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Systemic Dx Exam 3 KidneyDz
Lingel
59
Medical
Graduate
03/16/2011

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Cards

Term
What is the most common cause of kidney failure?
Definition
DM (40%)
Term
What is a second most common cause of kidney failure?
Definition
hypertension
Term
How much kindey fxn can be lost before sx develop?
Definition
80-90%
Term
When is pain felt during kidney failure/dx?
Definition
Only if stretching of renal fascia or muscular contraction of ureters
Term
What % of pt's have a GFR of 50-60 mL/min that are diagnosed by primary care physician?
Definition
18.00000%
Term
What is the threshold for kindey dx to be considered chronic?
Definition
3 mo
Term
What are the three general locations for kidney failure to act?
Definition
pre-renal - burns, blood loss, other systemic problem leads to kidney dysfunction

intrinsic - the kidney itself is the cause, perhaps with the medulla or tubules, etc. Even with normal bloodflow, still going to fail

post-renal - kidney stones, fluid backup due to blockage downstream
Term
What are common first s/sx of kidney dx?
Definition
HTN, pulmonary edema, HA, swelling of legs, nausea and vomiting, Weight loss, itching, cognitive impairment, tendency to bleed,
Term
What kidney dx s/sx are related to fluid balance problems?
Definition
HTN, swelling of legs, pulmonary edema
Term
What kidney dx s/sx are due to increased levels of urea, ions, and other waste products?
Definition
Fatigue, HA, weight loss, nausea and vomiting, cognitive fxn loss
Term
What causes itching in kidney dx?
Definition
phosphorus levels increase
Term
What are the s/sx of chronic kidney dx (CKD)?
Definition
<10mL/min GFR
Term
What products are increased in the system with decreased kidney fxn?
Definition
hormones and nitrogenous wastes
Term
What products are decreased in the system with kidney fxn loss?
Definition
EPO
Term
What is azotemia?
Definition
if the pt has s/sx of uremia
Term
Which organs are affected by CKD?
Definition
every system in the body
Term
What does CKD do to the skin?
Definition
increased pigmentation due to hormonal changes, and pruritis
Term
What does renal osteodystrophy cause systemically?
Definition
hyperparathyroidism --> calcitrol, osteosclerosis, osteomalacia, muscle weakness
Term
What is nocturia?
Definition
urinating at night
Term
What is polyuria?
Definition
incrased urination
Term
What is uremic frost?
Definition
Ca Sulfate and phosphate precipitate in the sweat, ODIFEROUS, smells like a porta potty, yellow discoloration of skin
Term
What is ESRD?
Definition
End stage renal dx
Term
Who is most prone to kidney dx?
Definition
8x greater in blacks
Term
What is the threshold for ESRD?
Definition
kidney fxn < 20%
Term
What is the main cause of death with impaired kidney fxn?
Definition
cardiovascular death, stroke
Term
How many people are affected by ESRD per yr in the US?
Definition
35k
Term
What is ARF?
Definition
Acute renal failure
Term
what are some causes of ARF?
Definition
hemorrhaging, shock, infections, autoimmune dx, meds
Term
What are s/sx of ARF?
Definition
loss of regulatory, excretatory, and endocrine fxn of kidney
Term
What % of pt's will fully recover from ARF if properly treated?
Definition
90.00000%
Term
What can pregnancy sometimes cause in the kidney?
Definition
Acute renal failure
Term
What is the most common cause of ARF?
Definition
acute tubular necrosis
Term
What is the onset of declined GFR in ATN?
Definition
minutes to days
Term
What causes ATN?
Definition
acute ischemic or nephrotoxic insult
Term
What tissue is destroyed in ATN?
Definition
tubular epithelial cells --> decreased ion transport
Term
Where do the destroyed epithelial cells go in ATN?
Definition
clog the tubules causing damaged vasculature from increased pressure
Term
What is the result of damaged vasculature in the kidney?
Definition
vasoconstriction, reduced urine volume, increased waste products in the blood
Term
What happens to endothelin, nitric oxide and PG levels in ATN?
Definition
increased endothelin, decreased PG and nitric oxide --> vasoconstriction
Term
What feedback loop causes reduced urine in ATN?
Definition
renin production increases --> less urine
Term
What is malignant hypertension?
Definition
uncommon form of HTN, medical emergency
Term
What is the tx of malignant hypertension?
Definition
immediate and aggressive anti-HTN therapy
Term
What are the s/sx of malignant hypertension?
Definition
BP > 120 mmHg, ONH edema, scotoma, encephalopathy, renal failure, CV (cardiovascular) abnormalities
Term
What is the pathophysiology of malignant hypertension?
Definition
vascular damage to kidney --> increased permeability of small vessels --> fibrosis of vessels --> narrowing of vessel lumun --> ischemia of kidney --> renin release --> even further vasoconstriction
Term
What are specific mechanism for meds to cause ARF?
Definition
Type 1 and Type IV hypersensitivity (hapten), med causes toxicity
Term
What can cause ARF through medication toxicity?
Definition
aminoglycosides cause 10% of pt's to have nephrotoxicity
Term
What is the timing of ARF onset after aminoglycoside regimens are started?
Definition
1 week
Term
What is the prognosis for ARF due to aminoglycoside nephrotoxicity?
Definition
very good change for recovery
Term
What cause of ARF is NOT dose related?
Definition
Type 1 and Type IV hypersensitivity
Term
What cause of ARF IS dose related?
Definition
aminoglycosides
Term
What can NSAID's cause in the kidney?
Definition
decreased PG --> vasoconstriction --> ARF
Term
What can radiographic contrast agents cause in the kidney?
Definition
ARF in up to 76% of pt's who take it
Term
What are risks for taking radiographic contrast agents?
Definition
pt's with pre-existing renal insufficiency
Term
What is a common precaution taken when using radiographic contrast agents?
Definition
IV to prevent dehydration
Term
Can radiographic contrast agents cause hypersensitivity rxns?
Definition
yes
Term
What dz's are related to glomelular dysfunction?
Definition
nephrotic syndrome, nephritic syndrome, membranoprolifereative glomerulonephritis
Term
What are s/sx of nephrotic syndrome?
Definition
massive proteinuria, edema (eyelids first), hypoalbuminemia, hyperlipiduria and hyperlipidemia
Term
What is nepthrotic syndrome?
Definition
derangement of glomelular capillary walls
Term
What causes the body to produce increased plasma proteins and lipoproteins?
Definition
hypoalbuminuria due to nephrotic syndrome
Term
What is pitting edema?
Definition
If skin is depressed manually, it will remain depressed after removing the source of pressure.
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