the normal flow of urine out of both kidneys?

Back 87

Postrenal ARF

Front 88

The degree of renal failure corresponds to what?

Back 88

Degree of obstruction

Front 89

Postrenal ARF is seen most often in who?

Back 89

Elderly men w/ enlarged prostate glands that obstruct the normal flow of urine

Front 90

This is a condition in which the flow of urine is blocked, causing it to back up and injure one or both kidneys?

Back 90

Obstructive uropathy

Front 91

What is seen in obstructive uropathy?

Back 91

Oliguria or anuria if both kidneys obstructed & polyuria if there is partial obstruction.

Front 92

T/F: anuria is rarelly seen in pre-renal or renal parenchymal dz?

Back 92

True

Front 93

Post renally, obstruction can occur where?

Back 93

Various levels like the bladder, the outlet, the level of the ureter, the prostate

Front 94

Can obstruction of bladder cause ARF? Why or why not?

Back 94

Rarely unless one of the kidneys is already destroyed or only have one kidney

Front 95

This condition is more difficult to Dx & urinalysis may be of little to no help?

Back 95

Post-renal ARF

Front 96

This may be the only type of acute renal failure where urinalysis may be normal.

Back 96

Post renal ARF

Front 97

What is the Tx of post renal obstruction?

Back 97

Relief of the obstruction

Front 98

W/ relief of obstruction, there is profound diuresis, why is this?

Back 98

Buildup of urea & other metabolites during the obstruction. Can have accumulation of excess salt & water & tubular defects caused by the obstruction.

Front 99

After obstruction relief, how long can polyuria last?

Back 99

A few hours to a few days

Front 100

After obstruction, what is the urine osmolarity?

Back 100

It’s isomolar w/ plasma; ½ of it is urea & the other ½ electrolytes

Front 101

Caused by a variety of mechanisms that damage structures within the kidney (glomerular, tubular or interstitial?

Back 101

Renal parenchymal dz

Front 102

What are some causes of renal parenchymal dz?

Back 102

Immunological, allergic, obstruction & subsequent necrosis, ischemic, & toxic substances

Front 103

W/c renal parenchymal dz is common in hospital admits? Why?

Back 103

Ischemic – common in hospital admits – kidney itself sustains no damage but if blood flow is blocked or reduced for over 40 min can result in acute tubular damage.

Front 104

w/c renal parenchymal dz occurs following uric acid pp in hyperuricemia?

Back 104

Obstruction & subsequent necrosis

Front 105

80% of cases of renal fall in what category?

Back 105

Acute tubular necrosis

Front 106

The tubular epithelial cells are sensitive to ________?

Back 106

Anoxia

Front 107

What patho can happen w/ tubular damage?

Back 107

Vasoconstriction to decrease GFR & damage itself can result in oliguria since tubular debris can block urinary outflow

Front 108

What happens if person survives ATN?

Back 108

will get regeneration of the epithelial cells – the recovery is nearly 100% if there is no basement membrane damage.

Front 109

What are the 2 most damaging effects of urinary obstruction?

Back 109

1) stasis of urine
2) & progressive dilation of the renal collecting ducts & renal tubular structures

Front 110

Why can stasis of urine have damaging effects

Back 110

predisposes to infection & stone formation

Front 111

Why can dilation of the tubules cause damaging effects?

Back 111

b/c it causes destruction & atrophy of renal tissue

Front 112

Of the 3 renal dz, pre, post & renal, w/c has the worst Px?

Back 112

Renal b/c it’s intrinsic to the kidneys

Front 113

ARF is a common threat to w/c group of people?

Back 113

Seriously ill persons in ICU w/ mortality ranging from 40-75%

Front 114

What is the most common indicator of ARF?

Back 114

Azotemia

Front 115

An accumulation of nitrogenous wastes in the blood & decrease in GFR?

Back 115

azotemia

Front 116

ATN is characterized by what?

Back 116

destruction of tubular epithelial cells w/ acute suprression of renal function

Front 117

WHat are the causes of ATN?

Back 117

1) ischemia
2) sepsis
3) nephrotoxic effects of drugs
4) tubular obstruction
5) toxins from massive infection

Front 118

What happens w/ long pre-renal ischemia. Know the flow chart

Back 118