Renal

Front 1

Kidney Functions

Back 1

1.Reabsorption of water, electrolytes, all glucose, amino acids, proteins and vitamins.
2.Aids with acid base balance-excretes bicarb
3.Removal of waste from blood and formation of urine.
4. Secretion of hormones
Erythropoietin- needed for RBC formation
Renin-RAS- Renin Aldosterone System
Vitamin D

Front 2

What is found in the
Cortex
Medulla

Back 2

Cortex: Contains all glomeruli+85% of nephron tubules. Juxtamedullary nephrons
Medulla: Tubules, ducts, Loop of Henle

Front 3

Function of
GLOMERULUS (found in cortex)

TUBULE (found in medulla)

Back 3

GLOMERULUS (found in cortex)
forms a protein-free filtrate from blood

TUBULE (found in medulla)
processes the filtrate to form urine

Front 4

Sympathetic innervation of kidney results in

Back 4

Stimulation of SNS results in renal vasoconstriction and renin release.

Front 5

1. The main driving force for filtration is
2. The most important physiologic regulator of GFR is

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1. hydrostatic pressure in the glomerular capillaries.
2. blood volume. Increased fluid intake increases blood volume increasing B/P slightly increasing GFR.

Front 6

How are glomerular capillaries protected from fluctuations in B/P

Back 6

by autoregulation

Front 7

What does the body do in response to a drop in blood pressure? (which accompanies the loss of fluid)

Back 7

1. triggers the hypothalamus to rapidly release ADH from post pituitary
2. ADH increases water reabsorption by the kidney by increasing water permeability of the distal tubules and collecting ducts
3. each juxtaglomerular apparatus which responds by secreting renin
4. This triggers the formation of angiotensin II which stimulates release of aldosterone from the adrenal cortex thus slowly boosting water reabsorption by the kidneys by increasing reabsorption of Na, and thus water

Front 8

glomerular filtrate contains

Back 8

everything but large molecules such as proteins, contains ions, urea, glucose, minerals, vit, some drugs
99% is actively reabsorbed

Front 9

nephraglia manifests as

Back 9

CVA tenderness

Front 10

Kidney Disease manifests as

Back 10

nephraglia
Abnormal Urinalysis
Abnormal findings in: KUB, US, CT, MRI, Biopsy

Front 11

Intrarenal disorder: Infection is caused by

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1. Hostile environment: Intrarenal: pH, urea
Postrenal: prostatic secretions and glands in women secrete mucous
2. Unidirectional flow- back flow causes damage
3. Epithelial cells trap bacteria for inflammatory mediators to kill bacteria:

Front 12

Kidney infection presents what symptoms?

Back 12

Thus, pain, urgency, frequency

Front 13

What populations are at risk for kidney infection

Back 13

Premature newborns
Children
Sexually active and pregnant women
Women on certain Antibiotics
Older women
Diabetics Think of diabetes as chronic inflammatory disease
Indwelling catheters

Front 14

Acute Pyelonephritis

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Infection of renal pelvis and interstitium

Front 15

Etiology Acute Pyelonephritis

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Pregnancy major risk factor- due to chg hormones-look on dip stick for protein in urine
DM- diabetes
Vesicoureteral reflux esp children- urine going back into kidney, congenital malformation
E. Coli in 80% of acute cases

Front 16

What is causing Acute Pyelonephritis

Back 16

Ascending bacteria along the ureters may enter via bloodstream
Epithelial cells trap bacteria for inflammatory mediators to kill bacteria- sticky bomb
Inflammatory chemokines=leukocytes + inflammatory mediators=parenchymal damage.

Front 17

What s/s presents with Acute Pyelonephritis

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Fever, chills; Urosepsis
UTI s/s frequency, urgency and pain on urination.
CVA tenderness

Front 18

How is Acute Pyelonephritis diagnosed?

Back 18

Urinalysis=significant bacteria
RBC, WBC(+casts), nitrates, proteinuria

Front 19

Treatment for Acute Pyelonephritis

Back 19

ABX 7-10 days
urine culture if w/o improvement in 48 hrs

Front 20

What do you look for in children when you can’t tell frequency or pain

Back 20

Look for Fever, chills

Front 21

Normal specific gravity of urine

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1.003-1.030

Front 22

What is the etiology of Chronic Pyelonephritis

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1. Recurring or inadequately managed infections
2. Inflammation and scarring of tissue
3. Acute may lead to chronic
4. Often associated with chronic obstruction
5. At Risk Individuals such as those with obstructive disorders i.e. renal calculi (stones), neurogenic bladder, vesicoureteral reflux or Intrarenal disease

Front 23

Chronic Pyelonephritis can lead to

Back 23

renal failure

Front 24

What is vesicoureteral reflux –

Back 24

urine goes back up to kidney

Front 25

Early sx of Chronic Pyelonephritis can often be minimal and may include __________.

Back 25

HTN, due to renin

Front 26

Dx Chronic Pyelonephritis :

Back 26

IV pyelogram & ultrasound

Front 27

Urinary Tract Obstruction can be caused by

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Congenital
Stones
Tumors
Trauma
Edema
Pregnancy
BPH

Front 28

which of the 3 is most dangerous? Calyceal stone, renal pelvic stone, upper ureter stone

Back 28

upper ureter stone, can kill you because ureter is blocked off

Front 29

Complications of obstruction:

Back 29

Infection, sepsis, acute renal failure and ?CKD chronic kidney disease

Front 30

Hydroureter-

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complete obstruction of ureter, renal pelvis and tubules enlarge

Front 31

Hydronephrosis-

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enlarged kidney

Front 32

Manifestations of renal obstructions:

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Wt gain, nausea, malaise, headaches, LE edema

Front 33

Renal Calculi Nephrolithiasis

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kidney stones

Front 34

most common Nephrolithiasis

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calcium oxalate most common

Front 35

contributors of renal calculi

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Contributors:
High pH in urine – alkaline. Bacteria split NH3
Uric acid - gout
Prolonged immobilization
Purine diets – organ meats
Increased BMI, change from a person’s normal

Front 36

If you find calcium in stone, this could indicate problems in the

Back 36

parathyroid

Front 37

presentations of renal calculi

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Presents with acute pain:
may be flank,
CVA,
testicles or labia
n/v, hematuria, elevated VS

Front 38

Diagnosis renal calculi

Back 38

Diagnosis
CT, UA for pH, CBC, BUN/Creatinine; dietary history, family history, medications

Front 39

treatment renal calculi

Back 39

Treatment:
pain relief and prevention; maybe surgical removal of the stone. Ultrasonic or laser lithotripsy.

Front 40

Glomerular Disorders

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Immune or inflammatory most often implicated- is responsible for it
Proteinuria is classically the clinical manifestation

Front 41

Classification r/t degree of proteinuria:
Nephrotic syndrome
Nephrosis
Nephritic syndrome

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Nephrotic syndrome >3to 3.5 gm/24 hrs
Nephrosis 2 gm/24 hrs
Nephritic syndrome mild proteinuria

Front 42

Glomerulonephritis

Back 42

Inflammation of glomerulus and surrounding tissue

Front 43

Inflammation of glomerulus and surrounding tissue r/t

Back 43

drugs
Toxins
vascular disorder
systemic diseases-DM, HTN
immunologic issues

Front 44

Leading cause of chronic and end stage renal failure

Back 44

Glomerulonephritis

Front 45

Pediatric etiology of glomerulonephritis

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β-hemolytic Streptococci

Front 46

Clinical manifestations of glomerulonephritis

Back 46

Hematuria-smoky urine
Edema r/t decreased GFR
Proteinuria
Oliguria- absence of urine
Hypertension- renin stimulated
Reduced complement levels due to infection

Front 47

What is responsible for manifestations of glomerulonephritis

Back 47

Capillaries are leaking

Front 48

Chronic Glomerulonephritis results from

Back 48

Several years of proteinuria and hematuria but no other symptoms

Front 49

Chronic Glomerulonephritis causes what changes in kidney?

Back 49

Fibrotic changes with tubular dilation and atrophy may develop.

Front 50

Chronic Glomerulonephritis is associated with

Back 50

Associated with hypercholesterolemia, IDDM type I, and SLE

Front 51

Three types of immune mechanism influencing renal disease

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1. Antigen – antibody
2. Antibodies against basement membrane
3. Streptococcal release of altering enzyme β-hemolytic Streptococci

Front 52

What effect does the immune response have on kidney which leads to renal failure

Back 52

All alter membrane permeability and increase swelling, decreasing blood flow and filtration

Front 53

What lab tests are abnormal with renal damage

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Elevated serum Creatinine and BUN
Proteinuria and hematuria, casts
Renal biopsy determines extent of injury and type.

Front 54

Treatment for renal damage

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consists of correcting underlying cause, and controlling for:
HTN, edema, hyperkalemia, hyperlipidemia

Front 55

Problems associated with Renal Disease
Calcium loss

Anemia

Back 55

decreased Ca stimulates PTH, Stimulated PTH causes release of calcium from the bone and enhanced urinary excretion of phophate. Overtime with decreased GFR less phosphate is excreted, and now increases, thus hyperphosphtemia and hypocalcemia and bone disease are acclerated

inadequate production of erythropoietin, Decreased RBCS life span

Front 56

Problems associated with Renal Disease
Lipids

Protein loss

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the ratio of LDL to HDL goes to LDL and an accelerated atherosclerosis occurs

Proteinuria and a negative nitrogen balance, but need to restrict dietary protein to preserve GFR

Front 57

Problems associated with Renal Disease
Acid Base

Hyperkalemia

Back 57

develop a acidotic state

increased plasma levels with progressive decrease of GFR

Front 58

Pathophysiology Renal Disease and HTN

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1. Released renin enzyme in response to the increased pressure in the renal vascular
2. Converts angiotension I to angiotension II
3. Vasoconstriction and increased arterial pressure
4. Increased aldosterone secretion
5. Systemic hypertension
6. Primary medication treatment:
ACE inhibitors

Front 59

Primary medication treatment for HTN due to renal disease

Back 59

ACE inhibitors

Front 60

ACE inhibitors:

Back 60

BLOCKS ANGIOTENSION I CONVERTING TO ANGIOTENSION II

Front 61

In order for the kidney to function properly it requires:

Back 61

Normal renal blood flow: RBF
Functioning Glomeruli: GFR
Functioning Tubules
Clear Urinary Outflow tract for drainage and elimination of urine formed from body’s waste

Front 62

What allows for the maintenance of a near normal Intrarenal hemodynamic environment (RBF, RPF, GFR and FF ) despite changes in the systemic blood pressure

Back 62

autoregulation

Front 63

Interruption of renal function has significant ramifications where?

Back 63

every body system

Front 64

Comorbidities with kidney disease:

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preexisting kidney conditions, HTN, DM, CHF, liver impairment/failure

Front 65

Elderly and problems with kidneys

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Autoregulation, concentrating urine, ADH/ thirst, K+, GFR.

Front 66

Oliguria

Back 66

<400 ml/24 hrs

Front 67

Anuria

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<100 ml/24 hrs

Front 68

Azotemia

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ALL METABOLITES ARE STAYING IN BODY
silent found by changes in BUN

Front 69

Uremia

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symptomatic, causes death
toxic condition of retention of waste products
clinical syndrome associated with fluid, electrolyte, and hormone imbalances and metabolic abnormalities

Front 70

Prerenal acute renal failure due to

Back 70

diminished perfusion of kidney due to
1.volume deficits due to fever, vomiting, diarrhea, burns, hemorrhage, overuse of diuretic
2.heart cannot generate output, CHF
3. vascular autoregulation interfered by ACE inhibitors, COX inhibitors, angiotension II receptor blocker, NSAIDS
4. nephrotic syndrome- mild protein loss due to gromular inflammation
5. hypercalcemia
6. thrombosis, embolus, dissection, stenosis

Front 71

What needs to be in balance for intrarenal autoregulation?

Back 71

vasodilatation and vasoconstriction

Front 72

what causes vasodilation?

Back 72

PG, Kinines, ANP, NO

Front 73

what causes vasoconstriction?

Back 73

Renin, All, ADH

Front 74

influence of intrarenal constriction of afferent arterioles on GFR

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loss of GFR

Front 75

Area involved in intrarenal Acute Renal Failure:

Back 75

vasculature, interstitial, glomerular or tubular

Front 76

most common cause of ARF Acute Renal Failure

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Acute tubular necrosis (ATN)

Front 77

Acute tubular necrosis (ATN) is a result of

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caused by prerenal ischemia

Front 78

ATN may lead to

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ESCRD, end stage chronic renal disease

Front 79

Ischemia + inflammatory response leads to

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Acute tubular necrosis

Front 80

Acute Renal Failure: Post Renal

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due to obstruction

Front 81

intraluminal intrinsic causes of post renal ARF

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stone, blood clot, papillary nec

Front 82

intramural intrinsic obstruction causes

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BPH, ureter stricture, carcinoma prostate, bladder tumor, radiation fibrosis

Front 83

extrinsic causes of ARF, post renal

Back 83

pelvic malignancies
prolapsed uterus

Front 84

Stages of ATN , acute tubular necrosis

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Oliguria stage
Diuretic stage
Recovery stage

Front 85

describe oliguria stage

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urine output drops=hypervolemia, THN, JVD
Metabolic wastes retained
Hyperkalemia, fluid electrolyte imbalance
uremic syndrome

Front 86

Describe diuretic stage

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polyuria due to concentrating mechanism not recovered
volume deficit
elevated BUN continues
hypokalemia

Front 87

describe recover stage

Back 87

full renal function recovered, serum creatine normal

Front 88

why does kidney disease cause anemia?

Back 88

kidneys don't manufacture erythropoietin