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137 Cards in this Set
- Front
- Back
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diuresis
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increase production of and elimination of urine
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dysuria
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painful urination
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azotemia
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increase in nitrogenous wast material
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papilledema
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swelling of the optic disc due to an increase in intracranial P
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polyuria
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excreting over 2000 mL/day
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oliguria
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excreting <500 mL/day (v. high specific gravity, darker, more concentrated)
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anuria
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excreting <125mL/day (VERY high specific
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nocturia
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excreting more than 500mL with LOW specific gravity at night time (not salty or concentrated)
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urine color
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normal, pale yellow
concentrated, amber diluted, clear |
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odor
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hay, grass, aromatic
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appearance
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normal: clear
cloud or turbid: from casts, WBC, fats, proteins... |
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specific gravity
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density, ability of the kidneys to concentrate urine
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high specific gravity
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dehydration
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low specific gravity
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over hydration, diabetes, congestive heart failure
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ph: alkaline urine
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veggie diet
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acid urine
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mixed diet
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proteinuria
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proteins in urine: albumin, orthostatic proteinuria, not always pathological
(bence jones proteinuria is pathological) |
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glucosuria
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sugar in urine, diabetes mellitus, transcient glucosuria (non pathological)
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cells in urine:
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epithelial cell: some ok
WBC: infection or contamination RBC: not always pathological, strenuous exercise, truck drivers, menses contamination |
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hematuria:
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blood in urine, early sign of cystitis (bladder infection), menses contamination
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ketonuria
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ketones in urine, starvation or any condition which burns body fat as fuel. atkins diet, diabetes mellitus
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casts
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plugs in nephron, made of gelled proteins, some hyaline casts are ok, WBC casts are NOT good
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crystals
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small, able to pass in the system, minerals that have somewhat "salted out"
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stones
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calcium oxalate, most common (72%), calcium phosphate, cysteine calculi (metabolic disorder), urate stones, magnesium ammonia phosphates (urea splitting bacteria)
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stones
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all create severe renal colic, if large enough, when passing down the ureters
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renal colic
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not relieved by position changes
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blood test
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urea nitrogen: nitrogenous waste, BUN
creatinine electrolytes |
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edema
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excess fluid in the interstitial spaces from capillaries caused by lack of sufficient protein material in the blood (albumin)
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pathology
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most kidney disfunctions cause proteins in the urine and edema in the body
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papilledema
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swelling of the optic nere due to brain edema
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central nervous system edema causes:
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confusion, agitation,,,,,
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edema test
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press against the tibia starting at the sock line and moving up. the higher the indentation, the greater the edema..
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turgor test
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pinch over the sternum or back of the hand and if the skin does not return immediately, suspect dehydration. elderly and thin may have a delay that is not a positive turgor test
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systemic hypertension
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more common in blacks
damages both kidneys |
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hydronephrosis
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back up of fluid in the kidney and balloons out the pelvis & kidney, can destroy nephrons, caused by obstruction, can lead to pyelonephritis
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renal artery stenosis
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causes kidney to recognize a decrease in perfusion and renin released. raises systemic blood pressure so perfusion of involved kidney improves. blows out the good kidney
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metabolic disorders:
diabetes mellitus |
arterioles affected, therefore kidneys a target
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gout
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urate crystals salt out in the kidney tissue and destroy the kidney function
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parathyroid tumor
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increase Ca and form stones
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systemic diseases
MS |
bladder stasis (difficulty in starting micturition)
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SLE
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kidney damage
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strep infection
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acute glomerulonephritis
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strep.
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bacteria that can shut down the kidneys in a "flash"
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congenital hereditary disorders:
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ectopic kidney (in the thoracic cavity)
polycystic kidney disease: grapelike clusters in the parenchyma (symptoms seen between 40 & 60 yrs old- assume adult) infantile polycystic kidney disease: fatal |
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pyelonephritis
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kidney infection
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glomerulonephritis
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strep!!
acute onset: can lead to kidney failure chronic: slower progress, smoldering acute |
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kidney failure
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strep., shock, trauma, burns, severe injury
acute... |
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uremic syndrome
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75% of nephrons lost
proteins in urine, edema, cerebral edema |
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uremic syndrome
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skin itches because of calcium deposit in skin
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uremic syndrome
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skin bruises, purpura: bleeding into skin, creating "rash"
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uremic syn.
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skin turns yellow from urochrome deposits (eyes remain white)
skin infetions from scratching waxy look |
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uremic syn.
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skin gets uremic frost& urate crystals form uremic fetor: breath smells like urine (yum!)
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uremic syn
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increase in nitrogenous waste in blood
increase in electrolytes in blood |
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anemia
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decrease in erythopoitin and fragile RBC with early death
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location
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posterior in the abdominal cavity
retroperitoneal |
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cushion
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kidneys are embedded in fat
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location
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each kidney is in contact posteriosuperiorly with the inferior surface of the diaphragm
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right kidney
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lower because of position of liver
related to the 12th rib posteriorly |
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left kidney
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related to the 11th and 12th ribs posteriorly
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upon changing position from supine to erect
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kidneys move about 3-4"
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position of kidneys
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maintained largely by fat deposits, renal vessels provide some support
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nephroptosis
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floating kidneys, occur frequently among truck drivers, horseback riders and motorcyclists
pain due to traction on the renal vessels |
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pain originating from the kidney or its vascular supply is referred to...
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the lumbar and inguinal regions
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renal capsule
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a true fibrous capsule of the kidney
can be easily stripped from the normal kidney may adhere to the kidney in certain pathological conditions in which scarring has occurred |
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renal capsule
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provides barrier against the spread of infection
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renal sinus
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is the cavity of the kidney
opens medially at the hilus |
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renal artery & vein
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enter and leave the sinus (respectively) at the hilus
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renal pelvis
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funnel shaped proximal end of the ureters, is continuous with the ureters proper distally and with the major calyces within the kidney
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renal parenchyma
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divided into the cortex and the medulla
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cortex
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composed primarily of the renal corpuscles, proximal and distal convoluted tubules
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renal corpuscle
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made of the glomerulus and the bowman's capsule
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renal medulla
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consists primarily of the straight tubules, henle's loop and the collecting ducts
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urine flow
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from the collecting ducts>>>papilla>>>>minor calyx>>>major calyx>>>renal pelvis>>>ureters>>>bladder>>>urethra
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blood supply to kidneys
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profuse, receiving 25% of the cardiac output
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L and R renal arteries arise from the...
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lateral aspecs of the aorta, usually b/n L1 and L2
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pain derived from the kidney and upper ureters is referred to...
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the T12 to L2 dermatomal distribution, the lumar and inguinal regions along with the anterior thigh
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one of the functions of the kidney is the conservation of...
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minerals and the maintenance of ionic balance in the body fluids
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each kidney contains a million...
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nephrons, which comprise the basic morphologic and physiologic units of the kidney
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ultrafiltrate of plasma
(provisional urine) |
exudes through the glomerular capillaries into the bowman's capsule
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bowman's capsule
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the beginning of the nephron
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proximal tubule
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select substances are absorbed from the provisional urine resulting in osmotic uptake of water.
some substances are secreted into provisional urine by the tubular epithelium |
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distal tubule
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Na & H20 may or may not be absorbed, depending on the circulating concentrations of ADH and Aldosterone
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fluid remainder that passes into the collecting ducts is...
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URINE
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how much provisional urine is produced each day and how much is actually micturated out after reabsorption?
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150-200L
1-2L |
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micturition
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voiding of the bladder
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urination
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pee passing through a tube
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what does the kidney produce to control blood pressure?
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vasoactive substances,
renin enzyme |
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ureters
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excretory ducts between the kidneys and bladder
ureters converge, but do not join, and enter the bladder posterior and inferior |
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ureters display _____ one to six times per minute
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intrinsic peristaltic activity
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Ureters narrow at..... (3 places)
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the junction between the renal pelvis and ureters proper,
at the point where the ureters cross the pelvic brim, where the ureters pass through the wall of the bladder |
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stone
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concretion or nephrolith,
may lodge or pass slowly through any one of these three areas (3 areas of ureter narrowing) |
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hydronephrosis
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and uretral distension would occur proximal to the stone
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distension of hydronephrosis causes...
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excruciating pain (renal colic) which has been reported to be among the most intense pains. ever!!!!
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upper uretral obstruction causes pain to be referred to the....
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lumbar region
(T12-L1) |
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middle uretral obstruction causes pain to be referred toward the...
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inguinal and pubic regions, anterior scrotum, mons pubis, superioanterior thigh (L1 and L2)
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lower uretral obstruction sauses pain to be referred to ....
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the perineum and leg (s2-s4)
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if a stone fails to move despite copious imbibition
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hydronephrosis may produce kidney dmamge and thus require treatment.
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lithotripsy
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a method of blasting the stones into smaller pieces that can pass down the ureters and out
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percutaneous nephrolithotomy
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through the skin kidney stone removal
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kidney with stenotic or occluded renal artery, or one that is nonfunctional with respect to the production of urine,,,,
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wil produce an overabundance of renin which produces an overabundance of angiotensin & systemic hypertension
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renal outflow tract can be visualized radiographically by
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intravenous pyelography (IVP)
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intravenous pyelography
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contract material, injected intravenously, is excreted by the kidney and concentrated in the outflow tract which appears as radiopaque. xrays demonstrate this process.
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urinary components (CA cmpnds and urea) may salt out in the calyces and concretions may dvp.
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usually nephroliths are small enough to pass out. they may become large enough to lodge within a ureter.
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staghorn concretions
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may completely occlude a calyx
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what % of the L ventricle's output of blood in each cardiac cycle is distributed to kidneys for filtration?
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25%
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afferent arteriole leads to the
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glomerulus
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glomerulus is surrounded by
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bowman's capsule
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blood leaving the glomerulus flows to the
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efferent arteriole
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vasa recta
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open, capillary-like tubing, parallel long loops of henle
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filtrate
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same as blood plasma except w/ no colloids or cells (lg. molecules)
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how much filtrate is produced per minute & filter through capillary and capsular membranes into the renal tubule?
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120mL of filtrate (deproteinized plasma- water, crystalloids, no colloids or cells)
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the glomerular membrane actes as a simple filter
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no energy is used up by the cells in filtration
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what is reabsorbed to peritubular capillaries?
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most of water,
essential or high threshold substances (glucose, sodium , essential salts, aminos, vitamin C) |
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glucose
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is all reabsorbed into the proximal nephron
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medium threshold
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some is reabsorbed (K+)
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low threshold
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urea, phosphates, uric acid
only small amts. absorbed |
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no threshold
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NONE is reabsorbed
creatinine, sulphates |
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ascending loop of henle
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is impermeable to H20
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80%
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of water is reabsorbed in the proximal tubule
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20%
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of water is reabsorbed in the distal tubule and collecting ducts
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what crosses the distal nephron?
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Na+ (chloride follows)
active transport |
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what is the tonicity in the loop of henle?
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hypertonic
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what is the tonicity in the vasa recta?
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hypertonic
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vasa recta comes off of the
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efferent arteriole
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vasa recta is involved in a
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cross current
counter current |
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Inulin
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tests glomerular FILTRATION
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plasma clearance
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the volume of plasma freed of the substance by the kidney in one minute
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Urea
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reabsorbs
clearance tests normal renal funcion filtration and ability to ....? |
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Diodone
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tests filtration and SECRETION.
an iodine containing material complete clearance of diodone from plasma in one passage through normal kidney, gauges not only glomerular filtration power (1) but, also the efficiency of the tubular epithelium to secrete (2) |
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excessive intake of water
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blood diluted
osmotic pressure decreased level of ADH in blood falls blood sodium reduced |
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insuficccient intake of electolytes
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by replacing only the water and not the salts lost in excess sweating, vomiting or diarrhea
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with too much water & not enough salt....
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ADH output from posterior pituitary is diminished
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diuresis
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increased output of dilute urine
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can water flow freely out of the proximal nephron?
the distal nephron? |
yes
no |
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insufficient intake of water &/or excessive intake of electrolytes (& Na+)
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osmotic pressure increased
level of ADH in blood rises blood sodium increased aldosterone withdrawn |
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insufficient intake of H20
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posterior pituitary discharges ADH to blood stream
increases permeability to water of the distal and collecting tubule |
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too much sal, not enough water
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no H20 can go from the distal nephron into the peritubular capillaries
ADH up, aldosterone down |
