Pathophys Test 3

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Author:
cgordon05
ID:
14470
Filename:
Pathophys Test 3
Updated:
2010-04-14 11:50:54
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Renal 6 11
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Description:
Renal 6-11
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  1. What are the systemic and local effects of angiotensin II? (p.20)
    • Powerful vasoconstrictor – one of the most powerful known to men
    • Causes rapid vasoconstriction by acting on vascular smooth muscle --> increases BP
    • Stimulates adrenals to release aldosterone --> increases Na+ reabsorption in distal tubules --> water reabsorption
    • Net effect = increased vascular volume --> increased BP
  2. Angiotensin II - functions
    • Increased Na+ reabsorption
    • Increased H2O reabsorption
    • Increased vascular volume
    • Increased BP
  3. What is the effect of ADH in the collecting ducts?
    Increased H2O reabsorption
  4. Review disorders for glomerular and renal function. (p.8-10)
    • Glomerulonephritis – autoimmune disease
    • o Capillary wall injured = increased membrane permeability
    • o Can result in permanent kidney damage
    • o Inflammatory condition
    • o Classic form develops in child 1-4 weeks after Group A Streptococcus infection
    • o Kidney can be primary organ or secondary
  5. Know significance of blood creatinine level as marker for renal function. (p.2-3)
    • Average creatinine clearance = 120 mL/min
    • Approximates GFR of 90 – 130 mL/min
    • Good marker for evaluating renal function
    • If GFR falls, creatinine clearance overestimates
    • Gold standard to measure creatinine clearance = 24-hour urine
  6. Review sequence of events that take place in an inflammatory process that leads to glomerular injury. (p.10)
    • (1) Endothelial cells and epithelial cell damage
    • (2) Increased glomerular permeability to proteins
    • (3) Accumulation of proteins in surrounding matrix with deposition of fibrin
    • (4) Proliferation of mesangial cells
    • (5) Sclerosis
  7. Goodpasture's Syndrome (p.10)
    • Autoantibodies react with basement membrane of glomerulus and basement membrane of lung alveoli
    • Lesions develop at same time in both lung and kidney
  8. Nephrotic Syndrome - clinical findings (p.11)
    • Massive amounts of proteinuria
    • o Daily loss of protein in urine can be 3.5 grams or more
    • o Immunoglobulins lost in urine --> increased susceptibility to infections
    • o Plasma proteins loss --> pro-coagulation and anti-coagulation imbalance --> increased arterial/venous thrombosis
    • Generalized edema (most obvious sign)
    • Hypoalbuminemia - plasma levels < 3 g/dL
    • o Normal = 3.4 – 5.4 g/dL
    • Hyperlipidemia and lipiduria
    • o Proteinuria --> increased synthesis in liver --> VLDL --> hyperlipidemia
    • o VLDL = look for nephrotic syndrome
  9. Causes of Nephrotic Syndrome - children vs. adults
    • Children <15 y.o. = cause R/T primary lesion in kidney
    • Adults = cause secondary to systemic disease, especially diabetes and systemic lupus erythmatosus
  10. Nephritic Syndrome - clinical findings
    • Hematuria –
    • o Initially microscopic
    • o Produces cola-colored urine
    • Some degree of oligura and azotemia
    • Hypertension
    • (Less likely to have generalized edema)
  11. Nephritic syndrome - causes
    • Primary lesion of glomerulus
    • Secondary to systemic disease
    • Post-streptococcal glomerulonephritis developing in children after Group A streptococcal infection

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