Term
|
Definition
| reabsorption of substances from the tublule into the capillaries of the peritubular network |
|
|
Term
| What are the nephrons 3 primary functions |
|
Definition
1) Filtration
2) Reabsorption
3) Secretion |
|
|
Term
|
Definition
| Removal of waste products via the glomerulus to Bowman's Capsule |
|
|
Term
|
Definition
| Removal of waste products from the peritubular network into the tubules |
|
|
Term
| What is the RSL? (Renal Solute Load) |
|
Definition
| Measure of the concentration of particles in a soln that the kidneys must excrete |
|
|
Term
| What is the function of the distal tubule? |
|
Definition
| Final modification of filtrate |
|
|
Term
| What does the glomerulus allow through and what doesn't it allow through? |
|
Definition
Allows: fluid, electrolytes and glucose
Prevents: plasma proteins and RBC's |
|
|
Term
| What are the kidneys in charge of regulating? (7) |
|
Definition
1) Acid-base chemistry
2) Calcium-phosphrous ratio
3) Na
4) K
5) Cl
6) Fluid
7) Blood pressure |
|
|
Term
| What are the 5 components of a nephron? |
|
Definition
1) Glomerulus
2) Proximal convoluted tubule
3) Loop of henle
4) distal tubule
5) Collecting Duct |
|
|
Term
| What is the function of the proximal convoluted tubule? |
|
Definition
| Primary site for reabsorption of filtered substances |
|
|
Term
| What are the products that are excreted at the end of protein metabolism? (from the kidney) |
|
Definition
| Urea, uric acid, phosphate, sulfate, creatinine, and organic acids |
|
|
Term
| What is the function of the glomerulus? |
|
Definition
| Filtering section of the nephron |
|
|
Term
| What is the function of the Loop of Henle? |
|
Definition
| same reabsorption of H20 and NaCl |
|
|
Term
| The kidneys degrade and excrete what circulating hormones? |
|
Definition
| GH, insulin, glucagon, PTH, and gastrin |
|
|
Term
| How do the kidneys regulate the acid-base balance? |
|
Definition
-by regenerating and conserving HCO3- and eliminating H+
-regulate by excreting ammonium ion (increases in acidosis) |
|
|
Term
| What is the GFR? (glomerular filtration rate) |
|
Definition
| amount of filtrate formed/minute = sum of filtration rates of all functioning nephrons ( |
|
|
Term
| What is the function of the collecting duct? |
|
Definition
| regulates amount of H20 in final urine |
|
|
Term
| What has the greatest effect on renal solute load? (4) |
|
Definition
|
|
Term
| What happens when there is an increase in serum ionized Ca? |
|
Definition
|
|
Term
| What happens when there is a decrease in serum ionized Ca? |
|
Definition
|
|
Term
| When sodium is low (hyopnatremia), what hormone is released? |
|
Definition
|
|
Term
| What happens when there is a deficient ECF (volume contraction)? |
|
Definition
1) increase in plasma osmolality
2) ADH secretion by posterior pituitary
3) increased perm. of distal tubule and collecting duct
4) Increased H20 reabsorption (antidiuresis)and decrease in urine volume |
|
|
Term
| When arterial BP is low, what system works to increase BP? |
|
Definition
| Renin-angiotensin-aldosterone system |
|
|
Term
| What do ACE inhibitors do? |
|
Definition
| decrease BP by altering the enzyme therefore not much angiotensin II is being produced |
|
|
Term
| What does ANP do? (broad) |
|
Definition
| Decreases reabsorption of Na in the distal tubule and collecting duct (increases Na excretion) |
|
|
Term
| What does Angiotensin II do? (4 things) |
|
Definition
1) mediates renal Na retention by stimulating aldosterone secretion
2) stimulates Na reabsorption at kidney
3) stimulates ADH secretion and thirst
4) stimulates arterlolar vasoconstriction, which increases BP |
|
|
Term
| What does ANP do when it comes to ECF volume expansion? |
|
Definition
1) acts on kidneys to inhibit renin secretion and to inhibit Na reabsorption
2) acts on adrenals to inhibit aldosterone secretion
3) acts on post. pituitary to inhibit ADH secretion
4) causes vasodilation and decrease BP |
|
|
Term
| How does the Kallikrein-Kinin system work? |
|
Definition
Brings down BP
-Kallikrein converts circulating kininogen to bradykinin |
|
|
Term
| What does aldosterone do? |
|
Definition
| increase Na reabsortpion and decrease Na excretion |
|
|
Term
|
Definition
| converts angiotensinogen to angiotensin I |
|
|
Term
| How does ACE act to raise BP? |
|
Definition
1) ACE activates angiotensin II and at the same time
2) acts as a kininase - inactivating bradykinin |
|
|
Term
| What is bradykinin and what does it do? |
|
Definition
| a peptide that acts as a potent vasodilator - lowers BP |
|
|
Term
| When sodium is high (hypernatremia), what hormone is released? |
|
Definition
| Atrial natriuretic peptide (ANP) |
|
|
Term
| When serum K (hyperkalemia) increases, what happens? |
|
Definition
Stimulation of aldosterone secretion
-aldosterone stimulates K+ uptake into cells and increases K excretion |
|
|
Term
| What happens when there is an excess ECF (volume expansion)? |
|
Definition
1) decrease in plasma osmolality
2) inhibition of ADH secretion
3) decrease perrmeablity of distal tubule and collecting duct
4) decrease H20 reabsorption and increase urine volume |
|
|
Term
| When arterial BP is high, what system brings BP down? |
|
Definition
|
|
Term
| What is Acute Renal Failure? |
|
Definition
abrupt decline in renal function, reflected by a sudden reduction in GFR, sufficient to result in rapid, steadily increasing retention of nitrogenous wastes (azotemia)
(with or without oliguira, short duration) |
|
|
Term
| What are the 3 causes of Acute Renal Failure? |
|
Definition
1) Prerenal
3) Intrinsitc (intrarenal)
3) Postrenal |
|
|
Term
| What are the prerenal causes of acute renal failure? |
|
Definition
-Circulatory collapse
-Severe dehydration
-Obstruction of renal arteries |
|
|
Term
| What are the postrenal causes of acute renal failure? |
|
Definition
CA of the bladder or prostate
Benign prostatic hypertrophy
Renal calculi or strictures |
|
|
Term
| What are the intrinsic (intrarenal) causes of acute renal failure? |
|
Definition
Acute tubular necrosis
Acute glomerulonephritis |
|
|
Term
| What are the top 2 causes of acute renal failure? |
|
Definition
| Circulatory collapse and acute tubular necrosis |
|
|
Term
| What is the cause of circulatory collapse in acute renal failure? |
|
Definition
| Blood flow not going to the kidney due to liver failure, cardiac failure, septic shock, burns and hemorrhage |
|
|
Term
| What is the cause of acute tubular necrosis in acute renal failure? |
|
Definition
| Due to trauma, surgery, sepsis, nephrotoxin exposure (antibiotics, contrast agents, and other drugs) |
|
|
Term
| What is mortality in patients with ARF typically due to? |
|
Definition
| severe infection or cardiopulmonary complications |
|
|
Term
| What are some factors that have been associated with worse prognosis in ARF? |
|
Definition
| Older age, previous health status, Pre-ICU hospitalization, sepsis, severity of illness (including need for ventilation) |
|
|
Term
| What are some clinical manifestations of AFR? |
|
Definition
| Decreased GFR with progessive azotemia (increase BUN and CR per day and also with severe catabolism) |
|
|
Term
| What are some common observations with ARF? |
|
Definition
Electrolyte abnormalities
Metabolic acidosis
Excessive protein catabolism
Insulin resistance and glucose intolerance |
|
|
Term
| What are the three phases that ARF may progress through? |
|
Definition
1) Anuric or oliguric phase
2) Diuretic phase
3) Recovery phase |
|
|
Term
| What is the anuric or oliguric phase of ARF characterized by and how long does it last? |
|
Definition
-Hematuria, proteinuria, abnormal fluid/electrolytes, typically requires renal replacement therapy
-Duration - 10 to 14 days |
|
|
Term
| What is the diuretic phase of ARF characterized by and how long does it last? |
|
Definition
urine output increases but reabsorptive capacity remains low
BUN and Cr remain high
Excessive losses of Na, K, and fluid
Duration - 10 days |
|
|
Term
| What is the recovery phase of ARF and how long does it last? |
|
Definition
Duration: 3 months to 1 year
although loss of function maybe permanent, renal function completely normalizes in most pts within 4 to 6 months |
|
|
Term
| Is kidney function reversible or irreversible in ARF? |
|
Definition
|
|
Term
| How is a donor selected in a renal transplant for CKD? |
|
Definition
ABO blood typing - need to be same blood type
Human leukocyte antigen (HLA) tissue typing |
|
|
Term
| What is Graft-vs-Host Rejection in a renal transplant for CKD? |
|
Definition
| A immune response against the transplated kidney - can occur anytime after renal transplantation |
|
|
Term
| What are the different types of Graft-vs-Host Rejection? |
|
Definition
1) Hyperacute rejection
2) Acute rejection
3) Chronic rejection |
|
|
Term
| What happens during hyperacute rejection? |
|
Definition
happens immediately post-op
transplanted kidney is rapidly destroyed as a result of preformed antibodies in the host that quickly recognize the graft as foreign |
|
|
Term
| What happens in acute rejection? |
|
Definition
happens during the first 3-4 months post-op
lymphocytes infiltrate and destroy the graft |
|
|
Term
| What is the management for ARF? |
|
Definition
| diganose and remove underlying cause |
|
|
Term
| What are indications for RRT (renal replacement therapy)? |
|
Definition
| Severe acidosis, severe hyperkalemia, marked azotemia, marked overhydration, uremic symptoms |
|
|
Term
| Two types of RRT that are used |
|
Definition
Intermittent hemodialysis (IHD)
Continuous renal replacement therapy (CRRT) |
|
|
Term
| Advantages of CRRT over IHD |
|
Definition
-superior uremic and metabolic control
- improved hemodynamic stability and gas exchange
- better tolerated if hypotensive
- better fluid control
- facilitation of sufficient NS w/o the need for protein, fluid and electrolyte restrictions b/c mimics the kidney
- improved renal recovery
- better outcomes |
|
|
Term
|
Definition
- Increased immediate costs (RN staffing)
- need for continuous anticoagulation therapy
- patient immobility - stuck in bed |
|
|
Term
| What are some goals of nutritional management of ARF? |
|
Definition
-maintenance or improvement of nutritional status w/o exacerbating metabolic derangements
-reverse protein catabolism
-min. uremic symptoms
-maintain fluid/electrolyte balance
-correct metabolic acidosis
-enhance wound healing
-support optimal resistance to infection
- reduce mortality |
|
|
Term
| ARF - energy needs and measurement |
|
Definition
indirect calorimetry is best - up to 130% of REE
Increased energy needs depending on stress degree |
|
|
Term
|
Definition
| depends on what type of dialysis or treatment they are on however, N balance studies are not practical |
|
|
Term
|
Definition
| Individualized restrictions |
|
|
Term
|
Definition
|
|
Term
| ARF - Potassium (glucose and insulin) |
|
Definition
Individualized
-Watch K levels when giving insulin, insulin drives an anabolic shift of K |
|
|
Term
|
Definition
|
|
Term
| What is Nephrotic Syndrome? |
|
Definition
heterogeneous combination of symptoms associated with other diseases
- a predictable complex that follows a severe, prolonged increase in glomerular permeability for protein |
|
|
Term
| What are renal contributors to nephrotic syndrome? |
|
Definition
| Chronic glerulonephritis, intercapillary glomerulosclerosis, IgA nephropathy, Lipoid nephrosis of childhood |
|
|
Term
| What are systemic contributions of nephrotic syndrome? |
|
Definition
| Diabetes mellitus, SLE, infection and neoplasms |
|
|
Term
| What are some clinical manifestations of Nephrotic Syndrome? |
|
Definition
Proteinuria
Hypobalbumineima w/consequent edema
Hyperlipidemia
Hypocalcemia
Anorexia, weakness, muscle wasting |
|
|
Term
| What are some mechanisms for hyperlipidemia in nephrotic syndrome? |
|
Definition
-Increased VLDL duce to increased TG synthesis and decreased LPL
-Increased excretion of HDL in the urine
-Albumin normally binds FFA's, w/hypoalbumenia , FFA's increase in circulation, inhibits LPL, and serum VLDL increases |
|
|
Term
| What are the 4 types of edema (massive) that can occur during Nephrotic Syndrome? |
|
Definition
1) Anasarca (whole body)
2) Pleural effusion (fluid in lungs)
3) Periorbital (tissue around eyes)
4) Pedal edema (ankles - painful)
massive due to low albumin levels |
|
|
Term
| What are the systemic causes of CKD? |
|
Definition
| Diabetes mellitus and Hypertension |
|
|
Term
| What are the renal causes of CKD? |
|
Definition
Chronic glomerulonephritis
Pyelonephritis
Polycystic kidney disease |
|
|
Term
| What are some progression promoters causes in CKD? |
|
Definition
| Systemic hypertension, glomerular hypertension, proteinuria, hyperlipidemia, dietary protein, dietary phosphate, interstital nephritis |
|
|
Term
|
Definition
| accumulation in the blood of abnormal quantities of N wastes |
|
|
Term
|
Definition
a marker of toxicity, not a disease
A clinical syndrome of malaise, weakness, N/V, muscle cramps, itching, metallic taste in mouth, neurological impairments brought on by azotemia |
|
|
Term
|
Definition
| as either kidney damage or GFR less than 60ml/min for more than three months |
|
|
Term
| How is kidney damage defined? |
|
Definition
| as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies |
|
|
Term
| What are some elevated lab findings in someone with CKD? |
|
Definition
|
|
Term
| What are some decreased lab findings in someone with CKD? |
|
Definition
| GFR, hemoglobin, Hematocrit, serum Ca and HCO3, blood pH |
|
|
Term
| What are some clinical manifestations of uremia (stage 5 CKD)? |
|
Definition
BUN greater than 100mg/dL and Cr greater than 10mg/dL
CNS, hematopoietic, dermatologic, cardiovascular, gastrointestinal, and skeletal |
|
|
Term
| What are some goals of Predialysis management? |
|
Definition
-Control uremic symptoms and complications
-Minimize tissue catabolism
-Maintain electrolyte balance
-Minimize osteodystrophy
-Correct acidosis
-Maintain growth
-Limit further renal impairment;postpone dialysis |
|
|
Term
| Do you want to restrict protein during predialysis in CKD? Why or why not? |
|
Definition
| Yes! to minimize retention of N wastes, minimize glomerular hyperfiltration, limit acidosis |
|
|
Term
| What stages is microalbumuria present? |
|
Definition
|
|
Term
| What stages is macroalbumuria present? |
|
Definition
|
|
Term
| Why are HBV (high biological value) proteins used for predialysis in CKD? |
|
Definition
| Provide essential AA for tissue synthesis but limit nonessential AA which contribute to accumulate of N waste |
|
|
Term
| Which proteins are considered HBV? |
|
Definition
| eggs, meat, poultry, fish |
|
|
Term
| Energy needs in predialysis - CKD |
|
Definition
repletion values, adjust for edema-free wt if less than 95% or greater than 115% of std wt
malnutrition is common
high fat, increased MUFA and complex CHO (not a lot though) |
|
|
Term
| What are some issues to consider for energy in predialysis - CKD |
|
Definition
Alterations in glucose homeostasis (insulin resistance, ppl w/type 1 may require less insulin)
Hypertriglyceridemia (increased production of TG in liver, decreased activity of LPL, impaired catabolism of lipoproteins) |
|
|
Term
| Does fluid need to be restricted in predialysis - CKD? |
|
Definition
| unnecessary until later stages of CKD |
|
|
Term
| Predialysis - CKD: Sodium |
|
Definition
| restrict when retaining Na unless a salt loser |
|
|
Term
| Predialysis - CKD: Potassium |
|
Definition
| usually unrestricted until late stages (5) |
|
|
Term
| Predialysis - CKD: Magnesium |
|
Definition
| not necessary until in renal failure |
|
|
Term
| What is renal osteodystrophy? |
|
Definition
High phosphorus and low calcium - causes hyperphoshatemia, hypocalcemia, vit d deficiency
driven by secondary hyperparathyroidism |
|
|
Term
| What is the role of parathyroid hormone (PTH) under normal conditions? |
|
Definition
-released in response to low serum Ca and high serum K
-Stimulates bone resorption of Ca (release of ca from bone)
- stimulates renal reabsorption of ca and renal activation of vit d which acts to increase GI absorption of Ca
-stimulates renal excretion of phosphate
-net result: normalization of serum Ca and P balance |
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