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Patho Quiz 7 Renal
Renal UCD
152
Nursing
Undergraduate 3
04/03/2012

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Term
Rhabdomyelosis
Definition
The breakdownof mm fibers that lead to the release of mm fiber (myoglobin) into the bloodstream
Term
What is normal GFR?
Definition
125 ml/min
Term
What does CRF stand for?
Definition
Chronic Renal Failure
Term
What is the breakdown of mm fibers that leads to the release of mm fiber (myoglobin) into the bloodstream?
Definition
rhabdomyolysis
Term
What are increased levels of nitrogens waste products, especially urea nitrogen, in the blood indicative of impaired renal clearance?
Definition
azotemia
Term
What is it called when blood is present in the urine?
Definition
hematuria
Term
What is it called when protein is present in the urine?
Definition
proteinuria
Term
What is severe decrease or lack of urine output of less than 100ml/day?
Definition
anuria
Term
What is urine output less than 400ml/day?
Definition
oliguria
Term
What are tiny tube-shaped particles made up of WBC, RBC, or kidney cells? They are held together by a protein released by the kidney.
Definition
urine casts
Term
What is point or place at which something originates, accumulates, or develops, as the center around which calculi (stone) form?
Definition
nidus
Term
What is the prescence of a stone or calculus anywhere in the urinary tract?
Definition
nephrolithiasis
Term
What is concretion of crystals of material (uric acid, calcium phosphate) that initially from in the calices or pelvis of the kidneys?
Definition
renal calculi
Term
What is distention of a ureter with urine , usually resulting from an obstruction process?
Definition
hydroureter
Term
What is it called when swelling of one kidney due to a backup of urine?
Definition
hydronephrosis
Term
What is it called when a healthcare provider taps on the area (with heal of closed fist over costovertebral angle) over the kidneys and it produces pain?
Definition
CVA tenderness
Term
What is it called when a patient abnormally needs to urinate in the middle of the night?
Definition
nocturia
Term
What is a strong and immediate urge to void brought about by involuntary detrusor overactivity?
Definition
urgency
Term
What is the term used to describe how often a patient is urinating?
Definition
frequency
Term
What is known as pus in the urine?
Definition
pyuria
Term
What is also known as painful urination?
Definition
dysuria
Term
What is the condition where urinary calculi are formed or located anywhere in the urinary system?
Definition
urolithiasis
Term
What is bladder dysfunction caused by a lesion at any level in the nervous system?
Definition
neurogenic bladder
Term
What is the ability to retain a bodily discharge voluntarily?
Definition
continence
Term
What is also known as urination?
Definition
micturition
Term
What is an infection of the kidney medulla or cortex?
Definition
pyelonephritis
Term
What is inflammation of the urothelium (lining of the bladder) resulting from infection, irritation, presence of a foreign body, or trauma?
Definition
cystitis
Term
What are the clinical manifestations of Benign Prostatic Hyperplasia/Hypertrophy (BPH)?
Definition
-weak urinary stream
-abdominal "pushing" to move urine
-urinary hesitancy
-incomplete bladder emptying
-urgency, frequency
Term
What is Benign Prostatic Hyperplasia/Hypertrophy (BPH)?
Definition
enlargement of the prostate (result of age, exogenous drugs testosterone) that puts pressure on the urethra
Term
What are the 2 major causes of chronic renal failure (CRF)?
Definition
-HTN
-DM
Term
What determines end-stage renal disease (ESRD)?
Definition
when GFR is decreased by 90% with GFR <10ml/min
Term
What are the levels of GFR with chronic renal failure (CRF)?
Definition
decreased by 75%
Term
How does mental status change with post renal acute renal failure (ARF)?
Definition
hyponatremia
Term
What are the clinical manifestations of post renal acute renal failure (ARF)?
Definition
-oliguria/anuria
-back/flank pain
-change in mental status (hyponatremia)
Term
What is post renal acute renal failure (ARF)?
Definition
"beyond the bladder" <5% of all ARF

Usually related to a urinary tract obstruction that affects the kidneys bilaterally
Term
What are the three stages of acute renal failure (ARF)?
Definition
1. oliguria- volume overload, increase K+, metabolic acidosis
2.diuretic-retention of tubular patency
3. recovery
Term
What are the causes acute tubular necrosis (ATN)?
Definition
-antibiotics
-chemicals
-heavy metal poisons
-rhabdomyelosis (mm injury)
-x-ray contrast media*
Term
What is the most frequent manifestation on intrarenal acute renal failure (ARF)?
Definition
acute tubular necrosis
Term
What is intrarenal acute renal failure (ARF) typically caused by?
Definition
exposure to toxins, drugs, or autoimmune
Term
What is acute tubular necrosis (ATN)?
Definition
decrease GFR to hypoxia/ischemia & tubular cell injury
Term
What is intrarenal acute renal failure (ARF)?
Definition
intrinsic to the kidney itself
Term
What are the clinical manifestations of pre-renal acute renal failure (ARF)?
Definition
-decreased GFR
-increased BUN & creatinine
-hyperkalemia
-tachycardia
-decreased urine output
-lethargy (confusion)
Term
What role does chronic NSAID use have in the potential development of pre-renal ARF?
Definition
renal PG maintains vasodilation of the renal artery/afferent arteriole. NSAIDS till inhibit this & cause vasoconstriction & hypoperfusion
Term
What might cause pre-renal acute renal failure (ARF)?
Definition
-decrease in renal perfusion
-no tubular damage but decreased GFR
Term
What is pre-renal acute renal failure (ARF)?
Definition
"before" the kidney (50% of all ARF)
Term
In acute renal failure (ARF) what are 2 major problems that can kill your patient quickly?
Definition
-hyperkalemia (high K+)
-metabolic acidosis (high H+)
Term
What is chronic renal failure (CRF)?
Definition
slow onset renal failure
Term
What is acute renal failure (ARF)?
Definition
rapid onset renal failure
Term
What are the clinical manifestations of polycystic kidney disease?
Definition
-abdominal pain
-hematuria
-proteinuria
-oliguria
-anuria
-HTN (fluid retention)
Term
What causes extreme pain in polycystic kidney disease?
Definition
the cysts swell and press against the renal capsule
Term
Where do the cysts develop in polycystic kidney disease?
Definition
-develop throughout cortex & medulla
Term
What do the cysts do in polycystic kidney disease?
Definition
-destroys normal nephrons
Term
How is polycystic kidney disease received?
Definition
-genetic
-defective gene on short arm of chromosome 16
-autosomal dominant pattern
Term
What type of casts are typical in pyelonephritis?
Definition
WBC cast
Term
Why do casts for in pyelonephritis?
Definition
inflammation of the kidney
Term
What type of casts form in glomerulonephritis?
Definition
RBC cast
Term
Why do casts form in glomerulonephritis?
Definition
leakage of RBC from glomerulus or severe tubular damage
Term
Where do casts form in glomerulonephritis?
Definition
only in DCT or collecting ducts
Term
What is the hallmark syndrome of nephrotic syndrome?
Definition
urinary casts
Term
What are the clinical manifestations of nephrotic syndrome?
Definition
-hypovolemia
-edema formation* (lack of oncotic pressure)
-protein malnutrition
-HTN
Term
What is nephrotic syndrome?
Definition
loss of protein in the urine of >3-5gm/day
Term
What is chronic glomerulonephritis?
Definition
fibrotic tissue development in the glomerulus leading to permanent decrease in GFR
Term
Why does HTN happen with glomerulonephritis?
Definition
-increases protein loss
-hypovolemia
-RAA kicks in
-Na+ & H₂O are retained
Term
Why is there increased serum lipids with glomerulonephritis?
Definition
-decreased albumin
-liver overproduces to compensate
Term
Why does edema happen with glomerulonephritis?
Definition
-protein loss
-less colloid osmotic pressure
Term
What are the clinical manifestations of glomerulonephritis?
Definition
-typically 7-10 days after strep throat
-hematuria & proteinuria
-oliguria from lowered GFR (<400mL/24 hrs)
-RBC casts
-edema
-increased lipids
-HTN
Term
The glomerular "leakiness" in glomerulonephritis allows what to happen?
Definition
RBC, WBC & protein into the urine
Term
What is the mechanism of acute glomerulonephritis?
Definition
-type III hypersensitivity
-Ab/Ag complex trapped in glomerulus
-inflammatory response
-glomerulus is compromised & damaged
-the damage allows RBC, WBC & protein into the urine
Term
Glomerulonephritis is always accompanied by ________GFR and ____________ creatinine
Definition
-decreased
-increased
Term
What is glomerulonephritis?
Definition
inflammation of the glomerulus
Term
What is a staghorn calculus?
Definition
-a stone formed in the renal pelvis shaped like a horn
-made from magnesium-ammonium-phosphate mix
Term
What characteristic of urine with favor supersaturation and stone formation in uric acid stone?
Definition
acidic urine
Term
What is the significance of a high purine diet with uric acid stones?
Definition
increase purine metabolism from high protein intake produces more uric acid (rich in meats, liver)
Term
What is hyperuricemia?
Definition
uric acid stones
Term
What characteristic of urine will favor calcium oxalate stone formation?
Definition
alkaline urine
Term
What are the risk factors for hypercalciuria?
Definition
-increased GI absorption of Ca++
-increased demineralization of Ca++ from bone
-defect in tubular secretion from kidneys
-high levels of uric acid
Term
What is hypercalciuria?
Definition
calcium oxalate stone
Term
Side 3















Where do stones form?
Definition
they can form anywhere but typically in the ureters
Term
What are the consequences of urinary tract obstruction?
Definition
there can be back pressure into the kidney, which can decrease GFR, leading to renal failure.
Term
What is hydroureter?
Definition
complete obstruction of ureter; accumulation of urine, ureter distended
Term
What is hydronephrosis?
Definition
enlarged, swollen kidney from backed up urine
Term
What is any interference with urine flow at any site along the urinary tract leading to accumulation of urine behind the obstruction?
Definition
UT obstruction
Term
What is the HALLMARK symptoms of pyelonephritis?
Definition
CVA tenderness (costovertebral angle tenderness)
Term
What are the s/s of pyelonephritis?
Definition
-patient looks sick
-chills
-fever
-back pain
-HA
Term
What is pyelonephritis?
Definition
infection of the renal pelvis, calices, parenchyma
Term
What are the s/s of a UTI?
Definition
-cystitis (inflammation of bladder lining)
-dysuria
-frequency
-fever
-low back pain
-cloudy and/or strong odor urine
-pyuria (WBC in urine)
Term
What risk factor for UTI's are nurses capable of reducing the number of UTIs related to?
Definition
catheterization
Term
What are some risk factors for UTI's?
Definition
-women: failure to void after sexual activity
-pregnancy
-men: rectal sex (no condom)
-BPH
-kidney stones
-diabetes
-catheter
-neurogenic bladder (voiding dysfunction
Term
Compare gender anatomical differences for risk of UTI's?
Definition
women have a shorter urethra then men therefore women are more at risk than men.
Term
What are the protective mechanisms associated with urine?
Definition
-voiding flushes out pathogens
-pH (acidic)
-osmolarity
-high concentration of UREA
Term
What are the characteristics of urine?
Definition
-sterile
-specific gravity 1.010-1.030
Term
What is the PSNS control on the bladder?
Definition
"void" (Ach)
-contracts detrusor mm
-relaxes internal sphincter
Term
What is the SNS control of the bladder?
Definition
"hold it" (NE)
-relaxes detrusor mm
-contracts external sphincter
Term
What is the triangle shape located in bladder that has openings from ureters. usually referring to the bladder mm?
Definition
trigone
Term
What is the smooth mm of the bladder body?
Definition
Detrusor Muscle
Term
What is located at base of urethra. controlled voluntarily?
Definition
External Sphincter
Term
What is located at base of bladder, top of urethra. controlled involuntary?
Definition
Internal Sphincter
Term
Discuss the process of voiding (micturition).
Most is under ANS and some is under Somatic
Definition
1. bladder fills
2.fullness felt (trigone stretched)
3. afferent signal to the brain
4. contraction of detrusor (muscarinic)
5. relaxation of internal sphincter (muscarinic)
Term
What is the capillary tuft at beginning of every nephron. it is the site of fluid filtration from the blood to the nephron tubule. it is what prevents passing of WBC, RBC, platelets?
Definition
glomerulus
Term
What is the cup-like sac that surrounds the golmerulus. it drains the glomerular filtrate directly into the PCT?
Definition
bowman's capsule
Term
What are located in the DCT. they sample the filtrate for NaCl content and send signals to the glomerulus to adjust GFR?
Definition
macula densa
Term
What is the endocrine gland that regulates the function of each nephron. the apparatus is made up of the macula densa cells, extraglomerular mesangial cells, and JG cells?
Definition
juxtaglomerular apparatus
Term
What is it called when proteins are negatively charged and attract ions which then attract H₂O?
Definition
capillary osmotic/oncotic pressure
Term
What opposes filtration by holding H₂O & ions in capillaries?
Definition
oncotic pressure
Term
What is the enzyme that is produced & released mainly by the liver. known as renin substrate. Angiotensin I is formed when renin acts on angiotensinogen?
Definition
angiotensinogen
Term
What is the enzyme that converts Angiotensin I to Angiotensin II?
Definition
ACE
Term
What is the RAAS pathway?
Definition
1. JG cells sense decreased BP
2. JG cells secrete renin
3. renin causes angiotensinogen to be converted to Angiotensin I
4. Angiotensin I circulates the lung and ACE converts it to Angiotensin II
5. Angiotensin II circulates to adrenal cortex & stimulates secretion of aldosterone
6. aldosterone increases reabsorption of Na+
7. therefore, water is retained & blood volume increases
Term
What is the role of aldosterone in the RAAS pathway and where is it secreted from?
Definition
-aldosterone increases reabsorption of Na+ (DCT)
-secreted from adrenal cortex
Term
On which part of the tubular system does aldosterone act on?
Definition
-distal convoluted tubule Na+ is reabsorbed(DCT)
-collecting duct K+ is excreted
Term
What is the role of ADH in blood volume maintenance?
Definition
-ADH is a vasopressin
-it is secreted from posterior pituitary in response to increased osmolality by the osmoreceptors in the hypothalamus
Term
On which part of the tubular system does ADH act on?
Definition
collecting duct where it stimulates water reabsorption
Term
What is the significance of HPO₄?
(handbook pg. 619-620)
Definition
this is used for an important buffer system. the excretion of H+ will be bound to a filtered phosphate and excreted in the urine. this excretes acid and gain bicarbonate
Term
What is the significance of NH₄?
Definition
excess H+ is attached to NH₃ to make NH₄ and excrete it through the kidneys.
Term
How does the kidneys excrete metabolic wastes?
Definition
it can excrete H+ attached to a NH₃ if the body is to acidic
Term
In the arterial blood, what is the best indicator of how well the kidneys are excreting metabolic wastes?
Definition
HCO₃ in the blood
Term
In arterial blood, what is the best indicator of how well the lungs are excreting metabolic wastes?
Definition
PaCO₂ in the blood
Term
Renin causes the conversion of what?
Definition
Angiotensinogen to Angiotensin I
Term
What is the role of the macula densa?
Definition
-sense changes in osmolality (NaCl)
-stimulate renin release from JG cells
Term
What is the role of the JG cells?
Definition
-they are baroreceptors
-they synthesize, store, and secrete renin
-smooth mm cells in walls of afferent arteriole
Term
What happens if the GFR is too high?
Definition
-all filtrate would be lost to urine (good & bad)
Term
What happens if the GFR is too low?
Definition
-too much tubular filtrate is reabsorbed
-glucose & waste products would be out of balance
Term
How does each individual nephron regulate GFR?
Definition
the macula densa in the DCT sense changes in the NaCl delivery
Term
What does not get filtered in the glomerulus?
Definition
negatively charged particles (protein) or particles too large to pass (RBC, WBC, platelets)
Term
What gets filtered in the glomerulus?
Definition
-water
-electrolytes (H+, K+)
-solutes (creatinine, urea, glucose)
-organic acids
-phosphates
Term
The driving force of filtration in the glomerulus is why?
Definition
hydrostatic pressure
Term
What vasoconstricts to keep GFR constant?
Definition
afferent arterioles
Term
How does systemic BP affect GFR?
Definition
if there is an increase in BP it will in turn increase GFR
Term
What is the goal of GFR?
Definition
to generate enough pressure for urine formation
Term
ow much Na+ & H₂O absorption occurs at the collecting duct?
Definition
3%
Term
How much Na+ & H₂O absorption occurs at the distal convoluted tubule (DCT)?
Definition
(DCT)?


7%
Term
How much Na+ & H₂O absorption occurs at the Ascending Loop of Henle?
Definition
30%
Term
How much Na+ & H₂O absorption occurs at the proximal convoluted tubule (PCT)?
Definition
60%
Term
What are efferent arterioles?
Definition
they transport blood out of the glomerulus
Term
What are afferent arterioles?
Definition
they transport blood into the glomerulus
Term
What are the functions of the nephron?
Definition
-filter water soluble substances from blood
-reabsorption of filtered nutrients, water, and electrolytes.
-secretion/excretion of wastes or excess substances into filtrate
Term
What is the function of the kidneys?
Definition
-maintains fluid & electrolyte balance
-disposal of water-soluble wastes
-EPO production
-vitamin D activation
-20% total glucose production
Term
End product of muscle metabolism excreted by the kidneys. Reflects GFR and used to test for ARF.
Definition
Serum creatinine
Term
For every doubling of serum creatinine, there is a _____ decr in GFR
Definition
50%
Term
Increased creatinine means _____ renal function
Definition
Worse/decreased
Term
Serum creatinine is relatively constant, unless there is _____
Definition
Muscle breakdown
Term
When is creatinine clearance test unreliable?
Definition
When GFR is low
Term
End product of protein metabolism used to test for ARF
Definition
Blood Urea Nitrogen (BUN)
Term
BUN _____ as GFR decr
Definition
Incr
Term
BUN _____ with liver disease
Definition
Decr
Term
BUN _____ with incr protein intake
Definition
Incr
Term
BUN _____ with decr fluid intake/dehydration
Definition
Incr
Term
BUN _____ with decr fluid intake/dehydration
Definition
Incr
Term
Bacterial counts greater than _____ in urinalysis indicate UTI
Definition
10,000/mL
Term
Test for kidney stones
Definition
Kidney-Ureter-Bladder (KUB)
Term
Why does KUB work?
Definition
90% of stones are radiopaque and can be seen on x-ray
Term
Used to breakup stones so they can be passed
Definition
Shockwave lithrotripsy
Term
Often elevated in presence of prostate cancers and other prostate disorders
Definition
PSA (Prostate Specific Antigen)
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