Human Patho Final

What is a characteristic of Acute Renal Failure?

Rapid onset - decrease in urine formation

Pre-renal acute renal failure is caused by

Imparied renal blood flow

What is NOT a category of causes for Acute Renal Failure

Hepatic-renal

A common indicator of Acute Renal Failure is

Azootemia and decreased GFR

What manifestation of chronic renal failure is directly related to the kindey inability to regulate NA+ and H20 balance

Hypertension

Chroninc renal failure is characterized by

Progessive, irreversible destruction of kindey structures

What is a treatment option for Post-renal arf

Identify and correct the underlying cause

What is a potential cause of intrrinsic or intra-renal arf

Toxic insult to tubular structures of nephron

What is a systemic effect of chronic renal failure releated to erythropoeitin production

Anemia

In Pre-renal arf, a disproportionate elevation of BUN in relation to serum creatinine levels is observed. What is the normal BUN: serum creatinine ratio

10:1

What syndrome dimishes GFRR and oliguria?

Nephritic

What syndrome has proliferation of glomerular cells

Nephritic

What syndrome leads to ECF accumulation, edema and hypertension

Nephritic

What syndrome increases in golmeular permeability

Nephrotic

What syndrome involves salt and water rentention

Nephrotic

What is the major cause of chronic kidney disease

diabetic glomerulosclerosis

With diabetic glomerulosclerosis will there be a reduced or englarged area for glomerular filtration

reduced area

When there is hypertensive glomerular diease will the blood flow to nephron increase or decrease

decrease

What does it mean by drug-related nephopathies

Exposure to high concentrations of drugs and metabolites

Stress UI

weak pelvic floor muscles cannot support the bladder

What UI is associated by loss of muscle tone due to aging, childbirths

Stress UI

What UI is triggered by coughing, sneezing, laughing and straining?

Stress UI

Overactive bladder / urge incontienence

sudden strong urge to void urine

What UI is seen in diabetes and stroke?

Overative bladder / urge incontinence

overflow incontinence

bladder cannot be emptied, overfills

What UI is seen in diabetes, prostate diseases, neurological disorders, underactive bladder conditions

Overflow incontience

Functional UI

Impaired functioning of the nervous system

What UI is seen by spinal cord injury and dementia

Functional

Acute pyelinephritis

bacterial infection of upper urinary tract

What is caused by abrupt, with fever, dysuria, frequency and urgency?

Acute Pyelinephritis

Chronic pyelonephritis

recurrent or persistent bacterial infection with urinary obustruction, urinary reflex

True or False : For urinary tract obstruction it can only be complete occulsion of urine outflow

False , it can be both complete and partial occlusion

For Urinary Tract obsutruction what Renal Calculi are involved?

Ca^2+ salts, Mg^2+ salts, urate, cystine

If there is a progression of dilation of renal collecting ducts and tubules what will happen?

Destruction / atrophy of renal tissues

What is vesicoureteral reflux?

blackflow of urine into ureter , increase pressure and damage to renal pelvis

What is Ureterorenal reflux?

Ureters blocked, reflex constriction of the renal artery ( protection)

chronic renal failure

irreversible, slow, pregressive loss of renal function

acute renal failure

rapid, reversible decline in renal funciton

Why is Acute renal failure reversible?

Due to the fact that if causes are corrected or removed before permanaent kidney damage

What is a common indicator is acute renal failure?

azoetemia and decreased GFR

What are the categories of cause of acute renal failure

pre-renal, intrinsic or intra-renal, and post-renal

pre-renal arf

impaired renal blood flow

for pre-renal arf tubule epithelia cells vulnerable to _____ _______ as GFR and urine output fall

ischemic damage

What is a treatment for pre-renal arf?

find underlying cause, improve kidney function

Intrinsic or Intra-Renal ARF

damage to structures within the kidney

Post-renal ARF

obstuction of urine output

What is a treatment for Post-renal ARF

underluing cause

What should you do for treatment for ARF

Identify and correct cause and fluids carefully regulated

How is acute tubular necrosis characterized by?

destruction of tubular epithelial cells with acute suppression of renal funciton

What is a cause of acute tubular necrosis

Nephrotoxic effects of drugs

What has improved mortality for chronic renal failure?

Dialysis and transplantation

Whast causes permanent loss of nephrons (diabetes, hypertesnion and glomerulonephritis)

Chronic Renal Failure

If a patient has kidney failure which results in GFR < 15 % of normal what would possible treatements be for the patient?

Dialysis and transplant

Bowman's capsule

a hollow bulb, housing glomerulus, where tubular system directly intersects with vasculature

Proximal tubule

site for uncontrolled reabsorption and secretion of selected (essential) substance

Loop of Henle

establihses osmotic gradient in renal medulla, important for abiliy to concentrate urine; water conservation

Distal tubule & collecting duct

site of variable, controlled reabsorption of Na+ and H2O and secretion of K+ and H+

The fluid leaving the collecting duct is what?

urine

What are substances that are essential to the body and can be saved?

tubular reabsorption

What are substances that can be elimated from the body?

tubular secretion

substances that enter the tubules via these transport mechanisms and manage to reach the end of the tubule will be present in the urine

Excreted

What is used to estimate renal blood flow?

Para-aminohippurate (PAH)

What is CrCl used clincially to do?

estimate GFR for dose adjustment

If clearance > GFR

more is coming out than was filtered, so some must have been secreted into renal tubules

If GFR > clearance

less is coming out than was filterd, so some must have been reabsorbed

Diuretics ______ solite and H2O excretion until compensatory mechanism re-establishes balance

Increase

Many diuretics cause K+ = ?

Hypokalemia

What is the mechanism of aldosterone antagonists (spironolactone)

Decrease in Na+ reabsorption and K+ secretion

What is the mechansim of Na channel blocker (triamterene)

Block ENaC and decrease K+ secretion

What is not a physiological function of the kidneys

production of red blood cells directly

Which part of the nephron is primarly responsible for establishing the osmotic gradient

Loop of Henle

What is the net filtration pressure in the glomerulus

10 mmHg

The glomerular filtation barrier includes all the following excdpt

Mesangial

What does the glomerular filtation barrier include?

1. Podocytes

2. Fenestrated endothelium

3. Basement membrane

The majoirty of nephrons in the human kidney are

Cortical

What pressure favors glomerular filtration

Glomerular capillary hydrostatic pressure

What is used to measure GFR because it is freely filtered and either secreted nor reabsorbed

Inulin

What is the function of para-aminohippurate (PAH) in renal physiology

Estimate renal plasama flow

What mechanism ensures constant delivery of sodium and chloride to the nephor

Tubuloglomerular feedback

During severge hemorrhage, GFR is reduced due to

Constriction of afferent arteriole

Kidneys

paired organs located retoperitoneally in upper dorsal region of abdominal cavity

Ureter

one tube originates from each kidney, provides passage of urine from kidney to bladder

Bladder

Urinary sac that stroes urine

What are the two major regions in the kidney?

cortex and medulla

Bowmans capsule

a hollow bulb, housing glomerulus, where tubular system directly intersects with vasculature

Proximal tubule

site for uncontrolled reabsorption and secretion of selected substances

Loop of Henle

establishes osmotic gradient in renal medulla, important for ability to concentrate urine; water conservation

Distal Tubule and Collecting duct

site of variable, controlled reabsoprtion of Na+ and H2O and secretiton of K+ and H+

Outward pressure > inward pressure = ?

filtration

What favors filtration?

glomerular hydrostatic pressure

Why is filtration efficient?

Because of high driving force and leaky nature of capillar (low resistance)

What is GFR?

an index of kidney function

What does a fall in GFR mean?

disease progession

What does an increase in GFR mean?

recovery (expect nephrotic syndrome)

Why does albumin not dilter well compared to water?

Large and has a net negative charge

Substance A in the blood is filtered at the glomerulus and secreted from the peritubular capillaries into the tubule, its excretion would ______ than GFR

Be greater (>)

Substance A in the blood is filtered at the glomerulus and is actively reabsorbed into the peritubular capillaries, Its excretion would _____ than GFR

Be less (<)

Passive Reabsoprtion

diffusion through cell membranes or via leaky tight junctions

Active Reabsorption

transport through renal tubule epithelial cells : REQUIRES ENERGY : ATP

What exhibit gradient- time transport?

PT reabsorption of Na+, Cl-, Urea and H20