Term
|
Definition
| longer than the L due to the liver |
|
|
Term
|
Definition
| contracts under parasympathetic stimulation to promote urination |
|
|
Term
|
Definition
part of renal corpusle
contains the single celled epithelium, podocytes; specialized cells which function to filter material with long foot light processes and fenestrations
basal lamina or basement membrane |
|
|
Term
|
Definition
|
|
Term
|
Definition
| ; to reabsorb and secrete ions and peptides resulting in an optimal serum composition. Most reabsorption of sodium and water occur in the proximal convoluted tubule. |
|
|
Term
| Glomerular Filtration and Urine Formation involves |
|
Definition
filtration of blood by the glomerulus to form an ultrafiltrate of urine
tubular reabsorption and secretion of electrolytes & nutrients needed to maintain the constancy of the internal environment while eliminating waste |
|
|
Term
| Glomerular Filtration and Urine Formation begins with |
|
Definition
| Filtration of essentially protein-free plasma through the glomerular capillaries into Bowman’s space |
|
|
Term
| System of high-pressure filtration is maintained by |
|
Definition
| glomerulus…located between 2 arterioles |
|
|
Term
| Renal Function through Glomerular Filtration |
|
Definition
Maintained through Starling Forces and surface area
Net filtration pressure is a function of
Glomerular capillary blood pressure
Opposing fluid pressure in Bowman’s space
Osmotic force of plasma protien
Net result is 16 mmHg
180 L of fluid filtered daily (125ml/min) |
|
|
Term
| Glomerular Filtration Rate - GFR |
|
Definition
~125mL of filtrate is formed each minute and this is called Glomerular Filtration Rate (GFR)
GFR = (140-age) x (lean body weight in kg) (serum creatinine mg/dl) x 72
Multiply by 0.85 for women |
|
|
Term
| GFR Filtration pressure and rate are regulated by |
|
Definition
the constriction and relaxation of the afferent and efferent arterioles
Constriction of the efferent arteriole
↑s resistance to outflow from the glomeruli and ↑s glomerular pressure & the GFR
Constriction of the afferent arteriole
↓s the renal blood flow, glomerular filtration pressure and thus, the GFR |
|
|
Term
| Constriction of the efferent arteriole |
|
Definition
| ↑s resistance to outflow from the glomeruli and ↑s glomerular pressure & the GFR |
|
|
Term
| Constriction of the afferent arteriole |
|
Definition
| ↓s the renal blood flow, glomerular filtration pressure and thus, the GFR |
|
|
Term
Provides a gauge of renal function
Measured clinically by collecting timed samples of blood and urine
Most easily obtained by measuring the concentration of creatinine and urea nitrogen in the serum |
|
Definition
| Glomerular Filtration Rate |
|
|
Term
| Most easily obtained by measuring the concentration of creatinine and urea nitrogen in the serum |
|
Definition
| Glomerular Filtration Rate |
|
|
Term
| Afferent and efferent arterioles are: |
|
Definition
innervated by the sympathetic nervous system
sensitive to vasoactive hormones (i.e. angiotensin II) |
|
|
Term
| During periods of strong sympathetic stimulation (i.e. shock) |
|
Definition
| Constriction of afferent arteriole causes a marked ↓ in renal blood flow → ↓ glomerular filtration pressure → ↓ urine output |
|
|
Term
|
Definition
Perfused with 1000-1300mL of blood/min = 20-25% of Cardiac Output
This large blood flow is necessary to ensure a sufficient GFR for the removal of waste products from the blood
Feedback mechanisms (intrinsic/extrinsic) keep blood flow and GFR constant despite changes in arterial BP |
|
|
Term
| THE JUXTAGLOMERULAR COMPLEX |
|
Definition
Located at the site where the distal tubule extends back to the glomerulus and then passes between the afferent & efferent arteriole
Thought to be a feedback control system that links changes in the GFR with renal blood flow |
|
|
Term
|
Definition
the distal tubular site nearest glomerulus is characterized by densely nucleated cells
Dense in NaCl and pressure receptors
Fxn to decrease afferent arteriolar resistance increased GFR
Stimulate renin secretion |
|
|
Term
|
Definition
Special secretory cells which are modified Smooth muscle cells of the media of the adjacent afferent arteriole
Contain granules of inactive renin |
|
|
Term
|
Definition
produces vasoconstriction of vascular smooth muscle
Yields Aldosterone synthesis from adrenal gland
Increase Na+ and H2O re-absorption from collecting ducts
ACE conversion to Angiotensin II is the rate limiting step |
|
|
Term
FEEDBACK MECHANISM
of the juxtaglomerular complex |
|
Definition
Links arterial BP level & renal blood flow to the GFR & composition of the distal tubular fluid
Monitors the systemic BP by sensing the flow and stretch of the afferent arteriole via JG cells innervated by ANS
Monitors the concentration of Na+Cl- in the tubular filtrate as is passes through the macula densa
Renin release prompted from the complex to stimulate the RAAS
End result – regulation of GFR
GFR may be estimated via the lab measured CrCl |
|
|
Term
|
Definition
byproduct of creatine metabolism
Creatine is a major muscle constituent
filtered by kidneys but not reabsorbed in the renal tubules
levels in blood and urine can be used to measure GFR
Daily rate is constant and determined by the mass of skeletal muscle
Normal serum creatinine:
Men = 0.8-1.3mg/dL
Women = 0.6-1.1mg/dL |
|
|
Term
| Creatinine Clearance (CrCl) is: |
|
Definition
| amount of creatinine completely cleared by the kidneys in 1 minute = rate of clearance of creatinine |
|
|
Term
|
Definition
C = clearance rate (mL/minute)
U = urine concentration (mg/dL)
V = urine volume excreted (mL/minute or 24 hours)
P = plasma concentration (mg/dL)
Clearance rate = urine concentration (Cr) x urine volume excreted
plasma concentration (Cr) |
|
|
Term
|
Definition
urine concentration (Cr) x urine volume excreted
/plasma concentration (Cr) |
|
|
Term
|
Definition
|
|
Term
| Creatinine Clearance testing |
|
Definition
on a 24-hour basis with blood sample drawn when urine collection is complete
two 1-hour urine specimens are collected & a blood sample is drawn in between
Practically, using Cockcroft-Gault equation for estimated CrCl
Variables; Gender, age, weight, serum Cr |
|
|
Term
|
Definition
Product of hepatic protien catabolism ammoniaBUN
Transported via RBCs for renal excretion
More variable in plasma then Cr. d/t reabsorption
Elevated BUN = azotemia; normal 10-20 mg/dl |
|
|
Term
|
Definition
| used in conjunction with Cr and CrCl as a measure of renal function |
|
|
Term
| BUN Fluctuations secondary to; |
|
Definition
Dietary intake of protein
Daily catabolic rate
GI bleeding (more produced)
Volume depletion (i.e. dehydration) – d/t increased reabsorption of sodium
Liver disease – BUN decreased
Various medications |
|
|
Term
| Used to estimate the source of renal insufficiency |
|
Definition
|
|
Term
|
Definition
Ratio > 20:1 – suspect pre-renal source (increased BUN reabsorption)
Ratio 10-20:1 – suspect post-renal (BUN normally absorbed by kidney)
Ratio <10:1 – suspect intra-renal source (BUN reabsorption decreased) |
|
|
Term
| suspect pre-renal source (increased BUN reabsorption) |
|
Definition
| BUN/Cr ratio Ratio > 20:1 |
|
|
Term
| suspect post-renal (BUN normally absorbed by kidney) |
|
Definition
| BUN/Cr ratio Ratio 10-20:1 |
|
|
Term
| suspect intra-renal source (BUN reabsorption decreased) |
|
Definition
|
|
Term
|
Definition
(<500 ml/day or 30 ml/hr)
Diminished or decreased urine output |
|
|
Term
|
Definition
(<100 ml/day)
Absence of urine formation |
|
|
Term
|
Definition
|
|
Term
|
Definition
Presence of protein in urine, usually albumin
Measured on dipstick
Microalbuminuria – 30-300 mg/dl via ultrasensitive dipsticks – early marker of diabetic nephropathy |
|
|
Term
| early marker of diabetic nephropathy |
|
Definition
|
|
Term
|
Definition
Presence of >4 WBCs per high-power field
Suggests urinary tract infection or inflammation |
|
|
Term
| Sterile pyruria (neg culture in presence of pyuria) suggests: |
|
Definition
Prostatitis
chronic urethritis
Renal tuberculosis
Renal stones
Interstitial nephritis |
|
|
Term
|
Definition
Detrusor hyperactivity associated with
hypersensitive bladder
Common in the elderly
Complain of intense urgency and leakage |
|
|
Term
| Treatment Urge Incontinence |
|
Definition
Bladder training
Pelvic muscle exercise
Bladder-relaxant drugs;
antimuscarinics; oxybutynin (ditropan) tolterodine (detrol)
Imipramine – also used for bedwetting (enuresis) |
|
|
Term
|
Definition
| Leakage associated with increased intra-abdominal pressure (coughing/sneezing) |
|
|
Term
| cause and treatment of stress incontinence |
|
Definition
Cause:
Hypermobility of bladder base and urethral incompetence frequently caused by lax perineal muscles
Treatment:
Pelvic muscle exercise, vaginal cones, biofeedback
Timed voiding
Estrogens
Surgery
Cymbalta – experimental |
|
|
Term
|
Definition
Leakage from a mechanically distended bladder
Complain of frequency, nocturia, leakage
Urodynamic testing to evaluate (pressures, imaging, flow, fullness) |
|
|
Term
| Overflow Incontinence Possible causes: |
|
Definition
Outflow obstruction – i.e BPH
Stricture
Prolapsed cystocele
Acontractile bladder
Idiopathic
Neurologic – spinal cord injury, stroke, diabetes |
|
|
Term
|
Definition
Idiopathic
Neurologic – spinal cord injury, stroke, diabetes |
|
|
Term
| Treatment Overflow Incontinence |
|
Definition
Surgical correction of obstruction
Alpha blockers in men (flomax)
Intermittent catheter drainage |
|
|
Term
|
Definition
| Inability or unwillingness to void |
|
|
Term
| Cause Functional Incontinence |
|
Definition
Cognitive impairment
Physical impairment
Environmental barriers
Physical restraints, iInaccessible toilets
Psychological problems
Depression, anger, hostility |
|
|
Term
Treatment:
Functional Incontinence |
|
Definition
Prompted voiding
Garment and padding
External collection devices |
|
|
Term
| Diagnostic Work-up: Incontinence |
|
Definition
Urinalysis
Urine culture
Electrolytes
Renal function labs |
|
|
Term
Urodynamics and urology referral
for incontinence |
|
Definition
Imaging (cystography, ultrasound)
Post-void residual urine volume
Identify urinary retention
Simply cystometry
Instillation of water into the bladder can identify bladder contractions and pressures |
|
|
Term
| Instillation of water into the bladder can identify bladder contractions and pressures |
|
Definition
|
|
Term
|
Definition
genetic disorder characterized by:
glomerulonephritis
endstage kidney disease
hearing loss
It can also affect the eyes
The presence of hematuria is almost always found in this condition |
|
|
Term
|
Definition
Glomerulonephritis with pulmonary hemorrhage
Characterized by URI followed by hemoptysis, SOB, renal insufficiency with proteinuria, HTN
Tx with immunosuppressants |
|
|
Term
| History pertinent to urinary complaints |
|
Definition
Diabetes
Hypertension
Polycystic Kidney Disease
Alport’s Disease-
Nephrolithiasis |
|
|
Term
| Condition Associated Risk Factors for Intrinsic Renal Disease |
|
Definition
Diabetes
HTN
Atherosclerotic occlusive diseases such as renal artery stenosis
Peripheral Vascular Disease
Contrast administration
Systemic Lupus Erythematosus – can cause lupus nephritis
Scleroderma |
|
|
Term
| Causes of Rapidly Progressive Renal Failure |
|
Definition
Obstructive uropathy
Malignant hypertension
Rapidly progressive glomerulonephritis
TTP/HUS – microangiopathic diseases
Atheromatous embolic disease
Bilateral renal artery stenosis
Scleroderma crisis
Multiple myeloma
Sepsis |
|
|
Term
|
Definition
|
|
Term
|
Definition
| calcinosis, raynauds, Esophageal dysmotility Sclerodactyl Teleangectasia |
|
|
Term
|
Definition
| Scleroderma is a connective tissue disease that involves changes in the skin, blood vessels, muscles, and internal organs. It is a type of autoimmune disorder, a condition that occurs when the immune system mistakenly attacks and destroys healthy body tissue. |
|
|
Term
|
Definition
Due to loss of negative charge on basal lamina
Major protinuria (>3.5g/day), edema, hyperlipidemia
Minimal change disease, membranous GN (Hepatitis, HIV, drugs) |
|
|
Term
|
Definition
Acute brown hematuria, decreased GFR
Due to renal inflammation and leads to ARF
Classic example; Post-streptococcal GN |
|
|
Term
| Major protinuria (>3.5g/day), edema, hyperlipidemia |
|
Definition
Nephrotic syndrome
of Glomerular disease |
|
|
Term
| post streptococcal glomerular nephritis |
|
Definition
| common in boys 7-14; follows strep through by about 2 weeks and impetigo after 6 weeks. Immune mediated with rare rapidly pogressive renal failure; shows up with hematuria, casts, flank pain, malaise, treat the underlying infection |
|
|
Term
| Acute Renal Failure (ARF) |
|
Definition
Complication of renal disease
Abrupt decline in the ability of one or both kidneys to excrete waste products resulting in the accumulation of nitrogenous wastes |
|
|
Term
|
Definition
Decreased urine output
Mental status changes
GI symptoms
Evidence for volume overload
Pericarditis
Increased BUN and serum creatinine
Hyperkalemia
Acidosis
Hypocalcemia
Hyperphophatemia
Abnormal urinalysis |
|
|
Term
|
Definition
Complication of renal disease overtime
Decreased renal function on the basis of progressive and irreversible nephron destruction |
|
|
Term
| Chronic Renal Failure causes |
|
Definition
| DM (30%), HTN (30%), glomerulonephritis (15%), polycystic kidney disease, obstructive uropathy |
|
|
Term
SSX:
chronic renal failure |
|
Definition
Lethargy, malaise, pruritus, anorexia, N/V, impotence, leg cramping, dyspnea, poor concentration
Ecchymosis, pallor, edema, rales, pleural effusions, HTN, pericardial friction rub, cardiomegaly, mental status change |
|
|
Term
| PE Findings of Renal Disease Patient skin |
|
Definition
Rash
pallor
Purpura
Petechiae
AV fistula thrills
Livedo reticularis
Semipermanent bluish mottling of skin on the legs & hands, and is aggravated by exposure to cold |
|
|
Term
|
Definition
| Semipermanent bluish mottling of skin on the legs & hands, and is aggravated by exposure to cold |
|
|
Term
HEENT
PE Findings of Renal Disease Patient |
|
Definition
Hemorrhage
Hypertensive changes
Diabetic retinopathy |
|
|
Term
| Genitourinary PE Findings of Renal Disease Patient |
|
Definition
| Prostate size or irregularity |
|
|
Term
| Neuro PE Findings of Renal Disease Patient |
|
Definition
Mental status changes
Sensation changes
Restlessness
Fasiculations
Hyper-reflexia |
|
|
Term
|
Definition
Severe metabolic derangements
Worsening acidosis
Severe volume overload/decompensated CHF
Severe uremic symptoms
Pericarditis, coagulopathy, encephalopathy |
|
|
Term
|
Definition
|
|
Term
|
Definition
| interstitial nephritis, pyelonephritis |
|
|
Term
|
Definition
| acute tubular necrosis, glomerulonephritis |
|
|
Term
|
Definition
| normal findings in concentrated urine |
|
|
Term
| Abdominal Plain Film (KUB) |
|
Definition
Determine renal size and shape
Radioopaque renal calculi are often apparent
Calcium, Struvite, cystine
Calcified neoplasms
Nephrocalcinosis
TB
Trauma |
|
|
Term
|
Definition
Assess renal size (more reliable eval than x-ray)
Determine obstructive uropathy
Obtain anatomic image of kidney & collecting system
Renal masses
Renal cysts: Simple cysts only (complex cysts or solid lesions require CT or MRI)
Hydronephrosis (dilation of the collecting system)
Abscess or hematoma
Renal vein thrombosis
Renal artery stenosis |
|
|
Term
Renal Ultrasound
Used to routinely to: |
|
Definition
Hydronephrosis (dilation of the collecting system)
Abscess or hematoma
guide kidney biopsy
Introduce nephrostomy tubes
Drain fluid collection around kidney |
|
|
Term
| IVP (intravenous pyelography) |
|
Definition
IV administration of iodinated radiographic contrast medium (excreted by glomerular filtration)
Contrast medium concentrates in renal tubules and produces a nephrogram image within first few mins of injection allowing visualization of calyces, renal pelvis, ureters, bladder as medium passes into collecting system |
|
|
Term
IVP (intravenous pyelography)
useful in detecting |
|
Definition
Good for delineating kidney anatomy
Indicated for flank pain, obstruction, bleeding, ?neoplasm |
|
|
Term
|
Definition
Radiopaque dye is administered through cystoscope
Useful in definition of obstructing lesions within the ureter or renal pelvis
Advantageous with IVP dye allergy and renal disease
Ureteric stones can be removed using a special basket |
|
|
Term
|
Definition
performed after radiopaque is administered through a catheter to fill the bladder
Patient then urinates |
|
|
Term
|
Definition
Detect vesicoureteral reflux (peds) – VCUG
Evaluates filling defects
pelvic trauma, fistula, Level of urinary incontinence, urethral strictures |
|
|
Term
CT
Most helpful in evaluating: |
|
Definition
Renal masses or stones
Complex cysts
Perinephric pathology
Vascular pathology (renal vein thrombosis)
Used to guide kidney biopsy or fluid collection (ie perinephric abscess) |
|
|
Term
|
Definition
Delineating complex renal masses
Staging renal tumors
Detecting invasion of renal veins
Diagnosing renovascular disease
An alternative to CT in patients with renal failure |
|
|
Term
| MRA – renal arteriography |
|
Definition
Injection of radiographic contrast (Gadolinium)
Assess renal vasculature |
|
|
Term
MRA – renal arteriography
useful in evaluation for |
|
Definition
Suspected renal artery stenosis or thrombosis
Renal mass
Unexplained hematuria
Suggested vascular malformation |
|
|
Term
|
Definition
Dysuria
Urgency
Back/flank pain
Hesitancy
Incontinence
fever |
|
|
Term
Medication use:
causes problems with urination |
|
Definition
nasal decongestants
tricyclic antidepressants
Anticholinergics |
|
|
Term
|
Definition
Suggests a glomerular source
Bilirubinuria
Myoglobin – seen in Rhabdomyolysis
Large amounts in urine turn color
Positive dip stick, negative for red cells |
|
|
Term
| coca cola urine, positive blood on dipstick, but NO RBC in microscopy |
|
Definition
|
|
Term
|
Definition
Warfarin
Heparin
ASA
Cyclophosphamide (hemorrhagic cystitis) |
|
|
Term
| Hematuria Begin at the beginning of stream? |
|
Definition
|
|
Term
| Hematuria Begin at the end of stream? |
|
Definition
|
|
Term
| Hematuria Throughout stream? |
|
Definition
Renal lesion
Ureteric lesion
Diffuse lesions |
|
|
Term
| Risk factors for urinary tract malignancy |
|
Definition
40-70 years of age
Tobacco use
Analgesic abuse
Pelvic irradiation
Occupational exposures – industrial solvents
Schistosomiasis
Irritative voiding symptoms
Most common symptom – gross hematuria
Urothelial cell carcinomas most common |
|
|
Term
| most common symptom of UT malignancy |
|
Definition
PAINLESS gross hematuria
Urothelial cell carcinomas most common |
|
|
Term
| Marker of kidney disease in adults |
|
Definition
|
|
Term
|
Definition
Functional – exercise, acute febrile illness
Overload – Multiple Myeloma, Rhabdomyolysis
Intrinsic nephropathy – ATN, fanconi’s syndrome
Infectious (HIV, hepatitis)
Autoimmune – SLE, Wegener’s granulomatosis |
|
|
Term
| Flank Pain: Diagnostic Work-up |
|
Definition
Urinalysis and urine culture
Renal or abdominal ultrasound
Abdominal CT without contrast
Cytoscopy
Intravenous pyelography
Retrograde ureteropyelography
Voiding cystourethrography
Lumbosacral spine x-ray
Abdominal ultrasound |
|
|
Term
|
Definition
Most commonly calcium
Uric acid stones- radiolucent
Struvite – from UTIs – ammonium/magnesium/calcium
Stones less then 5 mm usually pass
Complications; hydronephrosis from obstruction with ARF
Tx; fluids, flomax, pain meds, urology for large stones
Surgery; lithotripsy, scoping for extraction, ureteral stenting, nephrostomy tube placement |
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|
