Patho Ch _____ - Renal/Urinary

Pathophysiology Chapter _____ - Alterations in Renal and Urinary Function

filter and clean blood of toxin build-up, make urine, keep salt and minerals balanced, maintain blood pressure and blood volume, vitamin D production, hormone production (erythropoietin), and plasma pH balance are all functions belonging to which organ?

kdineys

the _____ are the only organs in the body that can directly remove acids from the blood

kidneys

what structure is described as the “filter” of the kidney?

glomerulus

the filters of the kidney (glomerular disease), the blood vessels, trauma, and urine backup are all mechanisms that can cause _____

kidney failure

a condition characterized by a decrease in urine production (less than 500 mL/day) - not an acute process, chronic/consistent condition

oliguria

oliguria is characterized by what urine production level?

less than 500mL/day

the absence of urine production (less than 50 mL/day, or typically none)

anuria

anuria is characterized by what urine production level?

less than 50mL/day

condition characterized by the excess of nitrogenous product of protein metabolism in the blood (high blood urea nitrogen [BUN])

azotemia

what is the normal range for blood urea nitrogen (BUN)

7-20mg/dL

a blood test measuring levels of blood urea nitrogen (BUN), creatinine, potassium, carbon dioxide (bicarbonate), sodium, chloride, and glucose is referred to as:

chem-7/sma-7/metabolic panel

increased levels of urea in the blood

uremia

what is the normal creatinine level?

0.6 - 1.3mg/dL

what are the two pitfalls to keep in mind when assessing blood creatinine levels?

dependent on muscle mass, can be elevated by certain medications

what two blood lab tests are used to measure kidney function?

BUN and creatinine

both primary and secondary causes of glomerulonephritis are a result of an _____ component leading to inflammation (inflammatory response)

immune

primary glomerulonephritis is inflammation of the glomeruli that is characterized by:

being limited to the kidneys

secondary glomerulonephritis is inflammation of the glomeruli that is characterized by:

being caused by systemic disease

immune mechanisms (the inflammatory response) are the main etiology for: primary or secondary glomerulonephritis?

both

glomerulonephritis caused by a streptococcal infection

acute post-streptococcal glomerulonephritis

what causes glomerulonephritis in the case of acute post-streptococcal glomerulonephritis?

antigen-producing bacterial cell wall

what substances should never be present in the urine under normal conditions?

blood and protein

if protein is present in the urine, the problem is always going to be at the _____

glomerulus

hematuria with red blood cell casts (dark urine), proteinuria exceeding 3 - 5g/day with albumin (macroalbuminuria) as the major protein, oliguria, hypertension, edema, metabolic acidosis, flank or back pain, general signs of inflammation - these are clinical manifestations of which condition?

glomerulonephritis

what kind of urinary cast is caused by chronic renal failure?

broad or waxy cast

what kind of urinary cast is caused by chronic renal failure due to acute tubular necrosis (ATN)?

granular cast

what kind of urinary cast is caused by interstitial nephritis or pyelonephritis?

WBC cast

what kind of urinary cast is caused by exercise, diuretics, and concentrated urine?

hyaline cast

what kind of urinary cast is caused by nephrotic syndrome?

fatty cast

what kind of urinary cast is caused by acute tubular necrosis (ATN)?

renal tubular epithelial cell cast

what kind of urinary cast is caused by glomerulonephritis?

RBC cast

low sodium diet, protein and fluid intake decrease for severe cases, and drug treatment (glucocorticoids, antihypertensives, antibiotics) are treatments for what condition?

glomerulonephritis

what is the drug of choice for treating glomerulonephritis?

glucocorticoids

what are the two types of presentations for patients with glomerulonephritis?

nephrotic and nephritic

nephrotic vs nephritic syndrome: glomerular injury/damage (non-immune/non-inflammatory), protein loss/proteinuria (more than 3.5g/day), hypoalbuminemia, hyperlipidemia and lipiduria, edema, vitamin D deficiency, and hypocalcemia - characterizes which one?

nephrotic

nephrotic vs nephritic syndrome: inflammation of the glomeruli, hematuria (dysmorphic RBC’s), RBC casts, azotemia, hypertension, oliguria, variable proteinuria (usually less than 3g/day) - characterizes which one?

nephritic

what is the main difference between nephrotic syndrome and nephritic syndrome?

the amount of protein loss (nephrotic has more)

nephrotic vs nephritic syndrome: which one is characterized by mass protein loss (proteinuria)? (this is due to damage to the glomerulus causing gaps in the filtration)

nephrotic

the liver is the organ that primarily creates proteins. in nephrotic syndrome, massive proteinuria & hypoalbuminemia causes the liver to overcompensate by creating _____. this is why _____ and _____ is observed in nephrotic syndrome.

lipoproteins, hyperlipidemia, hyperlipiduria

which organ in the body primarily produces proteins?

liver

nephrotic vs nephritic syndrome: hematuria with red blood cell casts characterizes which one? (this is due to inflammation)

nephritic

why is nephritic syndrome characterized by hematuria with blood cell casts?

inflammation

why is nephrotic syndrome characterized by mass protein loss (proteinuria)?

damage to glomerulus causes gaps in the filter

a condition characterized by a sudden/abrupt (within hours) decline in kidney function that encompasses both injury (structural damage) and impairment (loss of function)

acute kidney injury (aka acute renal failure)

about what percentage of patients who experience acute kidney injury (aka acute renal failure) will progress to renal insufficiency (most commonly), renal failure, or end stage kidney disease (aka end-stage renal failure)?

5%

afferent arteriole dilation is mediated by _____

prostaglandins

efferent arteriole dilation is mediated by _____

angiotensin II

sudden/severe decrease in renal perfusion → sudden decrease in glomerular filtration rate → renal injury - pathophysiology of which condition?

acute renal injury (aka acute renal failure)

mechanisms of oliguria in acute kidney injury: pre-renal causes are going to involve the _____

blood flow

mechanisms of oliguria in acute kidney injury: intra-renal causes are going to involve the _____

kidneys

mechanisms of oliguria in acute kidney injury: post-renal causes are going to involve _____

an obstruction of urine outflow

what is the most common cause of acute kidney injury (aka acute kidney failure)?

impaired renal blood flow

what is the most common cause of pre-renal acute kidney injury?

impaired renal blood flow

decreased intravascular fluid volume (burn, diarrhea), decreased cardiac output (MI, IHD, CHF), renal artery occlusion, and renal vasoconstriction are all examples of _____ causes of acute renal

pre-renal

glomerular filtration rate (GFR) declines because of the decrease in filtration pressure - this is the mechanism of a _____ cause of acute kidney injury

pre-renal

what is the most common cause of an intra-renal acute kidney injury?

acute tubular necrosis (ATN)

which etiology of acute renal injury can be caused by nephrotoxin (due to drugs [aminoglycosides, amphotericin-B, chemo-agent], metals [lead, aluminum] or contrast) or post-ischemic events?

intra-renal

what is the most common cause of a post-renal acute kidney injury?

urinary tract obstruction

kidney stones, prostate enlargement, compressive, or tumor - all examples of causes of _____ type of acute kidney injury

post-renal

what is the most common cause of chronic kidney disease (CKD)?

diabetes and hypertension

diabetes I and II, hypertension, and intrinsic kidney disease are conditions that may cause _____

chronic kidney disease (CKD)

a condition characterized by a progressive loss of renal function that affects nearly all organ systems

chronic kidney disease (CKD)

what is the diagnostic criteria for chronic kidney disease (CKD)?

GFR less than 60mL/min for 3 months

stages of chronic kidney disease (CKD): stage 1 GFR =

equal to or more than 90

stages of chronic kidney disease (CKD): GFR equal to or more than 90mL/min indicates which stage

1

stages of chronic kidney disease (CKD): stage 2 GFR =

60-89

stages of chronic kidney disease (CKD): GFR of 60-89mL/min indicates what stage

2

stages of chronic kidney disease (CKD): stage 3 GFR =

30-59

stages of chronic kidney disease (CKD): GFR of 30-59mL/min indicates what stage

3

stages of chronic kidney disease (CKD): stage 4 GFR =

15-29

stages of chronic kidney disease (CKD): GFR of 15-29mL/min indicates what stage?

4

stages of chronic kidney disease (CKD): stage 5 GFR =

less than 15

stages of chronic kidney disease (CKD): GFR of less than 15mL/min indicates what stage?

5

which stage of chronic kidney disease is considered kidney failure and requires the patient to be dialyzed or receive a transplant?

5

stages of chronic kidney disease (CKD): progression from stage 1 to stage 3 = _____, and progression from stage 3 to stage 5 = _____

may take years, rapid; months

what is the GFR for a normal, healthy individual? (note: in reality it is more like 110-115 max)

125

hypertension causes chronic kidney disease (CKD) over time by causing _____, which leads to loss of _____ (remember: hypertension = systemic blood vessel damage)

renal scarring, nephrons

fluid and electrolyte imbalance, metabolic acidosis (due to hydrogen ion retention), decreased vitamin D, hypocalcemia, anemia of chronic disease (due to low erythropoietin), ‘red eye’, lethargy/seizures/coma (due to electrolyte imbalance), urea crystals causing itchiness (pruritic excoriations), bone pain (due to hypocalcemia), muscle breakdown, amenorrhea, infertility, impotence, edema, anorexia/nausea/vomiting - clinical manifestations of what condition?

chronic kidney disease (CKD)

what is the drug of choice for treating a patient who has chronic kidney disease with hypertension?

ACE inhibitor - Lisinopril

what are the treatments for chronic kidney disease (CKD)?

treat underlying disease, dialysis, or transplant

normal pH level:

7.4 (7.35-7.45)

an increase in hydrogen (H+) causes _____

low pH (acidic)

low/acidic pH level:

less than 7.35

a decrease in hydrogen (H+) causes _____

high pH (alkaline/basic)

alkaline/basic/high pH level:

more than 7.45

proteins have _____ charges.

negative

what are the two organs that remove acids from the blood and control blood pH?

kidneys and lungs

systemic increase in hydrogen (H+) concentration or a decrease in bicarbonate results in:

acidosis

systemic decrease in hydrogen (H+) concentration or an increase in bicarbonate results in:

alkalosis

decrease in the blood pH results in:

acidemia

increase in the blood pH results in:

alkalemia

“elevation of pCO2 as a result of ventilation depression” defines:

respiratory acidosis

“lowered pCO2 as a result of alveolar hyperventilation” defines:

respiratory alkalosis

“reduced HCO3 or an increase in non-carbonic acids” defines:

metabolic acidosis

“increased HCO3 usually caused by an excessive loss of acids” defines:

metabolic alkalosis

normal blood PO2 (oxygen) levels:

less than 80 mmHg

normal blood PCO2 (carbon dioxide) levels:

40 mmHg (35-45)

normal blood HCO3 (bicarbonate ion) levels:

24 mEq/L (22-26)

normal blood oxygen saturation levels:

95-100%

what are the 4 total kinds of acid-base disturbances?

respiratory acidosis/alkalosis and metabolic acidosis/alkalosis