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137 Cards in this Set

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