Nurs 337 - Exam 4 (Nephrology & Acid-Base Balance)

What are the 3 Major Kidney Topics to Know From This Lecture?

1) Glomerulonephritis
2) Acute Kidney Injury
3) Chronic Kidney Disease

What are 7 Functions of the Kidneys?

1) Filter the blood

2) Make urine

3) Maintain salt/mineral balance

4) Maintain plasma pH balance

5) Maintain blood pressure & volume

6) Vitamin D production

7) Hormone production (Erythropoietin)

What are 4 Structures that Can Cause Kidney Failure?

1) the filters (glomerular disease)

2) the blood vessels

3) urine backup

4) trauma

What is Pyelonephritis?

What is Pyelonephritis?

Define Oliguria?

decreased urine production (less than 500 mL/day)

Define Anuria?

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

Define Azotemia. What Causes It? What Lab Test Will Be High?

Azotemia: excess of nitrogenous product (urea/creatinine) in the blood (due to protein metabolism)

Lab: elevated levels of Blood Urea Nitrogen (BUN)

What are 2 Examples of Nitrogenous Products in the Blood?

What are 3 Steps Associated w/ Glomerulus Filtration?

1) Filtration
2) Reabsorption
3) Secretion

What is Glomerulonephritis?

inflammation of the glomerulus

What is the Most Common Pathogenesis of Glomerulonephritis?

an immune response w/ inflammation (Type III hypersensitivity reaction: accumulation of antigen-antibody complexes in glomeruli)

What are 2 Types of Glomerulonephritis? Describe Each

1) Primary (isolated to the kidney)

2) Secondary (caused by systemic disease)

What Test Would Need to Be Performed to Distinguish Between Primary & Secondary Glomerulonephritis?

a biopsy

What are 7 Signs of Glomerulonephritis? What are 2 Major Signs?

1) Hematuria (w/ red blood cell casts)

2) Proteinuria (excess protein in urine) (albumin = major protein)

3) Oliguria (decreased urine production = less than 500 mL/day)

4) Hypertension

5) Edema (general, facial, periorbital)

6) Flank or Back Pain (due to edema & stretching of renal capsule)

7) General signs of inflammation

What Causes the Edema Associated with Glomerulonephritis? Why?

proteinuria (more protein lost in urine → low protein in blood → water leaves blood to interstitial space where more protein is → edema)

What is a Common Type of Glomerulonephritis?

acute poststreptococcal glomerulonephritis

Explain the Pathophysiology Behind Glomerulonephritis?

antigen-antibody complexes are deposited in glomerular capillaries → activates complement system → inflammatory response in glomeruli

What are 3 Results of the Inflammatory Response in the Glomeruli? Describe Each

1) Increased capillary permeability (allows leakage of RBCs & protein into urine)

2) Congestion & Cell Proliferation

3) Decreased GFR (causes fluid & waste retention in blood)

What Will the Presence of Casts in the Urine Tell You?

that the glomeruli are damaged, and not another part of the urinary tract

What are 7 Types of Urinary Casts? Describe Each

1) Renal Tubular Epithelial Cell Cast (acute tubular necrosis)

2) Broad/Waxy Cast (chronic renal failure)

3) Granular Cast (chronic renal failure)

4) Hyaline Cast (exercise/diuretics/concentrated urine)

5) Fatty Cast (nephrotic syndrome)

6) WBC Cast (interstitial nephritis/pyelonephritis)

7) RBC Cast (glomerulonephritis)

What are 3 Types of Diagnostics Used to Detect Glomerulonephritis?

1) Blood tests
2) Urinalysis
3) Check for Metabolic Acidosis

Name 3 Specific Blood Tests Used for Glomerulonephritis

1) elevated serum urea & creatinine levels

2) elevation of anti-DNase, streptococcal antibodies, anti-streptolysin, or anti-streptokinase

3) complement levels are decreased (used in renal inflammation)

What are 2 Things That Will Be Seen in a Urinalysis for Glomerulonephritis? What is 1 Thing That Will NOT Be Seen?

Will Be Seen: 1) proteinuria. 2) hematuria w/ RBC casts

Won't Be Seen: infection

What are 5 Treatments Used for Glomerulonephritis?

1) Sodium restriction

2) fluid restriction

3) protein restriction

4) glucocorticoids/corticosteroids (reduce inflammation)

5) antihypertensive meds

Which Corticosteroid is the Drug
of Choice for Glomerulonephritis?

prednisone

What are 2 Different Clinical Presentations of Glomerulonephritis?

1) Nephrotic syndrome
2) Nephritic syndrome

What Causes Nephrotic Syndrome?

glomerular damage without immune response or inflammation

What Causes Nephritic Syndrome?

glomerular damage due to immune (antigen-antibody) complex deposition in glomeruli with inflammation

What is the Most Common Specific Cause of Nephritic Syndrome?

Berger's disease (IgA neuropathy)

What are 6 Signs of Nephrotic Syndrome? What is a Hallmark Sign?

1) massive proteinuria (more than 3g/day)

2) hypoalbuminemia (low albumin in blood because its being lost in the urine)

3) hypocalcemia (low calcium in blood because less albumin to bind to it)

4) hyperlipidemia (high lipids in blood) & lipiduria (high lipids in urine)

5) peripheral edema

6) vitamin D deficiency

What are 5 Signs of Nephritic Syndrome? What is a Hallmark Sign?

1) hematuria w/ RBC casts (blood/RBCs in urine)

2) proteinuria (less than 3g/day)

3) oliguria (decreased urine production)

4) hypertension

5) azotemia (elevated amount of nitrogenous substances in blood, like urea/creatinine)

T/F: Acute Renal Failure is the currently accepted term

false, it is now called acute kidney injury

What is Acute Kidney Injury?

a sudden (within hours) decline in kidney function that includes both structural damage and loss of function

What are 3 Effects of Acute Kidney Injury

1) decrease in GFR
2) oliguria
3) azotemia

What are 3 Prognoses for Acute Kidney Injury?

1) renal insufficiency
2) renal failure
3) end-stage kidney disease

What are 3 Categories of Acute Kidney Injury? What are the Causes of Each?

1) Pre-renal: decreased renal blood flow

2) Intra-renal: renal tubular injury; intratubular obstruction

3) Post-renal: obstruction to urine flow after kidneys

What is the Most Common Cause of Acute Kidney Injury? (pre, intra, or post-renal)

decreased renal blood flow (pre-renal)

What are 4 Causes of Decreased Renal Blood Flow?

1) hypovolemia (low blood volume)

2) decreased cardiac output

3) renal artery occlusion

4) renal vasoconstriction

What is the Most Common Cause of Intra-renal Acute Kidney Injury?

acute tubular necrosis

What are 2 Causes of Tubular Necrosis?

1) prolonged ischemia

2) nephrotoxins (medications, metals, contrast)

What are 3 Causes of Post-renal Acute Kidney Injury?

urinary tract obstruction

1) kidney stones

2) tumor

3) prostate enlargement

What is Autoregulation in the Kidneys?

renal blood flow & glomerular filtration rate is able to be adjusted by the kidneys themselves

What Occurs in the Arterioles When There is Low Perfusion/Blood Flow to the Glomeruli? What are They Mediated By?

Afferent Arteriole Dilation (mediated by prostaglandins)

Efferent Arteriole Constriction (mediated by angiotensin II)