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If your not sure what answer should be entered, press the space bar and the next missing letter will be displayed. When you are all done, you should look back over all your answers and review the ones in red. These ones in red are the ones which you needed help on. Question: What is the of protein loss through the kidneys?Answer: The is that the glomerulus is damaged and proteinuria is an indicator of nephritic syndrome Question: How does loss through the kidneys happen?Answer: It occurs when the basement of the glomerulus is damaged and when the split pores are genetically mutated Question: What in the kidneys is to allow protein loss?Answer: The basement membrane of the is damaged ….. also if the split pores are genetically mutated Question: When is high as in nephritic syndrome what s/s will you see?Answer: Proteinuria, edema, hypoalbuminemia, & lipiduria, hypercoaulability, antithrombin III is excreated in excess in the urine, changes in protein C & S…. Question: Hyperfibrinogemia, impaired fibrinolysis, decreased immunity, trace mineral & Vit D deficiency, Hyperparathyrodisim, neural osteodystrophy & decreased Ca+ are also s/s of ____?Answer: syndrome Question: ____ is the principal selectivity barrier of the glomerulus?Answer: membrane is the principal selectivity barrier of the glomerulus Question: What does the basement of the glomerulus prevent from passing through? (hint there are 3 things)Answer: The membrane of the glomerulus prevents plasma proteins, erythrocytes, & leukocytes from passing through. Question: ____ are negatively charged & repelled by the basement membrane?Answer: plasma proteins are negatively charged & repelled by the membrane Question: ____ have a thin diaphragm of protein that restricts the filtration of some ____ that make it through the basement membrane?Answer: SLIT PORES have a thin of protein that restricts the filtration of some PLASMA PROTEIN that make it through the basement membrane Question: ____ is an important protein in the slit pores?Answer: Nephrin is an protein in the slit pores Question: A pt with genetically mutated slit pores will have what kind of ?Answer: proteinuria (protein in urine) Question: ___ & ___ are not present in urine?Answer: proteins & cells Question: If the ___ is injured, cells & proteins may filth through and be found in the urine?Answer: Question: ___ is an sign of basement membrane dysfunction?Answer: Question: ___, ____, & ____ are normally reabsorbed completely in the early proximal tubule?Answer: Nutrients, Vitamins, & Small proteins are normally reabsorbed in the early proximal tubule Question: Why does the glomerular capillary (colloid osmotic) pressure exit?Answer: it b/c proteins are present in the blood Question: What are negatively charged & attract positive ions, subsequently attract water?Answer: plasma Question: What keeps plasma proteins from being pushed against the wall?Answer: The glomerular capillary colloidal osmotic pressure opposes filtration by holding H2O & ions in the which are attracted to the plasma proteins Question: ___ & ___ are attracted to the plasma ?Answer: Ions & are attracted to the plasma proteins Question: Pressure is decreased at ___ & progressively increases the length of the ___?Answer: is decreased at the afferent end & progressively increases along the length of the capillary Question: plasma proteins do not filter into the ___?Answer: Bowman Question: If plasma proteins filter into the bowman capsule they would create ____?Answer: Bowman capsule oncotic Question: ___ would enhance glomerular filtration b/c attract cations & water?Answer: capsule oncotic pressure that is created with plasma proteins filter into the bowman capsule Question: In a kidney the bowman capsule oncotic pressure is ___?Answer: negligible Question: As blood passes through the capillaries, continued filtration leaves a greater concentration of proteins in the which ___ the oncotic pressure?Answer: Question: T/F Normal contains proteins?Answer: normal urine DOES NOT contain proteins Question: T/F A amount of protein in the urine is insignificant?Answer: Question: When should you investigate for glomerular capillary disease?Answer: when a pt of protein is more than 150mg/24 hrs Question: can cause the urine to be ___?Answer: Question: ___ is a collection of symptoms caused by glomerular ?Answer: Syndrome Question: Nephritic Syndrome is characterized by an ___ in capillary wall permeability to ___?Answer: Nephritic Syndrome is characterized by an in glomerular capillary wall permeability to serum proteins Question: The abnormality in nephritic syndrome is the loss of …?Answer: The predominant abnormality in nephritic syndrome is the loss of amounts of protein in the urine (↑ 3.5g/day) Question: Hypoalbuminemia, hyperlipidemia, edema, hypercoagulability, altered immunity & lipiduria are present secondarily to proteinuria in ____?Answer: nephritic Question: What is the most common cause of nephritic syndrome in ?Answer: Diabetic Question: What is the most common of nephritic syndrome in children?Answer: minimal disease Question: ___ is when hydrostatic & colloid oncotic pressures are not balanced in independent & periurbital areas?Answer: edema Question: In nephritic syndrome is due to altered clotting factors such as ….?Answer: (antithrombin III is excreted in in the urine; changes in protein C & S, hyperfibrinogenas is a result of ↑ hepatic production impaired fibrinolysis, & ↑ ability of plts to aggregate are probable contributors to an incident of thromboembolic event Question: What trace minerals are deficient in syndrome?Answer: Zinc, Fe- & Question: If a pt’s dipstick results revel protein in the urine what are the possible disorders? (Hint there are 6)Answer: renal HTN, glomerulepathies, nephritic syndrome, renal artery or vein , & pyllonephritis Question: Bowman capsule drains the glomerular filtrate directly into the ____ segment, where 2/3 of ___ & ___ are rapidly reabsorbed?Answer: Bowman capsule the glomerular filtrate directly into the Proximal Tubule segment (Proximal Convoluted Tubule), where 2/3 ofH2O & electrolytes are rapidly reabsorbed Question: What three things are normally reabsorbed completely in the proximal tubule?Answer: Nutrients, Vitamins, & proteins Question: The ___ is the site of most HCO3 ion , whereas Cl- ion is reabsorbed in where?Answer: The early proximal tubule is the site of most HCO3 ion reabsorption, whereas Cl- ion is in the late proximal tubule Question: The tubule is made up of ___ ___ & convoluted to provide a greater surface area for reabsorption?Answer: epithelium Question: In the proximal Tubule (cuboidal epithelium) the epithelial cells in this segment have ___ that form a border next to the filtrate & substantially increase the apical surface area?Answer: microvilli Question: Proximal tubule cells have high aderiosine triphosphate (ATP) requirements b/c most reabsorption utilizes active transport mechanisms that are dependent on ____ pumps in the basoleteral membrane?Answer: Na+-K+ ion Question: H2Ois passiveley through water channels made of ___ called what?Answer: H2O is reabsorbed passively through water channels made of called agnaporin 1 Question: Reabsorption of creates the osmotic force for what?Answer: H2O reabsorption Question: What is the average rate of the Glomerular Filtration Rate (GFR) & how is it ?Answer: 125ml/min & it is determined by the filtration in the glomerali & by the permeable surface area of the glomerular membrane Question: GFR is the of what?Answer: GFR is the product of filtration pressure & permeability constant determined by the physical principles of filtration across a membrane Question: The main force for filtration in the GFR is ___ by exerting a force against ___?Answer: hydrostatic pressure in the glomerular capillaries by a force against glomerular capillary walls Question: As blood circulates through capillaries the ___ ___ pushes blood against the walls & fluid is out?Answer: hydrostatic Question: One of the most important physiologic regulations of GFR is ____?Answer: volume Question: More blood -> more pressure, more pressure-> ____ GFR, and the opposite is true.Answer: Question: Auto-regulation in the GFR for large swings in __?Answer: BP Question: Decreased blood flow causes decreased GFR which leads to what?Answer: leads to decreased excretory & reabsorbtive capabilities of tubules causing decreased drug excretion & metabolites, decreased secretion of H+, decreased concentration, increased renal threshold of glucose Question: In the kidney’s tubule system, where is most glomerular filtrate ?Answer: Proximal Tubule segment (Proximal Convoluted ) Question: What is GFR?Answer: Glomerular Filtration Rate of 125ml/min Question: What does the GFR tell you about function?Answer: it tells you the overall function of the kidneys if the GFR to decreased excretory & reabsorbtive capabilities of tubules causing decreased drug excretion & metabolites, decreased secretion of H+, decreased urine concentration, increased renal thre Question: The most common causative agents of renal system infection are ____ such as what?Answer: gram negative bacteria such as Escherichia Coli (enterobacter & ). E. Coli 80% of the time Question: ____ is an infection of the renal pelvis & interstitium?Answer: Question: Acute Pyelonephritis - bacterial colonization commonly occurs in the renal papilla as a of what? Which intereferes with what? Allowing what?Answer: Acute Pyelonephritis - bacterial colonization commonly occurs in the renal papilla as a result of the increased osmolarity which interferes with WBC & complement function, thus allowing to multiply Question: In Acute Pyelonephritis Bacteria ascending from the ___ urinary tract seed in the renal calices & papillae first, whereas infection from ____ source starts in the ___ of the kidney?Answer: Bacteria ascending from the urinary tract seed in the renal calices & papillae first, wereas infection from ahematogenons source starts in the medulla of the kidney. Question: Regardless of the cause of acute pyelonephritis w/in ___ the spreads to the parenchyma & creates what? That results in what?Answer: Regardles of the cause, w/in 2-3days the infection spreads to the parenchyma & creates a widespread inflamtory response that results in arterial construction & edema in the infected of the kidneys. Question: In Acute Pyelonephritis renal scarring resulting in compressed kidney function is __ in otherwise healthy adults if the infection is managed?Answer: Question: In Pyelonephritis in what pts is renal scarring more common?Answer: Infants, Children, Pregnat women, & adults with other that inhibit either diagnosis, mgnt, or response to antibiotic therapy. Question: In acute Pyelonephritis of renal scaring is dependent on what?Answer: It is dependent on & effective Tx of the infection in all age groups Question: T/F S/S of pyelonephritis does not vary amoung age groups?Answer: it does vary amoung the age groups Question: What is the s/s of pyelonephritis in adults?Answer: classic- fever & chills of sudden onset, flank pain, UTI symptoms such as dysuria & urinary frequency or urgency. The hallmark symptom is tenderness or pain at the angle on palpation Question: What is the hallmark s/s of pyelonephritis?Answer: The hallmark symptom is tenderness or pain at the costovertebral on palpation Question: FYI - = ___ ex:nephralgia = kidney ___Answer: pain, Question: Neither or uretal pain is altered by changes in ___ ___?Answer: body Question: (Acute ) UTI's including pyelonephritis should be suspected in infants, children & elderly pts with generalized symptoms such as?Answer: such as , fever & malaise & decreased oral intake, occasional manifestation with abdominal pain, N/V Question: What is pyelonephritis characterized by...and is a consequence of ___?Answer: Chronic pyelonephritis is characterized by unilateral or bilateral pathologic changes in the as a consequence of infection Question: What are the manifestations of chronic pyelonephritis?Answer: Small atrophic kidneys with diffuse scarring & bunting of the calices are classic manifestations of pyelonephritis Question: In chronic pyelonephritis at risk have bacteriuria associated with? Give examplesAnswer: In chronic pyelonephritis individuals at risk have bacteriuria associated with obstructive uropathy such as calculi, neurologic deficits, vesicouretal reflux, or intrinsic renal disorder. Question: In chronic pyelonephritis; as a result of ___ infections, chronic inflamation develops with __ & ___ infiltration of the renal tissue?Answer: As a result of recurerent , chronic interstitial inflamation develops with lymphocyte & plasma cell infiltration of the renal tissue. Question: (Chronic Pyelonephritis): The interstitium has degrees of ___ or ____ with casts. fibrosis of the interstitium, including the renal tubules, decreased # of functional nephrons.Answer: dilated or renal tubules Question: T/F pyelonephritis has the same s/s of acute pyelonephritis?Answer: True Question: What is ?Answer: Cystitis is the inflammation of the urothelium Question: Cystitis may from what?Answer: may result from bacterial, fungal or paracitic infections, chemical irritants, foreign bodies (stones), or Question: most commonly results from ___?Answer: infection Question: What bacteria is the most common cause of ?Answer: E. Coli is responsible for 80% of cases of cystitis Question: Why is bacterial cystitis more common in ?Answer: It is more common in females than b/c of shorter urethra as well as a colonization ronte from the rectum & vagina to the urethra. Question: Research shows that who have recurent bacterial cystitis have ___,___, & ___that enhance binding properties of ___?Answer: Research demonstrated that women who have recurrent bacterial cystitis have uroepithelial, vaginal, & buccal epithelial cells that enhance binding properties of E. Question: Name 4 that increase the incidence of cystitis.Answer: decreased vaginal pH, decreased estrogen levels, & lewis bloog group LE (a-b-) & LE (a+b-) pheontypes are associated with increased incidence of Question: What are some OTHER risk factors of ?Answer: sexual activity, use of spermicides, catheterization, DM, poor hygiene, & type A bladder dysfunction/urin Question: What are the s/s of ?Answer: 10% asymptomatic; frequency; urgency; dysuria (painful urination); flank pain & pain in the area, low back, or both Question: In cystitis flank pain is ___ & can what?Answer: Flank pain is more serious & can indicate an infection protimal to the bladder Question: How may the urine appear visually in ?Answer: Visually, heamturia or cloudy urine may be Question: What will the urinalysis of a pt with show?Answer: urinalysis shows of known bacterial pathogen, WBCs, RBCs & nitrites Question: What is the difference between UTI and ?Answer: Pyelonephritis is an infection of the pelvis whereas a UTI can be an infection in the bladder, urethra, ureters or kidneys. UTIs may be asymptomatic Question: What are the s/s of a UTI?Answer: Some are asymptomatic. Urgent need to urinate (often w/ only a few drops of urine to pass); burning sensation when urinating; cloudy or blood-tinged urine; strong odor to the . Question: What are the s/s of a UTI that has ?Answer: pain in the lower back as well as fever, chills, N & Question: What are the differences in s/s of UTIs and ?Answer: In pyelonephritis fever & chills have a onset, flank pain, UTI symptoms such as dysuria & urinary frequency or urgency. chills and fever only happen in UTIs that have spread Question: pyelonephritis and UTIs which is more serious?Answer: pyelonephritis Question: What is the most causitive bacteria for UTI?Answer: E. Coli Question: What is a or Wilm's tummor & who does it occur in?Answer: A malignant neoplasm of the kidney occurring in young children the fifth year in 75% of the cases. Question: What is the most common abdominal tumor in ?Answer: Nephroblastoma or Wilm's Question: T/F Nephroblastoma or Wilm's tummor cannot be in adults?Answer: False it can be found in adults but it is rare in pts >15 Question: In nephroblastoma or Wilm's Tummor what is the most age group? males & females are ___ affected.Answer: most cases onset is b/t 3-5 yrs. males & females equally Question: What is the primary etiological basis of wilm's ? What does this defect result in?Answer: a defect on chromosome 11p13 is the primary etiologic basis of Wilm's defect. This results in abnormal growth A metanephric blastema w/o NL differentiation N2 tubules & glomeruli Question: 15% of children with Wilm;s tumors have abnormalities, including what?Answer: including Wilm's aniridia-genital - retardation syndrome, bech with- wiedemann syndrome, hemihypertropy, musculoskeletal anormalities & other genitonurinary abnormalities Question: What is the s/s of Wilm's ?Answer: A tumor mass of the flank or abdomen is palpable in 80% of cases. abdominal pain, HTN, & hematuria Question: ___ is initially identified by a parent or physician on physical exam.Answer: Nephroblastoma or Wilm's Question: What are the s/s that indicate a subscapular hemorrhage of the wilm's ?Answer: Sudden onset of pain & fever & findings of an abdominal mass, anemia, & HTN subscapsular hemorrhage of the Wilm's Tumor. Question: What are the most frequent early of a Wilms Tumor?Answer: The most early signs are hypertesopm, a palpable mass, pain and hematuria. Question: would you see a Wilms tumor?Answer: or flank Question: ___ is a syndrome of disorders characterized by an abrupt onset of hematuria & proteinuria in with azotemia & renal Na+ & H2OAnswer: glomerulonephritis Question: What are the s/s of glomerulonephritis?Answer: abrupt onset of hematuria & proteinuria in conjunction with azotemia & renal Na+ & Question: ___ is an infection process that indirectly causes or tirggers acute glomerulsnephritis by activating ____?Answer: Post-streptococcal glomerulonephritis is an infection process that causes or triggers acute glomerulsnephritis by activating inflammatory cells. Question: What does the circulating inflmmatory cells infiltrate in Post-streptococcal ?Answer: Circulating inflammatory cells infiltrate the glomerular caillary walls & establis antibody-antigen compleses w/in the . Question: In Post-streptococcal glomerulonephritis what is dispersed once the antibody-antigen complex that has been establised in the glomerullar capillary wall? what is relased as a result & what does this do to the wall?Answer: cerndement is & attracts neutrophils & monocytes. Lysosomal enzymes are then released & damage glomerular walls. Question: What results in Post-streptococcal once the glomerular wall has been damaged?Answer: The change in the structure of the glomerular wall results in a more permeable membrane. In essence, larger gaps in the glomerular wall decreases SA for filtering & allows previously molecules to enter the glomerular space. Question: In Post-streptococcal glomerulonephritis after the wall has been damaged 2 other processes are thought to take place. What are they?Answer: 1. Local vasoactive componets such as angiotenain & leukotrines contract messangical cells & reduce perfusion to glomerular capillares & 2 the bowman space may also be damamged as a result of deposition & criescent formation (accumulation of prolif Question: In Post-streptococcal what is fluid retention due to?Answer: Fluid retention is due to a decrease in GFR & tubule H20 & Na+ reabsorption. Question: In Post-streptococcal glomerulonephritis what does the H20 & Na+ due?Answer: H20 + Na+ reabsorption increases the vascular & extracelluar fluid of the pt Question: In Post-streptococcal glomerulonephritis hematuria & of RBC casts result why?Answer: Hematuria & evidence of RBC casts result b/c erythrocytes are now able to cross the more permable glomerular or walls N2 proximal tubule fluid (which is eventually urine) Question: What is the most common s/s or of Post-streptococcal glomerulonephritis?Answer: Gross hematuria manifested as smokey or -colored urine is the most common finding Question: What are the classic indicators of glomerulonephritis & what does it ?Answer: Red cells casts are classic indicators of glomerulonephritis & reperesent erythrocytes that have from the glomerular capillary N2 the tubule & then asumed the shape of the tubule. Question: In glemerulonephritis what type of cell cast will be ?Answer: Red cell cast are classic indicators.White cell casts may also be , particullary with inflammation in the glomerulus & interstitium. Question: In glomerulonephritis ____ is generally present in the urine?Answer: Question: In glomerulonephritis what are the systemically ?Answer: Systemically, disruptions r/t fluid volume changes are major manifestations - periorbital edema most common & areas cause lower extremity edema, apcites & plueral effusion Question: If the glomerulonephritis is thought to be psot whatantibodies are evaluated and what will BUN & Creaton levels tell you?Answer: If the glomerulonephritis is thought to be post streptococcal antibodies such as antistneptolysin O & are evaluated. BUN & Creaton levels evalate/estimate the extent of renal damage Question: Glomerulonephritis can lead to ____ which requires dialysis? What does dialysis due for the pt or what can happen to the pts kidneys?Answer: Glomerulonephritis can lead to rapidly progressive glomerulonephritis which requires dialysis which may allow pt to to NL normal fx or the pt may progress to renal failure. Question: ___ is a sudden, severe decrease in renal function that is reversiable?Answer: renal failure Question: What type of renal failure is potentially ?Answer: renal failure Question: What type of failure is associated with decrease in GFR, decreae in I/O over several hrs-days?Answer: Acute renal Question: What are the s/s of renal failure?Answer: Oliguria or anuria (rare) & usually azotemia (retention of wastes) Question: ___ is a broad term used to a wide variety of etologic factons.Answer: ARF Acute Failure Question: In ___ - 60% or more of community-????????????? ARF. What is the underlying factor?Answer: Prerenal failure - 60% or more of -acquired ARF. The underlying factor is diminished perfusion of the kidney. Question: In ____ the functional componets of the kidney are intact, but decreased blood flow to the kidney ultimately results in____?Answer: Prerenal failure, the functional components of the kidney are intact, but decreased blood flow to the ultimately results in decreased GFR Question: In Prerenal failure normally, the kidney can maintain a stable ___ in the face of ___, ___, or ___ through autoregulation, by alteration in the ___ & ___?Answer: Normally, the kidney can maintain a stable GFR in the face of HoTN, reduced blood volume, or reduced CO through autoregulation, primarily by alteration in the afferent & efferent Question: In Prerenal failure when mean systemic areterial pressure drops below ___, GFR is reduced.Answer: Question: What are some causes of failure?Answer: Hypovolemia-hemorrhage, , third spacing, buma, dehydration, decreased CO-caridiogenic shock, dysrhythmia, tamponade, CHF, MI, thromboembodic obstruction of renal vascular share the commorbility of reduced renal perfusion & often are referred to as is Question: T/F Usually, prerenal oliguria is easily if cause is identified?Answer: True Question: In prerenal failure decreased GFR ___ & thus decreases urine volume eliminated because why?Answer: Decreased GFR affects production of filtrate & thus decreases volume eliminated, b/c of the slow mvt through the renal tubules, more Na+ & H2O are reabsorbed N2 the bloodstream. Question: In prerenal failure glomerular hypoperfuma increases ___,___, & ___ which results in __ & __ retntion? I/O decreases to ____Answer: Glomerular hypoperfusion renin, angiotension II, & aldosterone production which results in Na+ & H20 retention. I/O decreases to <500ml/24hrs. Question: In prerenal failure when I/O decreases to <500ml/day ___ develops, indicating retention of ___ products reflected by ____?Answer: When I/O to <500ml/day azotemia develops, indicating retention of nitrogenous waste products reflected by increased BUN Question: The hemodynamic alterations that occur in ARF if allowed to will lead to what?Answer: The hemodynamic that occur in ARF if allowed to progress will lead to renal enclothelial ischemia. Question: What does enclothelial ischemia lead to in ARF?Answer: It leads to increased in endothelin-1 & a disruption in the release of the vasodilator nitric oxide, further decreasing renal flow. Question: What is -1?Answer: a vasoconstrictor Question: In ARF accumulation of inflmmatory __, __, & ___ leads to obstruction in the renal ____?Answer: Accumulation of inflammatory cytokines, leukocytes, & fibrin leads to in the renal micorcirculation Question: Name some meds that to prerenal failure.Answer: & ACE Inhibitors Question: In what type of renal failure is the common etiologic is obstruction of urine flow @ some point distal to kidney itself?Answer: Postrenal Question: In postrenal failure obstruction must be ___ to failure?Answer: Question: What are the of postrenal failure?Answer: BPH, calculi (stones), UTI, , strictures, altered bladder contraction Question: How does postrenal manifest?Answer: manifest as or anuria Question: In postrenal failure the obstruction of urine flow initially produces an increase in ___ pressure w/in the kidney & subsiquently increases the pressure in the ____?Answer: The obstruction of urine flow initially produces increase in netrograde pressure w/in the kidney & subsiquently increases the pressure in the Bowman capsule of Question: In postrenal failure the elevated pressure in the bowman capsule causes the elevated tubular pressure. The elevated tubular pressure opposes ____ and production of urine is impaired b/c ____?Answer: The elevated tubular pressure opposes glomerular capillary filtration pressure and of urine is impaired b/c of decreased GFR Question: In Postrenal failure why does develop?Answer: Azotemia develops b/c the kidneys ability to carry out waste meterials is impaired Question: What type of renal failure produces the most derangement in renal ?Answer: Intrarenal Question: In intrarenal failure what part of the is damaged?Answer: The functional unit of the kidney, the nephron is damaged. Question: In intrarenal failure what might be the site of and what can the injury lead to?Answer: the glomerulus may be the site of injury or most commonly, the renal tubules may be injured with the injury leading to acute tubular (ATN). Question: In failure how long can recovery take?Answer: B/C the nephron itself has been affected; recovery can take to months Question: If the is severly damaged & no recovery is possible what may it lead to?Answer: Question: What is the most common cause of intrarenal acute failure?Answer: (ATN) Acute Necrosis Question: What are the causes of (ATN) Acute Tubular ?Answer: prolonged prerenal ARF, trnasfusion reaction, Rhabdomyolyois), nephrotoxic acute necrosis(prolonged postrenial ARF, antibiotics, contrast, heavy metals) & inflamation Question: What are the metals that can cause ATN?Answer: lead, , carbon tetrachloride, insecticides, fungicides, cytotoxic drugs Question: What are some cytotoxic that can cause ATN?Answer: chemotherapy, hemolytic-uremic Question: What are two inflammations that can ATN?Answer: acute glomerulonephritis & pyelonephritis Question: ___ is a result of either ischemic or nephrotoxic injury to the ?Answer: ATN Question: ATN: injured tubular epithelial cells release intracellular debris N2 the ___, which in combination with proteins is the ___ result in formation of ____.Answer: AtN: injured tubular epithelial cells release intracellular debris N2 tubular lumen, which in combination with proteins is the tubules in formation of epithelial casts. Question: The casts in the tubules along with slughed ischemic & necrotic cells cause what in ATN?Answer: cause hernial obstruction which increases pressure in tubules & eventually backs up & increases pressure in the capsule, slowing GFR & furter damaging the glomeruli & tubules. Question: What is an part of ATN pathology?Answer: The back leak of filtrate that is caused by the epithelial casts with sloughed ischemic & necrotic cells causing the herrinal obstruction is an important part of ATN pathology Question: A pt with ATN that has lead to a herrinal obstruction,what can to the kidney?Answer: a obstruction causes decreased renal vascular perfusion, which leads to the kidney becoming hypoxic Question: In Intrarenal ___ releasead by the kidney result in congestion of the vascular bed by WBCs & pHsAnswer: Cytokines Question: In Intrarenal failure ischemic endothelial cells also release a variety of mediators such as ____ that constrict the intrarenal blood vessels, further contributing to the ____ & ____?Answer: Ischemic endothelial cells also release a variety of such as endothelin that constrict the intrarenal blood vessels, further contributing to the vascular congestion & impaired perfusion Question: Both Prerenal & Postrenal failure have I/O of ___ &___?Answer: oliguria & Question: failure has an I/O symptoms of ___ &___?Answer: or nonoliguria Question: What to the specific gravity in prerenal failure?Answer: It is in prerenal failure Question: What happens to the specific gravity in intrarenal ?Answer: It is in intrarenal failure Question: What happens to the especific gravity in failure?Answer: It is variable in postrenal failure sometimes other times decreased Question: What happens to the Na+ level in in prerenal failure?Answer: Urine Na+ is decreased in prerenal Question: What happens to the Na+ level in urine in intrarenal ?Answer: Na+ is increased in prerenal failure Question: What to the Na+ level in urine in postrenal failure?Answer: Na+ is variable Question: What happens in prerenal failure?Answer: Prerenal failure microscopically Question: What happens microscoply in failure?Answer: Intarenal failure microsopically Question: What happens microscoply in postreanl ?Answer: postrenal failure microsopically WBC, bacteria possibly Question: What is the BUN/Creat ratio of prerenal ?Answer: >20:1 in prerenal Question: What is the BUN/Creat ratio of intrarenal & failure?Answer: 10:1 in both intrarenal & failure Question: What are some pre causes of acute renal failure?Answer: Hypovolemia, hepatorenal syndrome, vascular problems such as atheroembolic disease & reanl vein thrombosis (complication of nephrotic syndrome)& usually sepsis Question: a cause of prerenal filaure is usually from ___ or ___ and fluid loss or excessive use of ___?Answer: usually from or dehydration & fluid loss or excessive use of diuretics. Question: Hepatorenal syndrome in which renal ___ is compromised in ____ can cause pre renal failureAnswer: Hepatorenal syndrome in which renal perfusion is compromised in liver failure can cause pre renal Question: What are some causes of Renal ?Answer: toxins, medications; rhabdomyolysis; hemolyisis; myeloma; sickle-cell disease; lupus erythematosus; glomerulonephritis; Goodpasture's syndrome; Wegener's granulomatosis or acute lupus nephritis with systemic lupus erythromatosus Question: Name some toxins or that can cause pre renal failure?Answer: (e.g. some NSAIDs, aminoglycoside antibiotics, contrast, lithium, phosphate nephropathy due to bowel preparation for colonoscopy with sodium phosphates) Question: What is rhabdomyolysis? The resultant release of ___ in the blood affects the kidney; it can be caused by ___ (especially in ____ and extensive blunt trauma), statins, stimulants and some other drugsAnswer: rhabdomyolysis (breakdown of muscle tissue) - the resultant release of myoglobin in the blood affects the kidney; it can be caused by injury (especially crush injury and extensive blunt trauma), statins, and some other drugs Question: What are some of post renal failure?Answer: interfering with normal bladder empthying (eg anticholinergics); benign prostatic hypertrophy or prostate cancer; kidney stones; due to abdominal malignancy (eg ovarian ca, colorectal ca); & obstructed urinary catheter Question: What are s/s of ARF?Answer: Dizziness; dry mouth; low blood pressure (hypotension); rapid heart rate; slack skin; thirst; weight loss; Urine output is usually low. The pt may also have of heart or liver disease Question: What are s/s of ARF? aka intrarenal failureAnswer: Fever, rash, arthralgia (joint pain; flank pain; , dizziness, confusion, seizure, oliguria, edema, HTN, papilledema, & heart failure Question: What are s/s of ARF?Answer: Pain, urination, distended bladder, edema, HTN, pain in lower back, lower abdomen, groin, genitalia, SEVERE Hematuria Question: What a pt of having oliguria?Answer: <500ml/day Question: What classifies a pt of anuria?Answer: <50ml/day Question: What are the s/s of failure?Answer: Nl perfusion is diminished with decreased I/O, when oliguric-anuria last 1-2 weeks, some pts have little or no oliguric phase & begin to make lg quantities of dilute urine signifying restoration of tubular patency phase last 2days-2wks. Increase pho Question: How long can the oliguric to phase lastAnswer: 1-2 Question: Some pts have no oliguric phase & begin to make large quantities of dilute urine signify8ing restoration of patency. How long does this phase last?Answer: 2days -2 Question: In ARF pts can have an ___ in phosporone with ___ createn clearance of ____ ml/min (NL= 125ml/min), crystals form from _____in __, ___, ___, ___, & ___- classified as osteodystrophies & metastatic calcifications.Answer: increases in phophorone with decreased creat clearance <25ml/min (NL = 125 ml/min), form from excess calcium phosphate in soft tissue, lungs, joints, brain, & heart- classified as osteodystrophies & metastatic calcifications Question: In ARF small decrease in plasma ioniced calcium levels leads to ____ stimulation, ___ stimulation, bone reasorption, & enhanced renal secreation of _____, impaired Vit ___, hydroxylation contributed to ___ & ___levels.Answer: Small decreases in plasma ionized calcium levels to parathryoid hormone (PTH) stimulation, osteoclasts stimulation, bone reasorption, & enhanced renal secretion of phosphate (phosphate excretion is impired in renal failure), impired Vit D & hydroxyl Question: In ARF is a s/s that may lead to what?Answer: hyperkalemia may lead to dysrhythmias or arrest, metabolic acidosis, decreased erythropoietin(a hormone growth factor essential for erythropoiesis in BM) leading to decreased Hct & Hbg & hyperparathyroidism Question: ___ is also d/t the continued release of renin by the kidney; which activates the ____? Ultimately this process results in the release of ___ from teh ___, which increases the retention of __ & ___ thus exacerbating the fluid overload problemAnswer: HTN is also d/t the continued release of renin by the kidney; which activates the renin-angiotensisn mechanism. Ultimately this process results in the of aldosterone from the adrenal cortex, which increases the rentention of Na+ & H2O thus exacerb Question: Why does volume overload devleop in renal failure that leads to HTN?Answer: Fluid volume overload develosp because the kidney can no longer excreate H2O & Na. JVD plumonary pulses raies in lungs, peripheral edema. HTN are s/s of volume overload Question: What is a s/s of volume overload?Answer: Question: How would renal damage or failure lead to HTN in a ?Answer: The kidney can no excreate H20 & Na, which leads to fluid volume overload which leads to HTN. Question: Fluid volume overload may lead to ___ intolerance producing an ___ in blood sugar Answer: Fluid overload may lead to CHO intolerance producing an increase in blood sugar level Question: Why are ACEI drugs helpful, especially in patients with ?Answer: ACEIs & ARBs reduce proteinuria & enhance glomerular hernodyamics. The use of ACEIs appears to slow the progression of CRF by proteting the kidney from hemodynamically mediated glomerular damage. Also in pts with Diabetes The risk of macroalbum Question: ACEIs block all production & interfere with constriction of the ___ arteriole. This can be particuallry detremental to renal fx in pts who require high filtration pressure, such as those with ___ or ____?Answer: ACEI's block all production & interfere with constriction of the efferent arteriole. This can be particullarly detremental to renal fx in pts who high filtration pressures, such as those with polycystic kidney disase or collecting system obstructi Question: Blood flows to the kidneys from the ___ through the ___ that divide N2 several interlobar .Answer: Blood flows to the kidneys from the abdominal through the renal arteries that divide into several interlobar arteries. Question: When the interlobar arteries reach the border of the __ 7 ___, they branch into the arcuate arteries that then travel along the ____ & branch further to form small interlobular arteries (going into the ___) & branch extensively to from the ____?Answer: When they reach the border of the medulla & cortex, they branch into the arculate arteries that then travel the cortical medullary border & branch further to form small interlobular arteries (going into the cortex) & branch extensively to form the a Question: The afferent arterioles divide to form ___ capillaries, which coalesce to form the ____?Answer: The afferent arterioles divide to form flomerular capillairies, which coalesce to form th arterioles. Question: Each nephrone has its own ___, , & ___?Answer: Each nephrone has its own arteriole, capillary , & efferent arteriole Question: As the unit of function, a nephone must accomplish what 3 functions?Answer: 1. filtration of soluble substances from the blood 2. reabsorption of filtred nutrients 3. secretion of wastes or excess substances into the filtrate Question: Chemical mediators are thought to be released in response to maculadensa signals, including vasoactive _____. Drugs that inhibit cycloxygenase, such as ___ & ___, interfere with ___ production & may precipitate excessive revovascular constriction in someAnswer: Chemical mediators are thought to be released in response to maculadensa signals, including vasoactive PROSTOGLANDINS. Drugs that inhibit cycloxygenase, such as ASA & NSAIDs, interfere with prostoglandin production & may excessive revovascular Question: Prostoglandins have ___ .Answer: Prostoglandins have vasodilating Question: ___ is composed of the glomerulus, the maculer densa, & specialized ___ cells, are located arround the glomerular arterioles.Answer: The juxtaglomerular apparatus is composed of the flomerulus, the mcculer densa & juxtaglomerular cells, which are located arround the glomerular arterioles Question: ___ & releases reneinAnswer: cells Question: ___ is an enzyme that converts angiotensinogen to I.Answer: Question: Angiotensin I is then converted to Angiotension II by ___ in the ___ capillary, which possesses angiotensin-converting enzyme activity.Answer: Angiotension I is then converted to Angiotension II by endothelial cells in the glomerular capillary, which angiotension converting enzyme activity Question: __ is a vasoconstrictor that constricts the ___ thus increasing GFR?Answer: Angiotension II is a potent vasoconstrictor that the efferent arterole, thus increasing GFR Question: How do prostaglandins help the ?Answer: The kidney increases prostaglandin synthesis to modulate renal resistance. Question: Why is renin ?Answer: A decrease in arterial blood pressure; a decrease in NaCL levels in the ultra-filtrate or sympathetic nervous system activity (that also controls blood pressure acting through the beta 1 adrenergic receptors Question: Renin is secreted from ______ (of the afferent arterioles), which are activated via signaling (the release of _____) from the macula densa, which respond to the rate of fluid flow through the distal tubule, by decreases in renal perfusion pressure (througAnswer: Renin is secreted from cells (of the afferent arterioles), which are activated via signaling (the release of prostaglandins) from the macula densa, which respond to the rate of fluid flow through the distal tubule, by decreases in renal pe Question: ___ activates the renin-angiotensin system by cleaving angiotensinogen, produced by the liver, to angiotensin I, which is further converted into angiotensin II by ACE, the angiotensin-converting enzyme primarily within the capillaries of the lungs.Answer: Renin activates the renin-angiotensin system by cleaving angiotensinogen, by the liver, to yield angiotensin I, which is further converted into angiotensin II by ACE, the angiotensin-converting enzyme primarily within the capillaries of the lungs Question: What is 's primary function?Answer: Renin's primary function is therefore to eventually cause an in blood pressure, leading to restoration of perfusion pressure in the kidneys. Question: Kidney stones form when there is a decrease in ____ volume or an excess of stone-forming substances in the ____. The most common type of kidney stone contains ____ in combination with either oxalate or phosphate. Other chemical compounds that can form stoAnswer: Kidney stones form when there is a decrease in urine volume or an excess of stone-forming substances in the urine. The most common type of stone contains calcium in combination with either oxalate or phosphate. Other chemical compounds that can for Question: ____ through reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones.Answer: Dehydration reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones. Question: ___ to the flow of urine can also lead to stone formation. Kidney can also result from ___; these are known as ___ or infection stones.Answer: Obstruction to the flow of urine can also lead to stone formation. Kidney stones can also result from infection in the tract; these are known as struvite or infection stones. Question: Name some that can lead to kidney stones.Answer: gout; hyperclciuria; hyperparathyroidism, kidney disease such as renal tubular acidosis and some inherited conditions including cystinuria & hyperoxaluira. Chronic diseases such as diabetes and HTN; Inflammatory bowel disease; pts who have had a Question: What are some that put a pt at risk for kidney stones?Answer: protease inhibitors (indinavir), a drug used to treat HIV infection; diuretics, calcium-containing antiacids Question: While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of _____ in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this ____. The ___Answer: While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body do not reli Question: calculi consist of combined organic material taht initially form the __ or ___ of the kidney?Answer: calicles or pelvis of the Question: The calculi may then migrate down the tract & cause what?Answer: pain, obstruction, & Question: The of a stone or calculus anywhere in the urinary tract is termed ___?Answer: Question: Factors calculus formation are what?Answer: supersteration (increased of the offending solute), an abnormal pH, or low urine volume. Question: A complex interrelationships between conditions conducive to crystallization, cellular response to crystals, & the of matrix materials to ehhance mineralization & substained activity of the usual process that inhibit Ca formation is involved in tAnswer: progression of calculi Question: What are some to stone formation?Answer: Inhibitors to stone formation include pyrophosphate, citrate, , & certain macromolecules such as glycoproteins,. Forms when Citrates & Magnesium is difcient in urine, hypercalciema Question: When the calculus is in the ___ no symptoms appear unless an or obstruction of the kidney is present?Answer: pelvis Question: What is the hallmark s/s of reanl ?Answer: |
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