RENAL PATHO

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Author:
cmatthews
ID:
209703
Filename:
RENAL PATHO
Updated:
2013-03-26 18:30:04
Tags:
BC CRNA PATHO EXAM
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Description:
Renal & urologic
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  1. Normal specific gravity is
    1.010-1.025
  2. When would you see High specific gravity (Greater than 1.025)
    Dehydration, SIADH, situations in which dye is eliminated by urine, or if protein is in urine
  3. When would you see LOW specific gravity (less than 1.010)
    • diabetes insipidus 
    • hydration
  4. TRUE or FALSE
    You would see casts in urine in nephrotic syndrome
    • TRUE 
    • See casts for:
    • ↑ protein level (nephrotic)

    • ↑urine osmolality
    • ↓urine pH
  5. Describe a normal UA
    • clear urine
    • SG 1.010-1.025
    • pH 4.6-4.8
    • NO glucose
    • NO ketones
    • NO blood (including RBC & WBC)
    • NO protein
    • NO bilirubin
    • NO casts
    • NO crystals
    • Few or NO epithelial cells
  6. How does the kidney regulate pH?
    By conserving Bicarbonate or excreting H+
  7. Kidneys receive ___% of CO
    22
  8. Normally most blood goes to the ____ of the kidney
    cortex
  9. In states of low perfusion (shock) more blood is re-routed to the ____ of the kidney
    • medulla.
    • ↓GFR to maintain urine concentration
  10. What is the functional unit of the kidney?
    The nephron!
  11. What are the three processes that occur in the nephron?
    • Glomerular filtration
    • Tubular re-absorption
    • Tubular secretion
  12. Normal GFR is ____ml/min
    125
  13. GFR provides a guage of ____ ___.
    renal function
  14. Normal urine output is __ml/min or __ml/hr.
    1ml/min or 60ml/hr (but not less than 30ml/hr)
  15. Glomerular filrate includes H20, glucose, electrolytes, and creatinine but NOT....
    protein,RBC, WBC (too large to cross glomerular wall)
  16. What are some substances secreted by tubules?
    K, H, urea, NH3, some drugs
  17. What is the normal creatinine clearance?
    115-125ml/min
  18. serum creatinine is the preferred measurement of renal function. Normal values are ___ for men and ___ for women.
    Normal men: 1-1.5mg (↑muscle mass)

    women: 0.7mg
  19. Creatinine levels reflect the ____
    GFR (creatinine is filtered out by kidneys and not reabsorbed so if filtering of kidney is deficient, creatinine blood levels rise)
  20. TRUE or FALSE
    BUN relates to GFR but it is less specific.
    • TRUE! urea is from byproduct of protein metabolism and made by the liver. 
    • Can be elevated from ↑protein in diet, bleeding, or CHF
  21. Normal BUN is ___
    10-20
  22. Normal BUN to creatinine ratio is
    10:1
  23. An endocrine function of the kidney is to activate ____ _.
    Vitamin D. Helps with regulation of calcium ad phosphate conservation and elimination.
  24. Kidney's help regulate RBC production by secreting ____
    erythropoietin. (Involved in all three stages of RBC production). Decreased renal function can cause anemia.
  25. How does the kidney control BP?
    • Through the Renin-Angiotensin-Aldosterone mechanism. 
    • Kidney secretes Renin, which increases aldosterone and angiotensin II (results in Na and fluid retention & vasoconstriction)
  26. Aldosterone promotes the absorption of ___ and the excretion of ___
    Na Absorption and K+ excretion
  27. Natriuretic peptides (from heart and brain) _____  secretion causing lower BP.
    renin
  28. How do Kidneys regulate the osmolality of the extracellular fluid?
    • Through the action of ADH
    • (secreted by the posterior pituitary causes water reabsorption)
  29. TRUE or FALSE 
    Creatinine levels will increase the moment kidney damage starts (before too much damage has been done)
    FALSE. Creatinine is not that sensitive in the beginning. Need to wait until the kidney is pretty damaged before you see rise in level.
  30. TRUE or FALSE
    Pre-renal failure is the most common cause of acute renal failure.
    TRUE
  31. What causes pre-renal failure?
    caused by impaired renal blood flow leading to ischemia in the nephrons (from dehydration, hemorrhage, shock, HF, anaphylaxis, sepsis)
  32. TRUE or FALSE
    There is a decreased risk of pre-renal failure with anesthesia.
    FALSE increased risk from increased blood flow!
  33. Post-renal failure is caused by what?
    Obstruction of the urinary collecting system anywhere from the calyces to the urethral meatus. (urethral or bladder cancer, renal calculi, BPH, urethral stricture)
  34. Intrinsic renal failure is caused by what?
    Actual tissue damage to the kidney caused by inflammatory or immunologic process (DIC) or from prolonged hypoperfusion. (Acute Tubular Necrosis, interstitial nephritis, nephrotoxic drugs)
  35. Acute renal failure has an onset of ____ to ___
    hours to days.
  36. TRUE or FALSE
    Acute renal failure is irreversible.
    FALSE, it is reversable
  37. Acute Tubular Necrosis (ATN) is an intrinsic type of renal failure. It has three phases, describe them.
    • Onset: precipitating event through tubular injury; hours to day; BUN and Creatinine gradually increase
    • Maintenance: ↓GFR. oliguria common, continue to ↑BUN, creatinine, K+ Metabolic acidosis. Weeks long. Can lead to HTN from prolonged oliguria
    • Recovery: gradual ↑ in UO & ↓ creatinine. May take 1 yr, may never recover 100% of nephron function.
  38. ATN is characterized by destruction of ___ ___ ___.
    Tubular epithelial cells, they slough off then cause obstruction which causes the back up. The filtrates in urine will go into intersistial space and get can cause damage.
  39. How do you manage Acute Renal Failure?
    • ID and correct cause!
    • Prevent, meds (change abx), monitor nutrition (↓proteins) dialysis
  40. Chronic kidney failure is a GFR less than ____ for 3M or longer
    60ml/min (defined by kidney damage)
  41. TRUE or FALSE.
    Irreversible damage can be found with chronic renal failure.
    TRUE!
  42. How do you treat chronic renal failure?
    • Prevent or slow the rate of nephron destruction. 
    • Treat UTI, anti-HTN therapy, stop smoking
    • Dialysis or transplant
  43. What is common cause of Chronic renal failure in kids under the age of 5yr?
    result of congenital malformations (renal dysplasia or obstructive uropathy)
  44. What is the common cause of renal failure in kids over the age of 5yr?
    • Acquired disease (glomerulonephritis)
    • inherited disorders predominate (familial nephronophthsis)
  45. What are some problems kids with chronic renal failure have (as opposed to adults)?
    Growth impairment, developmental delay, delay in sexual maturation, bone abnormalities, & development of psychosocial problems.
  46. Nephrotic syndrome is an increase in ____ ____.
    Glomerular permeability. (allows proteins to fit through)
  47. What are the characteristics of nephrotic syndrome?
    • proteinuria
    • hypoalbuminemia
    • hyperlipidemia (liver compensating for low protein)
    • Generalized edema (hallmark)
  48. Primary causes of nephrotic syndrom are found in _____. While secondary causes of nephrotic syndrome (DM, malignancy) are found in ____.
    • Children.
    • Adults
  49. The pathogenesis for Acute and chronic glomerulonephritis are the same. What is it?
    Glomerular injury from antigen-antibody complexes. They cause inflammation damage, leukocytes, fibrin, lysosomal enzymes, and damage to membrane permeability.
  50. In acute glomerulonephritis, what is the usual cause and s/s?
    • Cause: Group a post-streptococcal infection (can have 100% recovery)
    • S/S last 10-21 days:
    •    hematuria
    •    proteinuria
    •    ↓GFR
    •    Edema
    •    HTN
    •    Oliguria
  51. What is the usual cause of chronic glomerulonephritis?
    • Progessive course leading to CRF.
    • (DM, HTN, Chol) Tubular dilation and atrophy.
  52. Glomerulonephritis vs nephrotic sydrome
    • GN: more blood in urine
    • NS: protein!
    • GN pt usually older than in nephrotic
  53. Vesicoureteral reflux is usually caused by ___ ____.
    structural compromise. Seen in people w/repeat UTI
  54. TRUE or FALSE
    Vesicoureteral reflux is more common in kids.
    TRUE
  55. What is the treatment of Vesicoureteral reflux?
    Antibiotics. If severe, pt may need surgery. Could lead to renal failure.
  56. What

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