הערכת המטופל עם בעייה כלייתית

homeostasis

the main job the renal system is to maintain ____

retroperitoneum in the area of vertebrae T12-L3

location of the kidneys

lower

the right kidney is ______ than the left

renal capsule

a fibrous layer surrounding the kidney that contains blood and lymph vessels

adrenal gland

gland located on top of each kidney

renal capsule

is innervated by nerve ends. All of the pain receptors in the kidney are located here, so any stress to this area will cause a lot of pain

renal pyramids, papilla, minor calyx, major calyx, renal pelvis, ureter, bladder

path of the filtrate/urine through the kidney to the bladder starting from the renal medulla

minor calyx

after the filtrate passes through this point it is considered urine

renal cortex

area of the kidney where the nephrons are located

20-25%

how much of the cardiac output do the kidneys recieve

renal hilum

medial area of the kidney that through it the renal artery enters the kidney and the renal vein exits

peritubular capillaries

capillaries that surround the cortical nephrons and parts of the juxtamedullary nephrons located in the cortex

vasa recta

capillaries that surround the tubules of the juxtamedullary nephrons

10-20%

a kidney transplant will only be necessary if the amount of working nephrons decreases to below _________

juxtamedullary nephrons

nephrons that have very long loops of Henle that go deep into the medulla until they are at the same level as the collecting ducts. Their length is directly proportional to the ability to concentrate urine

glomerulus

part of the nephron responsible for filtration

tubules

part of the nephron responsible for moving the filtrate through the kidney to the renal pelvis while it undergoes changes to its concentration and make up.

bowman's capsule

epithelial structure that surrounds the glomerulus

fenestrated endothelium, basement membrane, slit diaphragm and podocytes

layers of the glomerular membrane that help with filtration

oncotic pressure

a type of osmatic pressure that is activated by proteins. It is against filtration so a higher protein level will decrease the GFR

juxtaglomerular complex

complex next to the glomerulus that contains cells sensitive to blood flow and that produce renin

macula densa cells

cells that are sensitive to changes in blood pressure and volume that cause renin release

urothelium and smooth muscles

layers of the ureter

urothelium

layer of epithelial cells in the ureter that allow for changes to the make up of the urine

transitional cell epithelium

another name for urothelium

glomerular filtration, reabsorption, secretion

three processes that help the kidney create urine

sodium/glucose transporter (SGLT)

through what transporter is glucose reabsorbed from the filtrate into the blood stream

220mg/dl

what is the transport maximum of glucoset

transport maximum

the amount of glucose the SGLT can handle to reabsorb. If there is more than this amount there won't be any receptors available for the glucose and it will excreted in the urine

SGLT 2 inhibitor

drug administered to cause glycosuria in diabetic patients in order to lower the amount of glucose in the blood stream. It was also found to lower mortality rates in heart disease

low molecular weight proteins

which type of proteins is it ok to find in the urine in small amounts

150mg/dl

up until what amount is considered regular levels of protein in the urine

30mg/dl

albumin levels in the urine are considered normal up until what amount?

microalbuminuria

urine albumin levels between 30-300mg/dl

macroalbuminuria

urine albumin levels above 300mg/dl

1000-1300ml/min

regular renal blood flow

PCT

most reabsorption in the nephron occurs where?

ADH

a hormone that concentrates the urine (and in extremely high levels can cause vasoconstriction)

vasopressin

another name for ADH

posterior pituitary gland

where is ADH secreted from

oxytocin

also secreted from the posterior pituitary gland. It is similar to ADH and so they are able to bind to each others receptors

decreased water intake

will cause osmolarity to increase, increase in ADH secretion, increase in concentrated urine

increased water intake

will call osmolarity to decrease, decrease in ADH secretion, increase in diluted urine

AQP2

which channels does ADH open when it is secreted causing the reabsorption of water into the blood stream

sodium

ADH doesn't cause an increase in blood pressure because it only causes water reabsorption and not also _____

renin

secreted from the macula densa cells. it is sensitive to low blood pressure and filtrate pressure

vasoconstriction and aldosterone secretion

2 main roles of angiotensin II

aldosterone

causes the opening of ENaC which leads to an increase in sodium reabsorption and an increase in blood pressure

Epithelial Sodium channels

ENaC

sodium, potassium and hydrogen

aldosterone secretion causes _____ ions to reenter the blood stream and ________ ions to enter the filtrate

severe hypertension, hypokalemia, metabolic alkalosis

signs of hyperaldosteronism

7.35-7.45

pH of blood

reabsorption of bicarbonate and secretion of hydrogen ions

how does the kidney regulate the acid/base balance

carbonic acid, water and CO2, lungs

when HCO3- is reabsorbed it will combine with the free H ions to form _______, which will then break into __________, the CO2 will then leave through the _______

respiratory acidosis

a patient with a lung problem that causes a build of CO2 will cause creation of carbonic acid that will break up into H2CO3 and H ions. The increase in H ions will cause ________

metabolic acidosis

if the kidneys don't keep bicarbonate levels up to normal, the increase in H ions will cause ________

ammonia

acts as a buffer by binding to H ions secreted in the urine to prevent the urine from being acidic

creatinine

used to measure GFR because it undergoes filtration but not reabsorption. (it is however secreted)

inulin

the gold standard for measuring GFR because when injected into the body it undergoes filtration in the kidney but not reabsorption or secretion

GFR

[volume of urine in 24 hours (ml/min) x urine creatinine levels (ml/dl) / serum creatinine (mg/dl)]

estimated GFR

[{(140-age) x (weight in kg)} / 72 x serum creatinine] x (x0.85 if female)

erythropoietin

secreted by the kidney when oxygen levels are low in order to increase RBC production

liver, kidney

vitamin D must undergo hydroxilization 2 times. the first time in the _________, and the second in the ______

calcium and phosphorus

vitamin D is responsible for the absorption of ________ in the digestive system

efferent, afferent

GFR will increase if the _______ arteriole is constricted and the _______ arteriole is dilated

prostaglandins

in charge of dilating the afferent arteriole to increase the GFR

Angiotensin II

responsible for constricting the efferent arteriole to increase GFR

NSAIDs

prevent creation of prostaglandins and cause a decrease in the GFR and interglomerular pressure

ACE inhibitors

prevent the creation of Angiotensin II and cause a decrease in the GFR and interglomerular pressure

proteinuria

in patients who have kidney failure and ________ you give ACE inhibitors despite the fact that it will decrease the GFR because in the long run it will improve mortality rates

urea

main waste product of proteins it must be excreted in the urine

uric acid

main waste product of purines. it is secreted in the urine

BUN

measurement of how many molecules of nitrogen are bonded to the urea. It is usually double the amount of the urea levels

30, 10%

from age ____ the average GFR of the patient decreases by _______ every 10 years

anamnesis

the first thing that is done when performing an assessment

כאב מותני

pain that mainly originates from the kidneys or ureters

suprapubic pain

pain that mainly originates from the bladder (can be because of urine retention, cystitis, growth)

cystitis

inflammation of the bladder

rectal pain

pain that is usually a sign of a prostate problem (such as prostatic cancer, prostatitis, BPH)

urethral pain

this pain is mainly caused by an STD or trauma

polycystic kidney disease

development of cysts in the kidneys with age. It is very easy to feel the kidneys in this situation

costovertebral angle

percussion of the kidneys is done by hitting the back at the ___________. you hit your own hand which is on the patient's back and not the patient directly

hyperaldosteronism

renal artery stenosis can lead to the development of

globus

a persistent or intermittent non-painful sensation of a lump or foreign body in the abdominal area by the midline (by the bladder)

bladder

all elderly male that complain about restlessness you should check if there is a problem with their ______

over 50%

the creatinine levels will not severely increase unless there is a loss of _______ of kidney function

malnutrition or severe liver damage

low BUN levels can be a sign of

causes of high BUN levels

chemotherapy, steroids, streneous physical activity, bleed in the upper digestive tract

upper digestive tract

if there is a bleed from an unknown source but the BUN levels are high and not in a proportionate level to creatinine. Then you should suspect that the source of the bleed is _________

clear

urine of this color can be because of diluted urine because of diuretics usage, excess fluids, glycosuria, alcohol addiction

yellow to milky white

urine of this color can be because of pyuria or infection

pyuria

when there is pus in the urine

pink to red

urine of this color can be a sign of hemolysis, hemoglobinuria, hematuria, period, or drugs such as rifampin and phenytoin

blue to greenish blue

urine of this color could be a sign of infection by the pseudomonas bacteria, or drugs such as amitriptyline

orange

urine of this color could be a sign of concentrated urine in response to dehydration, bilirubinuria, or drugs such as phenazopyridine and nitrofurontoin

brown

urine of this color could be a sign of very concentrated urine, old RBCs, porphyrin, or drugs such as iron, metronidazole, and quinine

hematuria

level higher than 3RBC/ high power field in the urine

causes of hematuria

urethritis, cystitis, prostatitis, kidney stones, tumors, systemic diseases, heparin, codomain

proteinuria

levels of protein in the urine above 150mg/dl

albumin

a dipstick urine test mainly shows levels of ______ in the urine