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42 Cards in this Set
- Front
- Back
What gets more bloodflow than any other organ in the body?
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Kidneys together receive approx. 20-25% of the cardiac output; more blood flow (mL/min/g of tissue) than any other organ
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what type of arteries lead to the kidney? what does this mean
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end vessels
no anastomoses, you block those bad boys and you are in trouble |
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what are the 4 major functions of the kidney?
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Excretion of waste products
Regulation of body water and salts Maintenance of body pH (acid-base balance) Hormonal activity ---(Erythropoietin Renin Prostaglandin) |
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where is one of the only places that makes erythropoeitin?
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kidney
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what kidney structure has the function of:
Filtration: solutes, endogenous wastes, exogenous substances |
Glomerulus
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what kidney structure has the function of:
Reabsorption & Secretion: water, solutes |
Tubules
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what kidney structure has the function of:
Support tissue: some hormonal control; helps maintain proper milieu |
Interstitium
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what kidney structure has the function of:
Maintain adequate blood flow: perfusion pressure; nutrients and oxygen |
Blood vessels
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what are the 4 medical kidney diseases? are the neoplastic or non-neoplastic
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Abnormal development
Glomerular Tubulointerstitial Renovascular non-neoplastic |
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what are the 2 divisions of neoplastic kidney diseases
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benign and malignant
these are further broken into adult/ped |
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what are 2 lab values that can show altered kidney function?
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serum and urine
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what 3 studies do you have to do for a tissue biopsy of the kidney?
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light microscopy: H/E, silver, trichrome, PAS
Immunofluorescence: antiboides identify abnoraml proteins within glomerulus Electromicroscopy: altered ultrastructure, primarily of glomerulus |
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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? |
1. Capillary endothelial cells (fenestrated)
2. Glomerular basement membrane (GBM) 3. Visceral epithelial cells (podocytes) – with foot processes (pedicles) that “fuse” to GBM |
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what type of cells are in the urinary space of the glomerulus
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parietal epithelial cells (Bowman's capsule)
(contiguous with tubular epithelial cells of the proximal convoluted tubule) |
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what are Mesangial cells and where are they?
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act like macrophages, can contract, can proliferate, and contribute to extracellular membrane and glomerular basement membrane
found in the glomerulus |
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What provides the major charge exclusion barrier in the kidney?
what about size? |
charge: Glomerular basement membrane
size: foot processes filtration slit diaphragm |
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what are 4 possible pathologic alterations in glomerular disease
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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) |
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what is Hyalinosis and what causes it
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Insudation of plasma proteins due to endothelial injury
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a proliferative response to glomerular damage =
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Glomerular hypercellularity:
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what normally deposits in or around the glomerular matrix in membranous glomerulopathy? what does this do?
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antibody complexed with antigen
this disrupts normal filtration, and you loose foot processes |
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primary presentations related to functioning of kidneys/urinary system
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Altered urine output
Altered fluid balance Altered electrolyte balance Altered urine (e.g., hematuria) Pain Localization Association |
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Primary vs. secondary renal disease
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Disease localized to kidneys or systemic disease that affects kidneys as well as other organs/tissues
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Two primary functional compartments of the kidney with respect to fluid/electrolyte homeostasis?
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1. Glomerulus → filtering (GFR)
Allow for elimination of unwanted solutes, water, wastes 2. Tubules → concentrating Conservation of water, retention of sufficient solutes |
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GFR = >90
Stage? |
1
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GFR = 60-80
Stage? |
2
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GFR = 30-59
Stage? |
3
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GFR = 15-29
Stage? |
4
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GFR = <15
Stage? |
5
kidney failure need dialysis |
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Blood urea nitrogen (BUN)
Creatinine (Cr) Uric acid if these are affected what is the problem in general |
Predominantly filtering
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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 |
Predominantly concentrating
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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 |
Generally tubular, chronic state could involve glomeruli as well
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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 |
Glomerular or tubulo-interstitial
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End product of NH3 metabolism in the liver = ?
(Amino acid and purine metabolism Filtered at the glomerulus, with partial tubular reabsorption) |
BUN
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what is BUN relationship to GFR?
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BUN is roughly inversely proportional to the GFR (BUN proportional to 1/GFR) … as GFR down, BUN up
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normal BUN range?
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10-20mg/dL
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Reduced glomerular perfusion and increased urea formation do what to BUN?
is this pre/renal/post |
increase BUN
pre-renal |
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Reduced glomerular perfusion, Urinary outflow obstruction do what to BUN?
is this pre/renal/post |
increase BUN
post-renal |
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normal serum creatine?
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~ 0.6-1.0 mg/dL (adult)
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this serum level is better than BUN at showing GFR
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serum Cr
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BUN/Cr ratio:
15-20:1 Reason for Azotemia? |
dehydration
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BUN/Cr ratio:
>15-20: 1 Reason for Azotemia? |
pre-renal (or post-renal)
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BUN/Cr ratio:
~10-15:1 Reason for Azotemia? |
renal
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