Patho of Kidney Disease - Lecture 3

What organ has the fx of maintaining fluid and acid base balance, regulating electrolyte concentration, detoxifying the blood, eliminating waste, regulating BP, aiding in RBC production, and regulates vitamin D and Ca formation?

kidneys

What are the components of the renal system?

kidneys, ureters, bladder, and urethra

What are the 3 primary sections of the renal system?

cortex, medulla, and pelvis

What are the parts of the renal cortex?

glomeruli, proximal tubules, renal corpuscles

What are the parts of the renal medulla?

pyramids, distal tubules, collecting ducts

What are the parts of the renal pelvis?

urine collection, start of ureter

What is the function role of the kidney that filters substances from the blood, reabsorb filtered nutrients and water, and secrete waste?

nephron

What labs are elevated if kidneys aren’t working well?

creatinine and BUN

What part of the nephron is that filters when the blood enters and squeezes out water, creatinine, electrolytes, and more but keeps body cells and proteins making filtrate?

glomerulus

What part of the nephron contains the glomerulus which hold the filtrate?

Bowman’s capsule

What part of the nephron is the site of reabsorption (pulls back into the blood) of glucose, amino acids, metabolites, electrolytes and water?

proximal tubule

What part of the nephron is the further absorption of water in the descending loop and absorption of electrolytes in the ascending limb?

loop of Henle

What type of diuretics are used in the loop of henle?

loop diuretics

What part of the nephron decides how much water and electrolytes to keep and where aldosterone starts to work?

distal tubules

What type of diuretics work in the distal tubule?

thiazide diuretics

What part of the nephron is the final place to change anything in the urine when aldosterone primarily works and ADH also works?

distal tubule

What diuretics work in the collecting tubule/duct?

Potassium sparing diuretics

What enters ureter via the renal pelvis and is propelled by the ureters into the bladder via peristalsis?

urine

What happens when the stretch receptors are activated and when a signal stimulates contraction of the detrusor muscle via parasympathetic cholinergic motor fibers, and relaxation of the internal and external urethral sphincters results in micturition?

bladder filling

When the urine is dark amber what may it indicate?

dehydration, renal and liver disease

When the urine is cloudy what may it indicate?

infection

When the urine has slight ammonia smell what may it indicate?

normal urine

What is the typical total urine volume?

750-2000 mL/day

How many mL/hr do the normal kidneys produce?

30 mL/hr

What hormone is produces by the pituitary gland and alters the collecting tubules’ permeability to water?

antidiuretic hormone (ADH)

What hormone is produced and released by the adranla cortex and regulates water reabsorption by the distal tubules, changes urines concentration by increasing sodium reabsorption, and helps control secretion of potassium by the distal tubules?

aldosterone

What hormone assists with converting vitamin D to its active form?

calcitriol

What hormone stimulates RBC production?

erythropoietin

What hormone affects the heart fx and BP by metabolizing catecholamines?

renalase

What hormone helps regulate BP through angiotensin conversion resulting vasoconstriction?

renin

What factors affect renal fx?

age, gender, muscle mass, permeability of capillary walls, vascular and filtration pressure, hydration status

What lab value is how much the glomerulus?

eGFR (glomerular filtration rate)

Why does a drop in eGFR indicate?

disease or dehydration

What lab value is thy byproduct of muscle metabolism that is supposed to be removed by the kidneys?

creatinine

What lab value is the measurement of how well kidneys removing waste and is supposed to be removed with filtration?

BUN (blood urea nitrogen)

When filtration drops what does it do to other kidney lab work?

creatinine and BUN rises

How do you preserve renal fx?

control BP and BG, stay hydrated, smoking cessation, limit alcohol and caffeine, caution with nephrotoxic drugs, renally dose meds based on kidney function

What is inflammation of the glomerulus due to injury to glomerulus triggering inflammatory reaction at the glomerulus, causing glomerular filtration membrane to be more permeable, allowing the passage or larger particles like protein or blood?

glomerulonephritis

What causes glomerulonephritis?

lupus, diabetic neuropathy, HTN, infections

What are symptoms of glomerulonephritis?

olgiuria, anuria, HTN, swelling, renal failure

What do labs look like of those with glomerulonephritis?

+protein, +hematuria, +casts on urine analysis, elevated creatinine and BUN, low GFR and protein in serum

What is treatment for glomerulonephritis?

treat cause, supportive care- low salt and phosphorus, limit nephrotoxic drugs, and maintain hydration

What is it when calculi form from substances that normally dissolve in the urine precipitate like calcium oxalate and calcium phosphate?

urolithiasis

What causes urolithiasis?

urinary stasis, dehydration, infection, elevated urinary levels of salts and minerals from pH changes, metabolic factors, and diet

What is a risk for urolithiasis?

renal tubule obstruction

What causes urolithiasis?

genetics, UTI, cystic kidney disease, diabetes, obesity, gout, hyperparathyroidism, gastric bypass

What are symptoms of urolithiasis?

severe pain and shooting in the flank area or costovertebral ang;e (CVA), hematuria

What does colic pain of urolithiasis look like?

distention of collecting system or ureter, acute, intermittent, radiating, excruciating pain, hematuria

What dose noncolic pain of urolithiasis look lke?

distention of renal calices or pelvis, dull, deep with varying intensity, hematuria

How do you diagnosis urolithiasis?

hx of pain, x-ray, CT, U/S, urinalysis, analysis or calculi composition

What can you do pharmacologically to treat urolithiasis?

analgesics, antimicrobials, diuretics

What can you do to remove calculi to treat urolithiasis?

increase fluid intake, reduction of calculi size, surgical removal, urethral stents

What can you do to prevent urolithiasis?

diet with foods low in calcium oxalate, fluids, management of gout, hyperparathyroidism

What is a sudden decline in kideny function r/t decreased blood flow, toxins, or sepsis?

acute kidney injury

What are types of AKI based on?

location

What is the common mechanism of AKI?

oliguria

What state of progression is prevention still possible in AKI?

initiating event

What phase of AKI is the oliguric phase?

maintenance phase

What phase of AKI is polyuric when recovery takes 3-12 months?

recovery phase

What type of AKI us caused by hypovolemia?

prerenal

What are symptoms of prerenal AKI?

low urine output, high urine osmolarity, low urine sodium

What type of AKI is caused by tubular necrosis, toxins like contrast media, heavy metals, myoglobin from crush injuries?

intrarenal

What are symptoms of intrarenal AKI?

low urine output, low urine osmolarity, high urine sodium

What type of AKI is caused by an obstruction in the urinary tract?

postrenal

What are symptoms of postrenal AKI?

flank pain and anuria

What supportive treatment can be done for AKI?

manage K/electrolyte levels, limit Na/P intake, balance fluid intake, avoid/reduce nephrotoxic drugs, short term dialysis in severe cases

What is progressive, irreversible loss of renal function, specifically damage to the nephrons, where they initially hypertrophy to keep up with demand?

chronic kidney disease

In chronic kidney disease they have largely normal fx until how many nerphrons are destroyed?

75% nephrons

In chronic kidney disease the sodium and water balance and the increased vascular volume causes what?

HTN

In chronic kidney disease the elimination of nitrogenous wastes cause uremia which causes what?

neuro manifestations

What causes anemia in chronic kidney disease?

EPO production

In chronic kidney disease the what causes hypocalcemia?

activation of vitamin D

What are symptoms of chronic kidney disease overall?

decreased urine, irregular pulses, fatigue, arrhythmias, sore and bleeding gums, ammonia smell to breath, brittle nails, brittle hair, flaky urea deposits, alter consciousness, muscle cramps and twitching, easy bruising and bleeding, fractures

What do blood studies of patients with chronic kidney disease look like?

low pH, bicarb, HCT, Hgb and high BUN, creatinine, sodium, potassium

What is the urine specific gravity in chronic kidney disease?

fixed at 1.010

What does a urinalysis of patients with chronic kidney disease look like?

proteinuria, glycosuria, RBSs, leukocytes, casts, crystals

What does an xray of patients with chronic kidney disease look like?

reduced kidney size

What does EEG of patients with chronic kidney disease look like?

metabolic encephalopathy

What are the symptoms of stage 1 chronic kidney disease?

none or maybe HTN

What are the symptoms of stage 2 chronic kidney disease?

subtle - HTN and increasing creatinine and urea levels

What are the symptoms of stage 3 chronic kidney disease?

mild - HTN and increasing creatinine and urea levels

What are the symptoms of stage 4 chronic kidney disease?

moderate - HTN, increasing creatinine and urea levels, EPO deficiency anemia, hyperphosphatemia, increased triglycerides, metabolic acidosis, hypercalcemia, salt/water retention

What are the symptoms of stage 5 chronic kidney disease?

severe - HTN, increasing creatinine and urea levels, EPO deficiency anemia, hyperphosphatemia, increased triglycerides, metabolic acidosis, hypercalcemia, salt/water retention

At what stage of chronic kidney disease is the pt at risk?

stage 1

At what stage of chronic kidney disease has function begun to be impaired and has been diagnosed?

stage 2

At what stage of chronic kidney disease does function show impairment?

stage 3

At what stage of chronic kidney disease does function become severely impaired?

stage 4

At what stage of chronic kidney disease does waste elimination, severely impaired, urea and creatinine levels build up in blood?

stage 5

What can you do to preserve kidney function in chronic kidney disease?

low protein intake, reduced Na/K intake, manage fluid balance

How can you treat chronic kidney disease?

dialysis and trasnplant