Renal

Question 1

Juxtamedullary nephrons vs Cortical Neohrons

Answer 1

Juxtamedullary nephron reach into the medulla with a long loop of Henly. They have think loops of Henly into the inner stripe allowing these nephrons to be predisposed to damage from low blood flow. 10% of our total nephrons Cortical nephrons do not extend into the inner zone. Less likely to be damaged. 90% of our total nephrons

Question 2

What is the equation for calculating GFR

Answer 2

(Urine Cr (mg/ml) * Volume Urine (ml/min)) / Plasma Cr (mg/ml) GFR= (((140-age) * lean weight (kg)) / (Plasma Cr * 72)) * 0.85

Question 3

1. Loop diuretics block what channel? 2. Thiazide diuretics block what channel?

Answer 3

1. Na+-K+-2Cl- pump 2. Block Na+ reabsorption

Question 4

Geriatric Considerations with the Kidneys

Answer 4

1. Loss of Nephrons 2. Diminished Renal Blood Flow 3. Decreased GFR 4. Decreased ability to conserve salt and water

Question 5

What can cause an increase in BUN with no renal damage?

Answer 5

Dietary protein intake

Question 6

1. Azotemia 2. Uremia

Answer 6

1. elevation in BUN and Cr levels related to decrease GFR 2. Elevation of urea in the blood

Question 7

1. Nephrolithiasis 2. Glumerulonephritis

Answer 7

1. Renal Stones 2. inflammation of the glumeruli

Question 8

Where is Kidney pain usually found?

Answer 8

Felt at the Costovertebral angle posteriorly and can follow the T10-L2 dermatomes around to anterior. *Back and Flank Pain

Question 9

Polycystic Kidney Disease — Genetics and What is going on in the kidney

Answer 9

-Development of cysts inside the kidney that can lead to obstruction of urine flow and renal failure - Can be autosomal dominant or recessive -

Question 10

Polycystic Kidney Disease -Clinical Manifestations -Treatment

Answer 10

Clinical Manifestations –Pain –HTN –Concomitant cystic liver involvement Treatment –Supportive – Dialysis

Question 11

Renal Cell Carcinoma -Manifestations -Predisposig Factors -Treatment

Answer 11

Manifestations –Tumor of the kidney (can be primary or secondary) —-Primary large, secondary seedlike –Can lead to Kidney Failure Predisposing Factors –Familial pattern –Smoking, Obesity, HTN Treatment –Nephrectomy

Question 12

Normal Protective mechanisms of the kidney against infections (6)

Answer 12

1. Acidic pH 2. Presence of Urea in Urine 3. Men: Bacteriostatic prostate secretions 4. Women: Glands in distal uretha secrete mucous 5. Micturition: Washed out pathogens 6. Unidirectional Urine Flow

Question 13

Pyelonephritis 2 causes

Answer 13

–Ascending infection from lower Urinary Tract (common) –Bacteremia

Question 14

Chronic Pyelonephritis –Manifestations –Treatment

Answer 14

Usually caused by reflux or obstructive process leading to urine stasis Manifestations –abd/flank pain, fever, malaise Treatment –Correct underlying process –Antimicrobial therapy

Question 15

Complete Urine Obstruction can result in?

Answer 15

1. Hydronephrosis 2. Decreased GFR 3. Ischemic Kidney Damage (b/c of increased intralumenal pressures) 4. Acute Tubular Necrosis 5. Chronic Kidney Disease

Question 16

Nephrolithiasis (Renal Stones) –What are they made from? Why do they form? Manifestations?

Answer 16

• Crystal Aggregates of organic and inorganic materials Calcium Crystals (most common)
• Can be made of uric acid, phosphate, or Oxalate (struvite, cystine)
• Manifestations
  
  • Intense renal colic pain with abrupt onset
  • N/V
  • Hematuria

Question 17

Nephrolithiasis –Treatment and prevention

Answer 17

Treatment – >2L fluids/day to pass stone –Lithotripsy can be used –Urethral Stenting –Pain medications Prevention –Stones tend to reoccur —Prevent with high fluid intake —–Also Dietary calcium prevents stone formation by binding oxalate and preventing absorption

Question 18

Nephrotic Syndrome –What is it characterized by? Disease processes causing? Symptoms

Answer 18

-Glomerular permeability to proteins -Urinary loss of >3.5 g protein/day Disease Processes Causing -SLE, DM, Minimal Change Disease Symptom -Edema -Hyperlipidemia (liver making many proteins) -Hypercoagulability (liver making proteins)

Question 19

Nephrotic Syndrome Treatment

Answer 19

-Diurectics -Lipid Lowering Agents -Antihypertensives -Immunosuppression

Question 20

Minimal Change Disease –What? Who? Symptoms? Treatment?

Answer 20

What? Deceased production of anions by the podocytes. Initiated by an allergic or immune condition Who? Children Symptoms? Sudden onset edema, nephrotic levels of protein loss, hypoalbuminemia Treatment? Corticosteroids

Question 21

Acute Glomerulonephritis –What? Manifestations? Treatment?

Answer 21

–Inflammation in the kidney from possible infection, resulting in degradation of the basement membrane. –GFR may fall due to contraction of the mesangial cells. Manifestations –Proteinuria, Oliguria, Azotemia, HTN, Edema Treatment –Steroids –ABX –Plasmapheresis –Supportive measures including HTN support

Question 22

Berger Disease

What?

Manifestations?

Prognosis?

Answer 22

• IgA Nephropathy
• Most common diagnosed
  
  • Common in adults
• Follows upper resp or GI infection
• Complex deposition and degradation causes injury to mesangial cells
• Manifestations –No Proteinuria, Edema, or HTN
  
  • hematuria presents in 1-2 days in the form of casts
• Prognosis –Variable, can progress to ESRD

Question 23

Chronic Glomerulonephritis What? Who? Treatment?

Answer 23

Progressive degradation of the kidney with collagen formation, ultimately leading to ESRD. Defined with slowly declining renal function Who? Multiple Sclerosis, ALS Treatment? Supportive with ultimately a Kidney transplant needed

Question 24

Normal BUN:Cr ratio

Answer 24

10:1 or 20:1

Question 25

ARF BUN:Cr rations for Prerenal, Intrarenal, Postrenal and why these numbers are seen?

Answer 25

Prerenal-- \>20:1-- both BUN and Cr have decreased filtration but urea has more time to be reabsorbed Intrarenal-- \<10:1-- Tubules are failing, less urea reabsorbed Post Renal-- 10-20:1-- Both Urea and Cr affected equally

Question 26

Possible Causes of Acute Renal Failure (ARF) (7)

Answer 26

Hypotension -- Overuse of Diuretics, Burns, Vomiting, Diarrhea, Edema 2. Renal Artery Obstruction 3. Drugs-- Ace Inhibitors, NSAIDS

Question 27

How to NSAIDs damage the kidney?

Answer 27

Block prostaglandins, prostaglandins provide vasodilation in the efferent arteriole, thereby causing vasoconstriction in the efferent arteriole and increased pressure within the glomerulus.

Question 28

Acute Tubular Necrosis (ATN)

Answer 28

Can be caused by decreased O2 to the outer medulla. --Cells die and slough off the tubule wall occluding tube. --Casts of dead cells are formed --increased intratubular and glomerular pressure --Increased tubular leaking into the medulla. --Reduced GFR and Oliguria \*Good prognosis if no other comorbidities

Question 29

Three Phases of ATN

Answer 29

* Prodromal Phase (immediate) * Injury has occured * Incerased BUN and Cr * Oliguric Phase (1-8 weeks) * Oliguria/anuria * Volume Overload * Hyperkalemia * Metabolic Acidosis * Postoliguric Phase (2 days-1 year) * Fluid Volume Deficeit * Labs begin to normalize

Question 30

Chronic Kidney Disease

Answer 30

Decreased Kidney function for 3 or more months --Kidneys can compensate till 75-80% of glomeruli are damaged \*Know the stages in the assessment lecture

Question 31

Common Causes of CKD

Answer 31

1. DM 2. HTN 3. Recurrent Polynephritis 4. Glomerulonephritis 5. Over 65 yoa 6. Polycystic Kidney Disease 7. Exposure to Toxins 8. Ethnicity

Question 32

Clinical Considerations of CKD

Answer 32

* HTN--Use ACE inhibitors * Control Glucoses * Manage ATN * Allow metabolic Acidosis * acidosis \<7.30 treat with NaHCO3 * acidosis 7.30-7.35 requires no treatment * Uremic Syndrome- retention of wastes * Electrolyte imbalances * Anemia- Lack of EPO ----EPO production correlates with GFR

Question 33

Extra-Renal manifestations of CKD

Answer 33

1. HTN--- r/t renin release 2. Pulm Edema-- secondary to fluid retention 3. Depressed Immune function 4. N/V and Anorexia 5. Anemia 6. Neuropathies

Question 34

How does Dialysis function?

Answer 34

Blood is removed from the body and run thru a tube within a solute bath. Solutes move via osmosis and thereby filter the blood. The blood is then returned to the patient. \*\*You want a Dialysis soln that has electrolyte values slightly lower than that of the blood, BUT has a higher osmotic pressure to pull fluid from the blood.

Question 35

Prostate Problems

Answer 35

BPH- Usually starts in central zone of the prostate and squeezes the urethra causing occusion Prostate Cancer-- Usually starts in the peripheral zone and does not form any symptoms until late stage often times. \*\* See Coexisting for TURP procedures