Renal: 2. Leonard : General Renal Pathology And Basic Laboratory Considerations

Front 1

What gets more bloodflow than any other organ in the body?

Back 1

Kidneys together receive approx. 20-25% of the cardiac output; more blood flow (mL/min/g of tissue) than any other organ

Front 2

what type of arteries lead to the kidney? what does this mean

Back 2

end vessels

no anastomoses, you block those bad boys and you are in trouble

Front 3

what are the 4 major functions of the kidney?

Back 3

Excretion of waste products
Regulation of body water and salts
Maintenance of body pH (acid-base balance)
Hormonal activity
---(Erythropoietin
Renin
Prostaglandin)

Front 4

where is one of the only places that makes erythropoeitin?

Back 4

kidney

Front 5

what kidney structure has the function of:

Filtration: solutes, endogenous wastes, exogenous substances

Back 5

Glomerulus

Front 6

what kidney structure has the function of:

Reabsorption & Secretion:
water, solutes

Back 6

Tubules

Front 7

what kidney structure has the function of:

Support tissue:
some hormonal control; helps maintain proper milieu

Back 7

Interstitium

Front 8

what kidney structure has the function of:

Maintain adequate blood flow:
perfusion pressure; nutrients and oxygen

Back 8

Blood vessels

Front 9

what are the 4 medical kidney diseases? are the neoplastic or non-neoplastic

Back 9

Abnormal development
Glomerular
Tubulointerstitial
Renovascular

non-neoplastic

Front 10

what are the 2 divisions of neoplastic kidney diseases

Back 10

benign and malignant

these are further broken into adult/ped

Front 11

what are 2 lab values that can show altered kidney function?

Back 11

serum and urine

Front 12

what 3 studies do you have to do for a tissue biopsy of the kidney?

Back 12

light microscopy: H/E, silver, trichrome, PAS

Immunofluorescence: antiboides identify abnoraml proteins within glomerulus

Electromicroscopy: altered ultrastructure, primarily of glomerulus

Front 13

in order, what 3 things do you have to go across in the glomerulus in the capillary space/lumen

aka what is the filtration membrane?

Back 13

1. Capillary endothelial cells (fenestrated)

2. Glomerular basement membrane (GBM)

3. Visceral epithelial cells (podocytes) – with foot processes (pedicles) that “fuse” to GBM

Front 14

what type of cells are in the urinary space of the glomerulus

Back 14

parietal epithelial cells (Bowman's capsule)

(contiguous with tubular epithelial cells of the proximal convoluted tubule)

Front 15

what are Mesangial cells and where are they?

Back 15

act like macrophages, can contract, can proliferate, and contribute to extracellular membrane and glomerular basement membrane

found in the glomerulus

Front 16

What provides the major charge exclusion barrier in the kidney?

what about size?

Back 16

charge: Glomerular basement membrane

size: foot processes filtration slit diaphragm

Front 17

what are 4 possible pathologic alterations in glomerular disease

Back 17

Increased glomerular cellularity

GBM thickening or alteration / Podocyte alteration

Hyalinosis (proteins that are present in plasma, and go into GBM, cause thinking)

Sclerosis
(Accumulation of E/C collagens in mesangium or capillary loops (e.g., diabetic glomerulosclerosis)

Front 18

what is Hyalinosis and what causes it

Back 18

Insudation of plasma proteins due to endothelial injury

Front 19

a proliferative response to glomerular damage =

Back 19

Glomerular hypercellularity:

Front 20

what normally deposits in or around the glomerular matrix in membranous glomerulopathy? what does this do?

Back 20

antibody complexed with antigen

this disrupts normal filtration, and you loose foot processes

Front 21

primary presentations related to functioning of kidneys/urinary system

Back 21

Altered urine output
Altered fluid balance
Altered electrolyte balance
Altered urine (e.g., hematuria)
Pain
Localization
Association

Front 22

Primary vs. secondary renal disease

Back 22

Disease localized to kidneys or systemic disease that affects kidneys as well as other organs/tissues

Front 23

Two primary functional compartments of the kidney with respect to fluid/electrolyte homeostasis?

Back 23

1. Glomerulus → filtering (GFR)
Allow for elimination of unwanted solutes, water, wastes

2. Tubules → concentrating
Conservation of water, retention of sufficient solutes

Front 24

GFR = >90

Stage?

Back 24

1

Front 25

GFR = 60-80

Stage?

Back 25

2

Front 26

GFR = 30-59

Stage?

Back 26

3

Front 27

GFR = 15-29

Stage?

Back 27

4

Front 28

GFR = <15

Stage?

Back 28

5

kidney failure

need dialysis

Front 29

Blood urea nitrogen (BUN)
Creatinine (Cr)
Uric acid

if these are affected what is the problem in general

Back 29

Predominantly filtering

Front 30

Electrolyte balance
Na, K, Ca, PO4
Osmolality (“solute density”)
Contributes to proper body compartment fluid balance


if these are affected what is the problem in general

Back 30

Predominantly concentrating

Front 31

Output, osmolality, and electrolytes (Na)
Concentrating ability of kidneys
End product of NH3 metabolism in the liver
Amino acid and purine metabolism
Filtered at the glomerulus, with partial tubular reabsorption


if these are affected what is the problem in general

Back 31

Generally tubular, chronic state could involve glomeruli as well

Front 32

Blood cells (presence and nature if present)
Products of inflammatory cells (leukocyte esterase) or bacterial cell metabolism (nitrite)
Tubular epithelial cells


if these are affected what is the problem in general

Back 32

Glomerular or tubulo-interstitial

Front 33

End product of NH3 metabolism in the liver = ?

(Amino acid and purine metabolism
Filtered at the glomerulus, with partial tubular reabsorption)

Back 33

BUN

Front 34

what is BUN relationship to GFR?

Back 34

BUN is roughly inversely proportional to the GFR (BUN proportional to 1/GFR) … as GFR down, BUN up

Front 35

normal BUN range?

Back 35

10-20mg/dL

Front 36

Reduced glomerular perfusion and increased urea formation do what to BUN?

is this pre/renal/post

Back 36

increase BUN

pre-renal

Front 37

Reduced glomerular perfusion, Urinary outflow obstruction do what to BUN?

is this pre/renal/post

Back 37

increase BUN

post-renal

Front 38

normal serum creatine?

Back 38

~ 0.6-1.0 mg/dL (adult)

Front 39

this serum level is better than BUN at showing GFR

Back 39

serum Cr

Front 40

BUN/Cr ratio:
15-20:1

Reason for Azotemia?

Back 40

dehydration

Front 41

BUN/Cr ratio:
>15-20: 1

Reason for Azotemia?

Back 41

pre-renal (or post-renal)

Front 42

BUN/Cr ratio:
~10-15:1

Reason for Azotemia?

Back 42

renal