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331 Cards in this Set

  • Front
  • Back
What are the kidneys fxn's?
1. Remove waste, 2. Regulate blood composition, 3. Excrete foreign substances
What is regulated in the blood by the kidneys?
1. Amount of water, 2. Quantity and concentration of ions, 3. Acid-base balance
What are some systems affected by kidney fxn?
GI, neurologic, muscle, heart, pretty much all systems
What shape is the kidney?
bean shaped, in back of abdomen at level of the lower ribs, each weighs 1/4 lb., dimensions: 4 x 2.5 x1.5 inches
What is the major renal vein?
blood returns to heart through inferior vena cava
What is the major renel artery?
major branch from aorta; 20% of systemic blood flow goes to kidney
What is the blood flow through the kidney?
2.1 L per minute
What is the kidney medulla?
containts light colored pyramids
What is the kidney pelvis?
flat funnel shaped cavity that collects the urine into the ureters
what is the kidney cortex?
Outer 1/3 of kidney, contains most of the filtration units
What does 'pilo' refer to?
renal pelvis involvement
Where is a nephron?
cortex and medulla, perpendicular to surface of kidney
How many nephrons per kidney?
What doe each nephron do?
produce urine, clean the blood
What has vasculature similar to the eye?
The kidney, so DM and SLE have similar effects on these structures
What is a nephron?
ball of capillaries, long thin tube with a hair pin loop, closed at one end
Where are peritubular capillaries?
around the nephron
Who do peritubular capillaries absorb?
water, solutes, which leave renal tubules
What provides blood to renal tissue?
peritubular capillaries
What is the glomerulus?
pinhead sized filtration capsule 1million per kindey
What is Bowman's Capsule?
hollow sphere around glomeruli that drain into the tubules
What is the urine pole?
where the urine drains from the glomeruli
Where is the vascular pole?
where blood enters the glomeruli
What are juxtaglomerular cells?
baroreceptors that sense pressure change that produce, store and excrete renin
Where are enlarged smooth muscle cells of afferent arterioles found in the kidneys?
juxtaglomerular cells
Where are Bowman's capsules located?
outer 1/3 of cortex
What are glomelular capillaries
ball of capillaries with fenestrated endothelium and incomplete basement membrane
What are mesangial cells?
Cells w/ phagocytic and contractile fxn to control blood flow
What holds the glomelular 'ball' together
mesangial cells
What capillary has an incomplete basement membrane?
glomelular capillaries
What are podocytes?
modified epithelial cells that support glomelular capillaries
What are podocytes similar to?
choriocapillaris and RPE cells
What gets through fenestrated structures more readily?
positively charged ions, substances found in high conc. Systemically, smaller size all facilitate movement across membrane
Why should protein NOT be able to get into the glomerulus?
proteins are large molecules, SHOULD be too large to get through
Is the glomelular capillary system high pressure?
yes, and it is leaky so exudates are forced through
What are the two important factors that control glomelular filtration rates?
time and pressure
Is there parasympathetic innervation in the afferent tubule?
What does sympathetic stimulation of the kidney do?
constricts arteriole and releases rein from juxtaglomelular cells
What does constriction of renal blood flow do?
slows blood flow and reduces filtration pressure
What does angiotensin II do under sympathetic stimulus?
constriction of efferent ateriole
What triggers angiotensin II?
What do PG's, nitric oxide, and endothelin do?
chemical mediators that influence renal blood vessels
Where is the afferent arteriole of the glomerulus?
upstream from glomerulus
Where is the efferent arteriole of the glomerulus?
downstream of glomerulus 'Efferent is the Exit'
Does the kidney try to maintain constant filtration?
What is the mechanism of initial filtration?
2-3x higher pressure than any other capillary bed is found in glomeruli; this forces substances through capillaries
What is the glomerulus selective for?
smaller substances, positive substances, configuration of the the substance
What is in filtrate?
water, ions, glucose, AA, bicarbonate
What is reabsorption?
substance filtered by glomeruli are brought back into the body
What is reabsorbed?
ions, glucose, amino acids from the lumen of nephron
What facilitates reabsorption?
specialized transporters on epithelial cells of nephrons
Are transporters active or passive?
How is Na+ related to reabsorption?
Na+ is sometimes exchanged with substances, enters together via shared transporters or can undergo solvent drag with reabsorbed substances
What are the two major modifers of absorption?
concentration, rate of filtrate flow
What does a higher flow of filtrate cause?
Less time for transporters to glean their targeted substance
Where does reabsorption of water occur?
along tubules in a passive mechanism, except for the Ascending and Distal Tubules
What % of total filtrate volume becomes urine?
What is reabsorbed in the proximal tubule?
80% of glomelular filtrate
What is reabsorbed in the Loop of Henle?
water and salt, 6% of filtrate reabsorbed here
What is reabsorbed in the distal tubule?
9% of filtrate. Variable reabsorption and active secretion occurs
What is reabsorbed in the collecting tubule?
4% of filtrate
What is excretion sometimes called?
What is the distal tubule sometimes called?
Distal convoluated tubule
What is excreted in the glomerulus?
water, ions, glucose, AA, bicarbonate
What % of Na is reabsorbed?
What does Na reabsorption depend on?
angiotensin II
how much water and Cl- is reabsorbed?
80%, passively
How much K+ is reabsorbed?
50%, actively
Where is the filtrate isotonic?
entrance to the loope of Henle
What is the only thing reabsorbed in the descending loop of Henle?
What is the osmolarity of the filtrate as it leaves the Loop of Henle?
What reabsorbs water reclaimed in the loop of Henle?
peritubular capillaries
What does ''water flows down hill'' remind?
That water flows out (reabsorbed) in the descending loop of Henle
As it enters the Ascending loop of Henle, what is the osmolarity?
Is the ascending loop of Henle permeable to water?
No. 'Water can't flow uphill'
What is reabsorbed in the Ascending Loop of Henle?
Na, K, Cl
What does the reabsorption of salt do to the medulla?
Makes it very hypertonic
What is the osmolarity of exit filtrate from the Acending loop of Henle?
Where are macula densa cells?
Specialized epithelial cells that connect the distal convoluated tubule
What do macula densa cells do?
Sense the levels sodium and chloride in filtrate.
What do macula dense cells do if NaCl is low in the filtrate?
encourage relase of renin from juxtaglomelular cells
What does parathyroid hormone induce in the distal tubule?
increased Ca++ absorption
Are early cells of the distal tubule permeable to water?
Is filtrate hypotonic or hypertonic in the distal tubule?
What is Na exchanged for in the distal tubule?
K+ is excreted actively, partly in exchange for Na+
How is Na reabsorbed in the collecting duct?
active transport
What does aldosterone increase in the collecting duct?
K+ excretion/Na+ reabsorption exchange
What does ADH do to the collecting duct?
allows water to pass through walls of collecting ducts
What is the osmolarity of urine in the collecting duct?
What is passively reabsorbed in the collecting duct?
What is the major stimulus for ADH secretion?
decreased blood volume
What measures blood volume?
baroreceptors found in a multitude of places like Aorta, pulmonary vessels, carotid artery
What mechanism do baroreceptors use to measure pressure?
measure stretch of BV walls
What does decreased blood volume cause?
low BP and increased osmolarity
Where are osmoreceptors found?
anterior hypothalamus
What are osmoreceptors most sensitive to?
Na+ and mannitol, glucose to a lesser effect
What does ADH cause in the kidney?
increased water reabsorption
What is the autocrine system?
hormones that bind to receptors and affect the fxn of the cell type that produced it.
What is a vasoactive peptide?
What are the type of endothelins?
E1, E2, E3
What do endothelins cause?
increased BP through vasoconstriction, can cause vasodilation in a minority of instances, Tends to cause salt and water retention
What is nitric oxide?
A molecular gas that has three forms that act on the kidney that is also a vasodilator and is how the macula densa cells talk to their juxtaglomerular buddies.
What does nitric oxide cause in the kidney?
more water to be excreted, helps macula densa cells to provide feedback
What may normotensive glaucoma be related to?
renal nitric oxides
What do renal PG's do?
increase blood flow to kidney; prevent vasoconstriction
What can impair water reabsorption through blocking ADH in the collecting duct?
renal PG's
What can prescribing PG's as an optometric drug cause systemically?
What prevents water and sodium reabsorption and prevents K excretion?
renal PG's
How is angiotensin II formed?
renin combines w/ angiotensinogen --> angiotensin I --> AG II
What is angiotensin II?
A potent vasoconstrictor that increases ADH release
What stimulates thirst?
angiotensin II
What is the general effect of increased angiotensin II?
increased BP
Where is ADH released from?
What increases aldosterone release from adrenal cortex?
What is released in response to hypoxia by the kidney?
What does EPO do?
stimulate bone marrow to produce RBC's
What does calcitriol do?
Stimulates absorption of calcium in intestine
What is the pH target for blood?
Where do excess H+ go?
neutralized by bicarbonates
What regulates bicarbonate regeneration?
How does the kidney influence blood pH?
excretes H+ or Bicarbonate
What is a sign of kidney disease?
What is a common problem with kidney dx?
What is the glomelular filtration rate?
Amt of filtrate formed in all nephrons
What % of renal plasma flow is filtered?
what is the normal glomelular filtration rate?
115-125 ml/minute
What is glomelular filtration rate use to assess?
renal fxn
How is a glomelular filtration rate measured?
collected blood is timed to see how fast substances are removed from the body
What test requires the pt to be in a clinic for hours to perform the test?
glomelular filtration rate
What is creatinine?
byproduct of muscle metabolism
What does the kidney do to creatinine?
filters it out, but does not reabsorb it out of the tubules
What is the normal value for a creatinine clearance test?
100 ml/minute
What is an abnormal value for creatinine clearance?
<60 = significant indicator of kidney dx
How is the creatinine clearance test performed?
urine is collected for 24 hrs w/ a blood draw at the end
What is the normal serum level of creatinine?
1.0 mg/100mL
What can influence normal creatinine serum levels?
gender and size of individual
If creatinine serum level is doubled, what does this mean?
kidney fxn has fallen to half of normal rate
If creatinine serum level is triple, what does this mean?
kidney fxn has fallen to 25% of normal rate
What is the BUN?
tests urea as an indicator of kidney fxn
What is urea?
end product of protein metabolism
What is the rate of urea excretion?
roughly 50% excreted, 50% reabsorbede
What is a normal value for urea in the BUN test?
7-20 mg/dL
What increases in the BUN test with decreasing kidney fxn?
urea levels
What is azotenia?
an asymptomatic malfunction that is indicative of poor urea release in kidney
What is abnormally seen in urinalysis?
protein, blood or glucose
What is the first sign of kidney involvement in DM?
albumin in the urine
What is the NGAL?
neutrophil gelatinase associated lipocalin
What does NGAL test for?
acute damage to the kidney, indicator of necessity for dialysis to allow kidney to heal/recover
What does increased potassium and phosphate levels indicate?
kidney failure
What does decreased calcium, pH and bicarbonate levels indicate?
kidney failure
What is cystoscopy?
flourescine imaging of the urethra, bladder, and ureteral orifices; allows for biopsy
What can ultrasound evaluate in the kidney?
structure, tumors, abnormalities
What % of US adults have chronic kidney dx?
What is CKD?
chronic kidney dx
How many die per year due to renal problems?
How many americans require dialysis or kidney transplantation to live?
How many people are waiting for a kidney?
How many people receive kidney transplants each year?
Is CKD increasing or decreasing in the US?
Know slides 3 and 4!!!! Redo and expand, also check slide 36 of prev ppt
What does CKD increase the risk for?
ARMD 3-5x greater, dry eye 15x greater
What can optometric prescribed medications cause?
renal side effects
What may be adjusted if CKD is suspected in a pt?
decreased dosage of meds may be required to protect kidneys
What is the most common cause of kidney failure?
DM (40%)
What is a second most common cause of kidney failure?
How much kindey fxn can be lost before sx develop?
When is pain felt during kidney failure/dx?
Only if stretching of renal fascia or muscular contraction of ureters
What % of pt's have a GFR of 50-60 mL/min that are diagnosed by primary care physician?
What is the threshold for kindey dx to be considered chronic?
3 mo
What are the three general locations for kidney failure to act?
pre-renal - burns, blood loss, other systemic problem leads to kidney dysfunction; intrinsic - the kidney itself is the cause, perhaps with the medulla or tubules, etc. Even with normal bloodflow, still going to fail. Post-renal - kidney stones, fluid backup due to blockage downstream
What are common first s/sx of kidney dx?
HTN, pulmonary edema, HA, swelling of legs, nausea and vomiting, Weight loss, itching, cognitive impairment, tendency to bleed,
What kidney dx s/sx are related to fluid balance problems?
HTN, swelling of legs, pulmonary edema
What kidney dx s/sx are due to increased levels of urea, ions, and other waste products?
Fatigue, HA, weight loss, nausea and vomiting, cognitive fxn loss
What causes itching in kidney dx?
phosphorus levels increase
What GRF rate is diagnostic for a normal person to go on dialysis?
<10mL/min GFR
What products are increased in the system with decreased kidney fxn?
hormones and nitrogenous wastes
What products are decreased in the system with kidney fxn loss?
What is azotemia?
If a patient has high levels of BUN but don't have symptoms of uremia.
Which organs are affected by CKD?
every system in the body
What does CKD do to the skin?
increased pigmentation due to hormonal changes, and pruritis
What does renal osteodystrophy cause systemically?
hyperparathyroidism --> calcitrol, osteosclerosis, osteomalacia, muscle weakness
What is nocturia?
urinating at night
What is polyuria?
incrased urination
What is uremic frost?
Ca Sulfate and phosphate precipitate in the sweat, ODIFEROUS, smells like a porta potty, yellow discoloration of skin
What is ESRD?
End stage renal dx
Who is most prone to kidney dx?
8x greater in blacks
What is the threshold for ESRD?
kidney fxn < 20%
What is the main cause of death with impaired kidney fxn?
cardiovascular death, stroke
How many people are affected by ESRD per yr in the US?
What is ARF?
Acute renal failure
what are some causes of ARF?
hemorrhaging, shock, infections, autoimmune dx, meds
What are s/sx of ARF?
loss of regulatory, excretatory, and endocrine fxn of kidney
What % of pt's will fully recover from ARF if properly treated?
What can pregnancy sometimes cause in the kidney?
Acute renal failure
What is the most common cause of ARF?
acute tubular necrosis
What is the onset of declined GFR in ATN?
minutes to days
What causes ATN?
acute ischemic or nephrotoxic insult
What tissue is destroyed in ATN?
tubular epithelial cells --> decreased ion transport
Where do the destroyed epithelial cells go in ATN?
clog the tubules causing damaged vasculature from increased pressure
What is the result of damaged vasculature in the kidney?
vasoconstriction, reduced urine volume, increased waste products in the blood
What happens to endothelin, nitric oxide and PG levels in ATN?
increased endothelin, decreased PG and nitric oxide --> vasoconstriction
What feedback loop causes reduced urine in ATN?
renin production increases --> less urine
What is malignant hypertension?
uncommon form of HTN, medical emergency
What is the tx of malignant hypertension?
immediate and aggressive anti-HTN therapy
What are the s/sx of malignant hypertension?
BP > 120 mmHg, ONH edema, scotoma, encephalopathy, renal failure, CV (cardiovascular) abnormalities
What is the pathophysiology of malignant hypertension?
vascular damage to kidney --> increased permeability of small vessels --> fibrosis of vessels --> narrowing of vessel lumun --> ischemia of kidney --> renin release --> even further vasoconstriction
What are specific mechanism for meds to cause ARF?
Type 1 and Type IV hypersensitivity (hapten), med causes toxicity
What can cause ARF through medication toxicity?
aminoglycosides cause 10% of pt's to have nephrotoxicity
What is the timing of ARF onset after aminoglycoside regimens are started?
1 week
What is the prognosis for ARF due to aminoglycoside nephrotoxicity?
very good change for recovery
What cause of ARF is NOT dose related?
Type 1 and Type IV hypersensitivity
What cause of ARF IS dose related?
What can NSAID's cause in the kidney?
decreased PG --> vasoconstriction --> ARF
What can radiographic contrast agents cause in the kidney?
ARF in up to 76% of pt's who take it
What are risks for taking radiographic contrast agents?
pt's with pre-existing renal insufficiency
What is a common precaution taken when using radiographic contrast agents?
IV to prevent dehydration
Can radiographic contrast agents cause hypersensitivity rxns?
What dz's are related to glomelular dysfunction?
nephrotic syndrome, nephritic syndrome, membranoprolifereative glomerulonephritis
What are s/sx of nephrotic syndrome?
massive proteinuria, edema (eyelids first), hypoalbuminemia, hyperlipiduria and hyperlipidemia
What is nepthrotic syndrome?
derangement of glomelular capillary walls
What causes the body to produce increased plasma proteins and lipoproteins?
hypoalbuminuria due to nephrotic syndrome
What is pitting edema?
If skin is depressed manually, it will remain depressed after removing the source of pressure.
What dx presents deranged capillaries?
nephrotic syndrome
Where does the edema start in nephrotic syndrome?
What causes bubbly urine?
nephrotic syndrome due to massive proteinuria
What does hypoalbuminemia cause?
lipoprotiein and plasma protein synthesis
What causes in increased risk of thromboembolism?
hyperlipidemia and hyperlipiduria
What causes nephrotic syndrome?
immune mediation, diabetes, NSAID, SLE, membranoproliferative glomerulonephritis, idiopathi c
What tx of nephrotic syndrome is 90% effective?
What is the rate of recurrence for nephrotic syndrome?
What is used for the first six months of nephrotic syndrome tx?
thrombo-prophylaxis (warfarin, etc)
What are ACE inhibitors?
decrease glomelular filtration rate, improve charge and size selections. Tx for nephrotic syndrome
What is steroid dependence?
Where reduction of corticosteroids causes the dx to relapse, pt becomes dependent on meds
What dx often displays steroid dependence/recurrence during tx?
nephrotic syndrome
What is acute glomerulonephritis also called?
acute nephritic syndrome
What presents abrupt hematuria with lesser amt's of proteinuria and impaired renal function?
acute nephritic syndrome
Why can blood leak through the glomerulus in acute nephritic syndrome?
the blood often cremates into smaller pieces
What is oliguria?
Decrease in urine production
What causes HTN in acute nephritic syndrome?
retention of salt
In acute nephritic syndrome, where is edema first seen?
What presents worse edema: acute nephritic syndrome or nephrotic syndrome?
Nephrotic syndrome
What is a common precursor to acute nephritic syndrome?
streptococcal infection in previous 10-14 days; Ag-Ab rxn
When is acute nephritic syndrome typically seen?
in children, more common in summer and autumn, more common in south
What is a precursor for 5% of acute nephritic syndrome cases?
strep throat
What dx develops nephritic syndrome up to 50% of the time?
post streptococcal pyoderma
If there is no prior strep infection seen with acute nephritic syndrome, what should be considered?
Can acute nephritic syndrome be idiopathic?
Howis acute nephritic syndrome treated?
salt restriction, diuretics/anti-hypertensives
What % of acuate nephritic syndrome completely recovers?
How long can acute nephritic syndrome take to clear up?
1-2 years
Does acute nephritic syndrome often progress to chronic renal failure?
What is dense deposit dx also called?
membranoproliferative glomerulonephritis
What causes Type I, II, and III hypersensitivity attack of glomerular and mesangium tissues?
dense deposit dx
What type of dense deposit dx presents with bilateral central drusen?
type II
When is drusen seen in teenagers?
dense deposit dx
What is TIN?
tubulointerstitial nephropathy
What is spared in TIN?
glomeruli and renal vessels
what is pyelonephritis?
bacterial infection of the renal pelvis
What is pyelonephritis often seen?
Is TIN acute or chronice?
What is TIN called if no bacteria are involved?
interstitial nephritis, caused by drugs and metabolic disorders, physical injury
What is a common first sign of TIN?
bilateral uveitis
What age does TIN present typically?
10-33 years
What gender is affected more by TIN?
female 3x > males
What % of TIN presents with uveitis (TINU)?
What dx presents fever, weight loss and fatigue in 50% of cases?
What % of TINU is recurrent?
What % of TINU presents with ocular symptoms first?
When is iridocyclitis seen?
What is the TX for TINU?
oral corticosteroids
What is APN?
acute pyelonephritis
What does APN present?
inflamed kidney and renal pelvis
What causes APN?
bacteria in through urethra --> bladder --> ureters --> kidney
Who is prone to APN?
Women due to shape and length of urethra, PREGNANCY
What is usually very responsive to antibiotics?
What are APN's s/sx?
fever, dysuria, flank/back pain, pyuria
What is chronic pyelonephritis?
slowly progressing/insidious dx of kidney
What are the s/sx of chronic pyelonephritis?
fatigue, don't feel well; generally vague sx
When is pus seen in urine?
chronic pyelonephritis
What can lead to renal dialysis?
chronic pyelonephritis
What presents frequent UTI, vesicoureteric reflux or diabetic nephropathy?
chronic pyelonephritis
What is the single most important cause of ESRD?
diabetic nephropathy
What do ACE inhibitors and angiotensin II treatments protect against?
diabetic nephropathy
Where is microalbinurai and proteinuria seen?
diabetic nephropathy
Does diabetic nephropathy usually progress?
Yes, end stage renal dx 1-5 years after onset generally
What presents nephrotic syndrome and azotemia?
diabetic nephropathy 3-5 years after proteinura
What is the classification of diabetic nephropathy?
glomerular dx
What can cause capillary basement membrane thickening?
diabetic nephropathy
What is Fabry dx?
glycosphingolipid metabolism
What enzyme defect causes Fabry dx?
alpha galactidase A
Is Fabry's genetic?
yes, x-linked recessive
What genetic dx presents symptoms in carriers?
Fabry dx
What is the occurrence of Fabry dx?
Is Fabry dx hard to diagnose?
Yes, due to s/sx variability
What presents in children with a burning sensation in the hands?
Fabry dx
What presents with raised rash on buttocks, groin, thighs?
Fabry dx
What is corneal whorl?
Also called verticillata
where is decreased sweating seen?
Fabry dx
What is the most common ocular sign seen in 90% of Fabry dx?
corneal whorl or verticillata
What is the best way to see corneal whorl?
transillumination in biomicroscopy
What dx causes build up of lipids in tissues?
Fabry dx
What causes increased conj vessel tortuosity?
Fabry dx
What kind of cataract is caused by Fabrys?
spoke like(stellate), anterior subcapsular, follows suture lines, white in appearance
What are the systemic kidney complications from Fabry?
renal failure --> proteinuria, azotemia, uremia
What age does 50% of fabry pts present renal failure?
Renal failure, GI dysfunction, cardiovascular and cerebrovascular problems are seen systemically in what dx?
Fabry dx
How is Fabry tested for?
enzyme assay, genetic testing
How is Fabry treated?
enzyme replacement, agalsidase beta via IV
What is nephrolithiasis?
Formation of a stone in the collecting system of the kidney
Where are kidney stones usually seen?
What is a calculus?
Another term for kidney stone
What % of autopsies show a kidney stone?
What are polygenic kidney stones?
Stones due to dehydration, medication, gout
What is the composition of a kidney calculus?
calcium 75%; Mg 15%; uric acid or cystine 10%
What common ocular drug can cause kidney stones?
What % of people will have a kidney stone at some point in their life?
What is the peak incidence of kidney stones?
20-45 years
What are men more prone to than women?
kidney stones and Fabry's disease
What can cause hematuria?
kidney stones
What does kidney stone impingement of ureter cause?
severe, suddent pain onset
What is the best way to diagnose a kidney stone?
cat scan
What % of stones pass sponataneously?
What is the most important tx for kidney stones
pain relief
What do alpha adrenergic blocks and calcium channel blockers cause for kidney stone pt's?
ureter relaxation
What are common ways to prevent kidney stones?
don't drink too much milk, diet, hydration
What is shockwave lithotripsy?
Uses radio waves to break up a kidney stone into small, passable pieces
What is renal cell carcinoma?
80-90% of all malignant kidney tumors
What can cause renal atherosclerosis?
diabetic nephropathy
What dx affects both afferent and efferent arterioles of the kidney?
diabetic nephropathy
What is pyelonephritis?
increased susceptibility to renal infection leads to infection of the renal pelvis
What can cause pyelonephritis?