NURS 337: Exam #4 - Diseases of the Kidneys/Acid-Base Disorders (FINAL)

What filters and clean the blood of toxic build up?

Kidneys

What organ makes urine?

Kidneys

What type of substances are balanced with the kidneys?

Salts and minerals

What do kidneys maintain?

Blood pressure and blood volume

What type of vitamin does the kidney produce?

Vitamin D

What type of hormone does the the kidney produce?

Erythropoetin

Kidneys are associated with plasma pH balance (T/F)?

True

What disease in the kidneys is called when there is a problem with filtering?

Glomerular disease

What are other things associated with the failure of kidneys?

- Blood vessels

- Trauma

- Urine backup

What is the decreased urine production (less than 500 mL/day)?

Oliguria

What is the absence of urine production (less than 50 mL/day)?

Anuria

What is the excess of nitrogenous product of protein metabolism in the blood (increased blood urea nitrogen) - BUN?

Azotemia

What is the Blood Urea Nitrogen level in Azotemia?

7 - 20 mg/dL

What is the increase level of urea in the blood?

Uremia

What is the "normal" creatinine level?

0.6 - 1.3 mg/dL

"Normal" Creatinine levels are dependent on?

Muscle Mass

"Normal" Creatinine levels are falsely?

Elevated on medications

What are one of the glomerular disorders?

Glomerulonephritis

What is the inflammation of the glomerulus?

Glomerulonephritis

What is primary glomerulonephritis?

Isolated to the kidney

What is secondary glomerulonephritis?

Caused by a systemic disease

What are the immune mechanisms of glomerulonephritis?

The main etiology for primary and secondary injury

What is another name for acute post streptococcal glomerulonephritis?

Archetype

What type of antibodies are present in glomerulonephritis?

Antistreptococcal antibodies

Glomerulonephritis forms a?

Antigen-antibody complex

What type of system does glomerulonephritis activate?

Complement system

What part of the kidney does glomerulonephritis have a inflammatory response to?

Glomeruli

What is increased in during the inflammatory response in glomerulonephritis?

Increased capillary permeability leakage of protein and erythrocytes

The pathophysiology of glomerular disorders has to do with congestion and cell proliferation? (T/F)

True

What is decreased in glomerulonephritis?

Decreased GFR retention of fluid and wastes

What are the two major manifestations of glomerulonephritis?

- Hematuria

- Proteinuria

What is a red blood cells casts (dark urine)

Hematuria

Exceeding 3 to 5 g/day with albumin (macroalbuminuria) as the major protein?

Proteinuria

What are the other manifestations of glomerulonephritis?

- Oliguria

- Hypertension

- Edema

- Metabolic acidosis

- Flank or back pain

- General signs of inflammation

What is associated with glomerulonephritis edema?

Generalized, facial, periorbital

What is associated with flank or back pain in glomerulonephritis?

Edema and stretching of renal capsule

What are the evaluation tests used to screen for glomerulonephritis?

- Blood tests

- Urinalysis

What do the blood tests in glomerulonephritis show?

- Elevated serum urea and creatinine levels

- Elevation of anti-DNase B, streptococcal antibodies, anti-streptolysin, antistreptokinase

- Complement levels decreased (use in renal inflammation)

What do the urinalysis in glomerulonephritis show?

- Proteinuria

- Hematuria

- Erythrocyte casts

- No evidence of infection

What are the general treatment for glomerulonephritis?

- Low sodium diet

- Protein and fluid intake decreased in severe cases

What are the drug treatments for glomerulonephritis?

- Glucocorticoids (prednisone)

- Antihypertensives

- Antibiotics

What is caused by glomerular injury/damage? (non-immune/non-inflammatory)

Nephrotic Syndrome

What happens during loss of proteins in nephrotic syndrome?

- Proteinuria

- Hypoalbumineia

What are the values in nephrotic syndrome for proteinuria?

Greater than 3.5 g/day

What are the values in nephrotic syndrome for hypoalbumineia?

Less than 3.5 g/dL

Hyperlipidemia and lipiduria?

Nephrotic Syndrome

There is edema in Nephrotic Syndrome (T/F)?

True

What type of deficiency is in Nephrotic Syndrome?

Vitamin D

There is hypercalcemia in Nephrotic syndrome?

False, hypocalcemia

What syndrome is associated with hematuria with dysmorphi red blood cells?

Nephritic Syndrome

There is red blood cells casts in nephritic syndrome?

True

Hypertension is another symptom of nephritic syndrome?

True

Azotemia is part of nephritic syndrome?

True

Oliguria is seen in nephritic syndrome?

True

What are the values of variable proteinuria in nephritic syndrome?

Usually less than 3g/day

What is the sudden/abrupt (within hours) decline in kidney function that encompasses both injury (structural damage) and impairment (loss of function)?

Acute kidney injury

There is a decrease in glomerular filtration and urine output?

Acute kidney injury

There is a accumulation of nitrogenous waste products in blood?

Acute kidney injury

What is the prognosis of acute kidney injury?

- Renal insufficiency

- Renal failure

- End of stage kidney disease

What is the renal blood flow and glomerular filtration rate - held constant?

Autoregulation in Acute Kidney Injury

When there is a decrease in perfusion in acute kidney injury what happens?

- Dilate afferent arteriole

- Constrict efferent arteriole

Afferent dilation in acute kidney injury is mediated by?

Prostaglandins

Efferent constriction in acute kidney injury is affected by?

Angiotensin II

What are the 3 types of acute kidney injury?

- Prerenal

- Intrarenal

- Post Renal

What happens if there is a sudden/severe decrease in renal perfusion in acute kidney injury?

- Sudden decrease glomerular filtration rate

- Renal injury

What is the most common cause of acute kidney injury?

Prerenal

What is the etiology of prerenal acute kidney injury?

Impaired blood flow

What is decreased in prerenal acute kidney injury?

- Intravascular fluid volume (burn, diarrhea)

- Cardiac output (MI, IHD, CHF)

There is a renal artery occlusion in prerenal acute kidney injury?

True

There is a renal vasoconstriction in prerenal acute kidney injury?

True

What happens if the GFR declines in prerenal acute kidney injury?

Decreases in filtration pressure

What is the most common cause of acute tubular necrosis?

Intrarenal - Acute Kidney injury

What are the drugs that cause disease in Intrarenal Acute Kidney Injury?

- Aminoglycosides

- Amphotericin-B

- Chemo agent

What metals that cause disease in intrarenal acute kidney injury?

Lead and aluminum

There is post ischemic events in acute kidney injury?

Yes

What is the urinary tract obstruction?

Post-renal in acute kidney injury

What is the interference with flow or urine at any site along the urinary tract?

Urinary tract obstruction seen in post renal

What are the causes of disease in post renal acute kidney injury?

- Kidney stones

- Prostate enlargement

- Compressive

- Tumor

What is the progressive loss of renal function that affects nearly all organ systems?

Chronic Kidney Disease (CKD)

What is the cause of disease in chronic kidney disease?

Diabetes type I and II, hypertension, intrinsic kidney disease

How do we diagnose chronic kidney disease?

GFR is less than 60 mL/min x 3 months

What are the imbalances in chronic kidney disease?

Fluid and electrolyte (sodium) imbalance

In chronic kidney disease sodium excretion increases what happens?

Sodium deficit and volume loss

When the sodium excretion increases in chronic kidney disease what happens to the concentration and dilution ability?

It diminishes

What happens if there is a potassium imbalance in chronic kidney disease?

- Hypokalemia early

- Late + oliguria -> hyperkalemia

There will be metabolic acidosis when GFR is at what percentage in chronic kidney disease?

Less than 30%

There is a decreased Vitamin D in chronic kidney disease?

Yes!

There is hypocalemia in chronic kidney disease?

Yes

What causes anemia of chronic disease in chronic kidney disease?

Low erythropoietin

How do we treat chronic kidney disease?

Manage underlying causes

Patients with chronic kidney disease with diabetic mellitus how do we treat their condition?

Improve glucose control will improve major kidney outcomes in Type II diabetes

How do we manage patient's blood pressure with hypertension in chronic kidney disease?

Keep blood pressure less than 130/80 mmHg = critical

What is a drug used to treat for hypertension in chronic kidney disease?

- Angiotensin converting enzyme inhibitor (ACE) - lisinopril

- Angiotensin II receptor (ARB)

What are other treatments used for chronic kidney disease?

- Dialysis

- Transplant

What is carefully regulated via multiple mechanics, and small changes significantly alter biological processes?

Acid-base

pH of 7.4 (7.35-7.45)?

Neutral for biological fluids

An increase in [H+] causes

the pH is low (acidic: pH < 7.35)

A decrease in [H+] causes

the pH is high (alkaline: pH > 7.45)

Blood, good buffer, and proteins have negative changes?

Acid-base

What organs are mainly affected with acid-base?

- Respiratory (lungs)

- Kidneys