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2012-09-11 15:36:44
kidney diseases part

kidney diseases part 1
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  1. Primary function of kidney
    to filter blood or plasma to produce urine
  2. Secondary function of kidney
    • maintain water and electrolyte balance
    • maintain pH levels (both lungs and kidneys involved in acid-base balance)
    • produce hormones
  3. Hormones produces in the kidney
    • erythropoietin (RBC production)
    • renin (BP regulation)
  4. Anatomy of the nephron
    • afferent arterioles (carry blood to glomerulus)
    • efferent arterioles (carry blood from glomerulus)
    • glomerulus (filter unit of nephron)
  5. Anatomy of glomerulus
    • glomerular capsule
    • proximal convoluted tubule
    • loop of Henle
    • distal convoluted tubue
    • juxtaglomerular apparatus
    • collecting duct
  6. Formation of urine
    • three part process takes place in different parts of nephron
    • 1) glomerular filtration
    • 2) tubular reabsorption
    • 3) tubular secretion
  7. Glomerular filtration
    • osmotic concentration similar to that of plasma
    • blood in glomerulus has two components: filterable and nonfilterable
  8. Tubular reabsorption
    • occurs as molecules and ions are both passively and actively reabsorbed from the nephron into the blood
    • osmolarity of blood is maintained by presences of both plasma proteins and salts
    • urine concentration increases/decreases as it descends/ascends the nephron cortex and medullary due to substance not reasborbed
  9. Non-filterable components of blood in glomerulus
    • protein
    • RBC
    • platelets
  10. Tubular secretion
    second way by which substances are removed from blood and added to tubular fluid
  11. Other substances that regulate salt and water reabsorption
    • aldosterone (mineralcorticosteroid)
    • antidiuretic hormone (ADH)
  12. Indicators of disease
    • changes in urination
    • chills and fever
    • dysuria
    • edema (caused by plasma protein loss)
    • fatigue
    • hematuria
    • hypertension
    • loss of appetite
    • proteinuria (foamy urine due to protein levels)
    • pyuria
  13. Diagnostic tests or procedures
    • urinalysis (physical or gross appearance of urine)
    • dipstick
    • microscopy
    • cystoscopy
    • intravenous pyelogram (IVP)
  14. Urinalysis
    • color
    • turbidity
    • odor
  15. Red urine
    • indicative of blood, hemoglobin or beets
    • Further proof that no one should ever eat beets
  16. Beer-brown urine
  17. Black urine
    • melanin
    • indicates that cancer has spread to liver
  18. Orange, blue or green urine
    presence of food, dye or food metabolites
  19. Turbidity of urine
    • well-mixed sample will be either clear or turbid
    • normal urine is clear
    • centrifuge to determine if cause is cells or crystals (cloud settles to bottom) or bacterial (remains cloudy)
  20. Strong odor
    • normal urine smells like pee
    • normal asparagus also smells like pee
    • ketones smell fruity or like nail polish remover
    • nail polish remover does not smell like pee. Obvs Pete is sniffing something.
    • fecal smells indicate that urine is putrid
    • ammonia smells indicate alkaline urine (pH ~8-9)
  21. Parameters measured in dipstick tests
    • pH
    • specific gravity
    • albuminuria
    • glucose
    • ketones
    • nitrites
    • leukocyte esterase
  22. Causes of high urinary pH (alkali urine)
    • diet - vegetarian, low carb, lots of citrus fruit
    • systemic alkalosis
    • renal tubular acidosis
    • fanconi syndrome
    • UTI
    • certain drugs (amphotercin B, carbonic anhydrase inhibitors, NaHCO3, salicylate OD)
    • stale ammoniacal sample
  23. Causes of low urinary pH (acidic urine)
    • diet - high protein or lots of fruits (like cranberries)
    • systemic acidosis
    • diabetes mellitus
    • starvation
    • diarrhea
    • malasorption
    • phenylketonuria
    • alaptonuria or alacaptonuria
    • renal tuberculosis
  24. Causes of decreased gravity
    • You're on the moon!
    • excessive hydration
    • nephrogenic diabetes insipidus
    • acute glomerulonephritis
    • pyelonephritis
    • acute tubular necrosis
    • alkaline urine
  25. Causes of fixed specific gravity
    • chronic renal failure
    • chronic glomerulonephritis
  26. Causes of increased specific gravity
    • You're on Mars!
    • dehydration
    • syndrome of inappropriate antidiuretic hormone hypersecretion
    • adrenal insufficiency
    • pre-renal failure
    • hyponatremia with edema
    • liver failure
    • nephrotic syndrome
    • glycosuria
    • proteinuria
    • IV contrast dye
    • urine contamination
    • low molecular weight dextran solution
  27. Causes of albuminuria
    chronic kidney disease
  28. Causes of glucose in urine
    diabetes mellitus
  29. Causes of hematuria
    • glomerulonephritis
    • kidney stones
    • tuberculosis
    • cystitis
    • tumors
  30. Causes of microscopic particles in urine
    • pyuria
    • casts: fatty, granular, hyaline, RBC, renal tubular epithelial, waxy, WBC
  31. Abnormalities identified by cystoscopy
    • blood in urine
    • inflammation
    • kidney stones
    • polyps
    • tumors of urinary bladder or ureter
    • urethral strictures or narrowings
  32. Abnormalities identified by intavenous pyelogram (IVP)
    • urinary bladder and kidney infections
    • blood in urine
    • flank pain possibly due to kidney stones
    • tumors
    • urinary tract damage after an abdominal injury
  33. Glomerulonephritis
    • inflammatory disease of glomeruli affecting the filtering waste and fluids from the blood
    • usually caused by antigen-antibody (Ag-Ab) reaction following a hemolytic streptococcal infection
  34. Process of glomerulonephritis
    • Ag-Ab complexes form in blood becoming trapped in glomeruli and triggering an inflammatory response
    • neutrophils respond to inflamed glomeruli
    • glomerular blood flow is reduced and impede the filtration rate resulting in decreased urine formation
    • glomeruli degenerate and become extremely permeable
    • albumin and RBCs appear in urine
    • kidney failure may occur, leading to accumulation of dangerous levels of fluid and waste in body
  35. Causes of glomerulonephritis
    • post-steptococcal glomerulonephritis
    • bacterial endocarditis
    • viral infections
    • immune diseases (systemic lupus erythematosus or nephritis, Goodpasture's syndrome, IgA nephropathy, vaculitis [polyarteritis, Wegener's granulomatosis]
    • HPB
    • diabetes kidney disease
    • focal segmental glomerulosclerosis
  36. Signs and symptoms of glomerulonephritis
    • chills and fever
    • loss of appetite
    • fatigue or weakness from anemia or kidney failure
    • edema
    • less frequent urination
    • hematuria
    • proteinuria
    • hypertension
  37. Treament of acute glomerulonephritis
    • bed rest
    • dietary restrictions
    • medications (calcium channel blockers, beta-adrenergic receptor antagonists)
    • diuretics