Renal Exam 3
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| show | The concern is that the glomerulus is damaged and proteinuria is an indicator of nephritic syndrome
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| How does protein loss through the kidneys happen? | show 🗑
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| What in the kidneys is damaged to allow protein loss? | show 🗑
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| When protein is high as in nephritic syndrome what s/s will you see? | show 🗑
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| Hyperfibrinogemia, impaired fibrinolysis, decreased immunity, trace mineral & Vit D deficiency, Hyperparathyrodisim, neural osteodystrophy & decreased Ca+ are also s/s of ____? | show 🗑
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| show | basement membrane is the principal selectivity barrier of the glomerulus
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| What does the basement membrane of the glomerulus prevent from passing through? (hint there are 3 things) | show 🗑
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| show | plasma proteins are negatively charged & repelled by the basement membrane
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| ____ have a thin diaphragm of protein that restricts the filtration of some ____ that make it through the basement membrane? | show 🗑
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| show | Nephrin is an important protein in the slit pores
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| A pt with genetically mutated slit pores will have what kind of urine? | show 🗑
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| show | proteins & blood cells
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| show | glomerulus
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| ___ is an IMPORTANT sign of basement membrane dysfunction? | show 🗑
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| show | Nutrients, Vitamins, & Small proteins are normally reabsorbed completely in the early proximal tubule
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| show | it exists b/c proteins are present in the blood
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| show | plasma proteins
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| show | The glomerular capillary colloidal osmotic pressure opposes filtration by holding H2O & ions in the capillaries which are attracted to the plasma proteins
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| ___ & ___ are attracted to the plasma proteins? | show 🗑
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| Pressure is decreased at ___ & progressively increases along the length of the ___? | show 🗑
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| Normally plasma proteins do not filter into the ___? | show 🗑
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| show | Bowman capsule oncotic pressure
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| ___ would enhance glomerular filtration b/c proteins attract cations & water? | show 🗑
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| In a healthy kidney the bowman capsule oncotic pressure is ___? | show 🗑
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| As blood passes through the capillaries, continued filtration leaves a greater concentration of proteins in the capillaries which ___ the oncotic pressure? | show 🗑
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| show | False normal urine DOES NOT contain proteins
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| show | True
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| show | when a pt excretion of protein is more than 150mg/24 hrs
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| Proteinuria can cause the urine to be ___? | show 🗑
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| ___ is a collection of symptoms caused by glomerular disease? | show 🗑
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| Nephritic Syndrome is characterized by an ___ in glomerular capillary wall permeability to ___? | show 🗑
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| The predominant abnormality in nephritic syndrome is the loss of …? | show 🗑
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| Hypoalbuminemia, hyperlipidemia, edema, hypercoagulability, altered immunity & lipiduria are present secondarily to proteinuria in ____? | show 🗑
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| show | Diabetic neuropathy
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| show | minimal change disease
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| ___ is when hydrostatic & colloid oncotic pressures are not balanced in independent areas & periurbital areas? | show 🗑
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| In nephritic syndrome hypercoagulability is due to altered clotting factors such as ….? | show 🗑
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| show | Zinc, Fe- & copper
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| show | renal HTN, glomerulepathies, nephritic syndrome, renal artery or vein thrombosis, & pyllonephritis
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| show | Bowman capsule drains the glomerular filtrate directly into the Proximal Tubule segment (Proximal Convoluted Tubule), where 2/3 ofH2O & electrolytes are rapidly reabsorbed
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| What three things are normally reabsorbed completely in the early proximal tubule? | show 🗑
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| The ___ is the site of most HCO3 ion reabsorption, whereas Cl- ion is reabsorbed in where? | show 🗑
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| The proximal tubule is made up of ___ ___ & convoluted to provide a greater surface area for reabsorption? | show 🗑
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| show | microvilli
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| show | Na+-K+ ion pumps
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| show | H2O is reabsorbed passively through water channels made of proteins called agnaporin 1
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| show | Passive H2O reabsorption
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| show | 125ml/min & it is determined by the filtration pressure in the glomerali & by the permeable surface area of the glomerular membrane
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| show | GFR is the product of filtration pressure & permeability constant determined by the physical principles of filtration across a capillary membrane
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| The main driving force for filtration in the GFR is ___ by exerting a force against ___? | show 🗑
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| show | hydrostatic pressure
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| show | blood volume
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| More blood -> more pressure, more pressure-> ____ GFR, and the opposite is true. | show 🗑
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| Auto-regulation in the GFR adjusts for large swings in __? | show 🗑
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| Decreased renal blood flow causes decreased GFR which leads to what? | show 🗑
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| show | Proximal Tubule segment (Proximal Convoluted Tubule)
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| What is GFR? | show 🗑
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| What does the GFR tell you about kidney function? | show 🗑
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| The most common causative agents of renal system infection are ____ such as what? | show 🗑
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| show | Pyelonephritis
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| show | 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 bacteria to multiply
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| 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? | show 🗑
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| Regardless of the cause of acute pyelonephritis w/in ___ the infection spreads to the parenchyma & creates what? That results in what? | show 🗑
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| show | Rare
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| show | Infants, Children, Pregnat women, & adults with other comobiditis that inhibit either diagnosis, mgnt, or response to antibiotic therapy.
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| In acute Pyelonephritis prevention of renal scaring is dependent on what? | show 🗑
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| T/F S/S of acute pyelonephritis does not vary amoung age groups? | show 🗑
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| show | 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 costovertebral angle on palpation
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| What is the hallmark s/s of acute pyelonephritis? | show 🗑
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| FYI - algia = ___ ex:nephralgia = kidney ___ | show 🗑
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| Neither renal or uretal pain is altered by changes in ___ ___? | show 🗑
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| (Acute Pyelonephritis) UTI's including pyelonephritis should be suspected in infants, children & elderly pts with generalized symptoms such as? | show 🗑
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| show | Chronic pyelonephritis is characterized by unilateral or bilateral pathologic changes in the kidney as a consequence of infection
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| show | Small atrophic kidneys with diffuse scarring & bunting of the calices are classic manifestations of chronic pyelonephritis
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| In chronic pyelonephritis individuals at risk have bacteriuria associated with? Give examples | show 🗑
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| show | As a result of recurerent infections, chronic interstitial inflamation develops with lymphocyte & plasma cell infiltration of the renal tissue.
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| show | dilated or atrophic renal tubules
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| T/F Chronic pyelonephritis has the same s/s of acute pyelonephritis? | show 🗑
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| What is cystitis? | show 🗑
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| Cystitis may result from what? | show 🗑
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| Cystitis most commonly results from ___? | show 🗑
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| What bacteria is the most common cause of cystitis? | show 🗑
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| show | It is more common in females than males b/c of shorter urethra as well as a colonization ronte from the rectum & vagina to the urethra.
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| show | Research demonstrated that women who have recurrent bacterial cystitis have uroepithelial, vaginal, & buccal epithelial cells that enhance binding properties of E. Coli
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| show | decreased vaginal pH, decreased estrogen levels, & lewis bloog group LE (a-b-) & LE (a+b-) pheontypes are associated with increased incidence of cystitis
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| show | sexual activity, use of spermicides, catheterization, DM, poor hygiene, & type A bladder dysfunction/urin stasis
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| What are the s/s of cystitis? | show 🗑
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| In cystitis flank pain is ___ & can indicate what? | show 🗑
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| show | Visually, heamturia or cloudy urine may be evident
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| What will the urinalysis of a pt with cystitis show? | show 🗑
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| show | Pyelonephritis is an infection of the renal pelvis whereas a UTI can be an infection in the bladder, urethra, ureters or kidneys. UTIs may be asymptomatic
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| show | 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 urine.
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| What are the s/s of a UTI that has spread? | show 🗑
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| show | In pyelonephritis fever & chills have a sudden onset, flank pain, UTI symptoms such as dysuria & urinary frequency or urgency. chills and fever only happen in UTIs that have spread
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| show | pyelonephritis
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| show | E. Coli
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| show | A malignant neoplasm of the kidney occurring in young children before the fifth year in 75% of the cases.
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| show | Nephroblastoma or Wilm's Tumor
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| show | False it can be found in adults but it is rare in pts >15 yrs
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| show | most cases onset is b/t 3-5 yrs. males & females equally affected
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| What is the primary etiological basis of wilm's tumors? What does this defect result in? | show 🗑
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| 15% of children with Wilm;s tumors have other abnormalities, including what? | show 🗑
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| show | A tumor mass of the flank or abdomen is palpable in 80% of cases. abdominal pain, HTN, & microscopic hematuria
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| ___ is initially identified by a parent or physician on routine physical exam. | show 🗑
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| What are the s/s that indicate a subscapular hemorrhage of the wilm's tumor? | show 🗑
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| show | The most frequent early signs are hypertesopm, a palpable mass, pain and hematuria.
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| Where would you see a Wilms tumor? | show 🗑
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| ___ is a syndrome of disorders characterized by an abrupt onset of hematuria & proteinuria in conjunction with azotemia & renal Na+ & H2O | show 🗑
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| What are the s/s of acute glomerulonephritis? | show 🗑
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| ___ is an infection process that indirectly causes or tirggers acute glomerulsnephritis by activating ____? | show 🗑
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| What does the circulating inflmmatory cells infiltrate in Post-streptococcal glomerulonephritis? | show 🗑
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| show | cerndement is deposited & attracts neutrophils & monocytes. Lysosomal enzymes are then released & damage glomerular walls.
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| What results in Post-streptococcal glomerulonephritis once the glomerular wall has been damaged? | show 🗑
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| show | 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 fibrin deposition & criescent formation (accumulation of prolif
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| In Post-streptococcal glomerulonephritis what is fluid retention due to? | show 🗑
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| In Post-streptococcal glomerulonephritis what does the H20 & Na+ reabsorption due? | show 🗑
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| show | Hematuria & evidence of RBC casts result b/c erythrocytes are now able to cross the more permable glomerular or peritubular walls N2 proximal tubule fluid (which is eventually urine)
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| show | Gross hematuria manifested as smokey or coffee-colored urine is the most common finding
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| What are the classic indicators of glomerulonephritis & what does it represent? | show 🗑
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| In glemerulonephritis what type of cell cast will be present? | show 🗑
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| In glomerulonephritis ____ is generally present in the urine? | show 🗑
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| show | Systemically, disruptions r/t fluid volume changes are major manifestations - periorbital edema most common & dependent areas cause lower extremity edema, apcites & plueral effusion
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| show | If the glomerulonephritis is thought to be post streptococcal antibodies such as antistneptolysin O & antistneptokinase are evaluated. BUN & Creaton levels evalate/estimate the extent of renal damage
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| Glomerulonephritis can lead to ____ which requires dialysis? What does dialysis due for the pt or what can happen to the pts kidneys? | show 🗑
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| show | Acute renal failure
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| show | Acute renal failure
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| What type of kidney failure is associated with decrease in GFR, decreae in I/O over several hrs-days? | show 🗑
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| What are the s/s of acute renal failure? | show 🗑
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| show | ARF Acute Renal Failure
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| show | Prerenal failure - 60% or more of community-acquired ARF. The underlying factor is diminished perfusion of the kidney.
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| show | Prerenal failure, the functional components of the kidney are intact, but decreased blood flow to the kidney ultimately results in decreased GFR
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| show | 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 arterioles
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| In Prerenal failure when mean systemic areterial pressure drops below ___, GFR is sharply reduced. | show 🗑
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| What are some causes of prerenal failure? | show 🗑
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| T/F Usually, prerenal oliguria is easily reveresed if cause is identified? | show 🗑
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| show | Decreased GFR affects production of filtrate & thus decreases urine volume eliminated, b/c of the slow mvt through the renal tubules, more Na+ & H2O are reabsorbed N2 the bloodstream.
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| show | Glomerular hypoperfusion increases renin, angiotension II, & aldosterone production which results in Na+ & H20 retention. I/O decreases to <500ml/24hrs.
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| show | When I/O decreases to <500ml/day azotemia develops, indicating retention of nitrogenous waste products reflected by increased BUN
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| show | The hemodynamic alterations that occur in ARF if allowed to progress will lead to renal enclothelial ischemia.
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| What does renal enclothelial ischemia lead to in ARF? | show 🗑
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| show | a potent vasoconstrictor
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| show | Accumulation of inflammatory cytokines, leukocytes, & fibrin leads to obstruction in the renal micorcirculation
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| Name some meds that contribute to prerenal failure. | show 🗑
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| In what type of renal failure is the common etiologic factor is obstruction of urine flow @ some point distal to kidney itself? | show 🗑
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| show | bilateral
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| What are the causes of postrenal failure? | show 🗑
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| show | manifest as oliguria or anuria
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| In postrenal failure the obstruction of urine flow initially produces an increase in ___ pressure w/in the kidney & subsiquently increases the pressure in the ____? | show 🗑
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| show | The elevated tubular pressure opposes glomerular capillary filtration pressure and production of urine is impaired b/c of decreased GFR
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| In Postrenal failure why does azotemia develop? | show 🗑
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| show | Intrarenal failure
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| show | The functional unit of the kidney, the nephron itself is damaged.
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| show | the glomerulus may be the site of injury or most commonly, the renal tubules may be injured with the injury leading to acute tubular necrosis (ATN).
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| show | B/C the nephron itself has been affected; recovery can take weeks to months
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| If the nephron is severly damaged & no recovery is possible what may it lead to? | show 🗑
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| What is the most common cause of intrarenal acute renal failure? | show 🗑
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| show | prolonged prerenal ARF, trnasfusion reaction, Rhabdomyolyois), nephrotoxic acute tubular necrosis(prolonged postrenial ARF, antibiotics, contrast, heavy metals) & inflamation
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| show | lead, murcury, carbon tetrachloride, insecticides, fungicides, cytotoxic drugs
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| What are some cytotoxic drugs that can cause ATN? | show 🗑
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| show | acute glomerulonephritis & acute pyelonephritis
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| ___ is a result of either ischemic or nephrotoxic injury to the tubules? | show 🗑
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| ATN: injured tubular epithelial cells release intracellular debris N2 the ___, which in combination with proteins is the ___ result in formation of ____. | show 🗑
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| show | cause hernial obstruction which increases pressure in tubules & eventually backs up & increases pressure in the bowman capsule, slowing GFR & furter damaging the glomeruli & tubules.
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| What is an important part of ATN pathology? | show 🗑
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| A pt with ATN that has lead to a herrinal obstruction,what can happen to the kidney? | show 🗑
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| In Intrarenal failure ___ releasead by the kidney result in congestion of the vascular bed by WBCs & pHs | show 🗑
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| In Intrarenal failure ischemic endothelial cells also release a variety of mediators such as ____ that constrict the intrarenal blood vessels, further contributing to the ____ & ____? | show 🗑
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| show | oliguria & anuria
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| show | oliguria or nonoliguria
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| What happens to the specific gravity in prerenal failure? | show 🗑
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| show | It is decreased in intrarenal failure
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| show | It is variable in postrenal failure sometimes increased other times decreased
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| What happens to the Na+ level in urine in prerenal failure? | show 🗑
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| show | Urine Na+ is increased in prerenal failure
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| What happens to the Na+ level in urine in postrenal failure? | show 🗑
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| show | Prerenal failure microscopically Normal
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| What happens microscoply in intarenal failure? | show 🗑
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| What happens microscoply in postreanl failure? | show 🗑
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| What is the BUN/Creat ratio of prerenal failure? | show 🗑
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| show | 10:1 in both intrarenal & postrenal failure
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| show | Hypovolemia, hepatorenal syndrome, vascular problems such as atheroembolic disease & reanl vein thrombosis (complication of nephrotic syndrome)& infection usually sepsis
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| show | usually from shock or dehydration & fluid loss or excessive use of diuretics.
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| show | Hepatorenal syndrome in which renal perfusion is compromised in liver failure can cause pre renal failure
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| show | toxins, medications; rhabdomyolysis; hemolyisis; multiple myeloma; sickle-cell disease; lupus erythematosus; glomerulonephritis; Goodpasture's syndrome; Wegener's granulomatosis or acute lupus nephritis with systemic lupus erythromatosus
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| Name some toxins or medications that can cause pre renal failure? | show 🗑
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| show | 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, stimulants and some other drugs
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| What are some causes of post renal failure? | show 🗑
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| What are s/s of prerenal ARF? | show 🗑
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| What are s/s of intrinsic ARF? aka intrarenal failure | show 🗑
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| show | Pain, difficult urination, distended bladder, edema, HTN, pain in lower back, lower abdomen, groin, genitalia, SEVERE Hematuria
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| What classifies a pt of having oliguria? | show 🗑
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| What classifies a pt of having anuria? | show 🗑
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| show | Nl perfusion is diminished with decreased I/O, when oliguric-anuria phase 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
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| show | 1-2 weeks
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| Some pts have no oliguric phase & begin to make large quantities of dilute urine signify8ing restoration of tubular patency. How long does this phase last? | show 🗑
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| 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. | show 🗑
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| 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. | show 🗑
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| In ARF hyperkalemia is a s/s that may lead to what? | show 🗑
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| ___ 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 problem | show 🗑
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| show | 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 fluid volume overload
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| What is a s/s of fluid volume overload? | show 🗑
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| show | The kidney can no longer excreate H20 & Na, which leads to fluid volume overload which leads to HTN.
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| show | Fluid volume overload may lead to CHO intolerance producing an increase in blood sugar level
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| show | 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 developing macroalbum
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| show | ACEI's block all production & interfere with constriction of the efferent arteriole. This can be particullarly detremental to renal fx in pts who require high filtration pressures, such as those with polycystic kidney disase or collecting system obstructi
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| show | Blood flows to the kidneys from the abdominal aorta through the renal arteries that divide into several interlobar arteries.
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| show | When they reach the border of the medulla & cortex, they branch into the arculate arteries that then travel along the cortical medullary border & branch further to form small interlobular arteries (going into the cortex) & branch extensively to form the a
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| The afferent arterioles divide to form ___ capillaries, which coalesce to form the ____? | show 🗑
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| show | Each nephrone has its own afferent arteriole, capillary , & efferent arteriole
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| show | 1. filtration of water soluble substances from the blood 2. reabsorption of filtred nutrients 3. secretion of wastes or excess substances into the filtrate
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| 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 some | show 🗑
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| show | Prostoglandins have vasodilating properties
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| ___ is composed of the glomerulus, the maculer densa, & specialized ___ cells, which are located arround the glomerular arterioles. | show 🗑
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| ___ produces & releases renein | show 🗑
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| ___ is an enzyme that converts angiotensinogen to angiotensin I. | show 🗑
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| Angiotensin I is then converted to Angiotension II by ___ cells in the ___ capillary, which possesses angiotensin-converting enzyme activity. | show 🗑
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| show | Angiotension II is a potent vasoconstrictor that constricts the efferent arterole, thus increasing GFR
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| How do prostaglandins help the kidneys? | show 🗑
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| Why is renin released? | show 🗑
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| 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 (throug | show 🗑
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| ___ activates the renin-angiotensin system by cleaving angiotensinogen, produced 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. | show 🗑
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| show | Renin's primary function is therefore to eventually cause an increase in blood pressure, leading to restoration of perfusion pressure in the kidneys.
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| 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 sto | show 🗑
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| show | Dehydration through reduced fluid intake or strenuous exercise without adequate fluid replacement increases the risk of kidney stones.
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| ___ to the flow of urine can also lead to stone formation. Kidney stones can also result from ___; these are known as ___ or infection stones. | show 🗑
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| show | gout; hyperclciuria; hyperparathyroidism, kidney disease such as renal tubular acidosis and some inherited metabolic conditions including cystinuria & hyperoxaluira. Chronic diseases such as diabetes and HTN; Inflammatory bowel disease; pts who have had a
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| show | protease inhibitors Crixivan (indinavir), a drug used to treat HIV infection; diuretics, calcium-containing antiacids
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| 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 ___ | show 🗑
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| show | calicles or pelvis of the kidney
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| show | pain, obstruction, & infection
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| show | nephrolithiasis
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| show | supersteration (increased concentration of the offending solute), an abnormal pH, or low urine volume.
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| show | etiologic progression of calculi
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| show | Inhibitors to stone formation include pyrophosphate, citrate, megnesium, & certain macromolecules such as glycoproteins,. Forms when Citrates & Magnesium is difcient in urine, hypercalciema
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| When the calculus is in the ___ no symptoms appear unless an infection or obstruction of the kidney is present? | show 🗑
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| show | PAIN
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Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
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If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
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