Term
| what is the normal lenght of kidney? and what are three layers surronding kidney? |
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Definition
renal capsule, adipose capsule and renal fascia.
10-12 cm |
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Term
| what is the first step of urine produciton? |
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Definition
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Term
| what are 3 components of filtration membrane? (layers) |
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Definition
Glomerular endothelial
basal lamina
slit membrane of filtration slits |
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Term
| what is the normal net filtration pressure? |
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Definition
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Term
| what are two main GFR regulation mechanisms |
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Definition
control blood flow in and our of glomerular
or
control glomerular surface area via contraction or relaxation of mesangial cell |
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Term
| when ADH is produced in excess what is it called? |
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Definition
| syndrome of inappropriate ADH (SIADH) |
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Term
| what are the clinical menifestation of SIADH? |
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Definition
| There is resorption of excessive amounts of free water, with resultant hyponatremia. The clinical manifestations of SIADH are dominated by hyponatremia, cerebral edema, and resultant neurologic dysfunction |
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Term
| if kidney is less than 9 cm then...what should be suspected. |
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Definition
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Term
| what should be suspected when hydronephrosis is seen in US? |
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Definition
| obstruction like prostate enlargement |
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Term
| what is the dx test for ADPKD> |
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Definition
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Term
| for renal stone which test is best? |
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Definition
| Noncontrast helical CT to detect renal stones is 95% sensitive and 98% specific in pts presenting with acute flank pain |
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Term
| for difinitive stating of renal neoplasms what test ..ct or us |
|
Definition
| CT: Definitive role in staging renal neoplasms, and imaging kidneys following trauma |
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Term
| to visualize renal cortex and medulla. + to stage renal cell carcinoma |
|
Definition
MRI :
Loss of corticomedullary function (GN, hydronephrosis, renal vascular occlusion, renal failure) will be evident on MRI |
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|
Term
| most sensitive test for renal artery stenosis? |
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Definition
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Term
| what is VCUG? and what is it used for? |
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Definition
Voided Cystourethrography.Preferred method for eval of urinary reflux
Consider for any child who presents with UTI prior to toilet training, because reflux results in significant, permanent scarring. If dx…tx with long-term antibx – cover for E. coli
mostly used in peds who gets freq uti. |
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Term
| what is one half of total urinary solids? and what is the serum marker for that substance? |
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Definition
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Term
| BUN normal value? when does it inc? |
|
Definition
8-20 mg/dl
Usually increased with acute and chronic renal failure, and urinary obstruction
other causes Increased with dehydration, reduced renal perfusion (CHF, hypovolemia), increased dietary protein, and accelerated catabolism (fever, trauma, GI bleeding), steroids, tetracycline |
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Term
| what is the serum marker for estimating GFR? |
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Definition
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Term
| is creatinine reabsorbable? what is it anyways? |
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Definition
| Is a product of muscle metabolism produced at a relatively constant rate and cleared by renal excretion. It is freely filterable by the glomerulus and not reabsorbed/secreted by the renal tubules |
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Term
| when does creatinine inc? |
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Definition
Usually increased with acute or chronic renal failure, and urinary tract obstruction
May also be increased with increased cooked meat intake, increased muscle mass, and meds such as cephalosporins, cimetidine, probenecid, and trimethoprim |
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Term
| what is most commonly used to estimate GFR? and what is the gold standard for GFR |
|
Definition
MC: creatinine clearance.
Gold S.: Glomerular filtration rate is measured by determining the plasma concentration and excretion of a marker substance. |
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Term
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Definition
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|
Term
| if GFR is between 30-59? less than 15? |
|
Definition
<15: kidney failure
30-59: moderate dec in filtration rate |
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|
Term
| what is the formula for cr clearance? |
|
Definition
Ccr = (140-age) x weight (kg)
_______________________
Pcr x 72 |
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Term
| what is the name of formula that calculates the amount of sodium actually excreted by body relative to amount filtered by kidneys? |
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Definition
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Term
| wht do you tell the pt when collecting urine sample? |
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Definition
| first morning void and mid-stream |
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Term
| what is the normal Specific gravity and wht is the significance? |
|
Definition
Gives important insight into hydration status and concentrating ability of kidneys
Normal range: 1.003-1.030 |
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Term
| if you trace nitrites in the urine what do you suspect? and leukocyte esterase? |
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Definition
Many gram-neg bacteria can reduce nitrate to nitrite, which is thus an indicator for bacteriuria
Leukocyte esterase: enzyme produced by neutrophil |
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|
Term
| when is pyuria suspected? |
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Definition
| Presence of > 5 leukocytes per high power field is considered significant pyuria |
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|
Term
| what is the function of tamm-horsfall mucoprotein? |
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Definition
| thy are uromodulin: Uromodulin may act as a constitutive inhibitor of calcium crystallization in renal fluids. Excretion of uromodulin in urine may provide defense against UTIs. |
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Term
| what kind of cast is seen that indicates intraparenchymal bleeding? |
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Definition
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|
Term
| what kind of cast characteristic for pyelonephritis and useful in distinguishing this d/o from lower tract infection? |
|
Definition
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Term
| what type of cast do you see in acute tubular necrosis? when do you see granular casts? |
|
Definition
Tubular cell casts
granular casts: Consist of finely or coarsely granular material. Nonspecific, but usually pathologic. Can be seen in ATN, GN, or tubulointerstitial dz |
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|
Term
| what casts: Form in tubules that have become dilated and atrophic due to chronic parenchymal dz. Freq. seen in CRF |
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Definition
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Term
| define Acute renal failure. |
|
Definition
| A condition in which the glomerular filtration rate is abruptly reduced, causing a sudden retention of endogenous and exogenous metabolites (urea, potassium, phosphate, sulfate, creatinine, administered drugs) that are normally cleared by the kidneys |
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|
Term
| out of pre,post and intrinsic renal, which one is MC cause of renal failure. |
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Definition
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|
Term
| what happen if hypoperfusion of kidney is not restored back? |
|
Definition
If immediately reversed with restoration of blood flow, renal parenchymal damage
does not occur
If hypoperfusion persists, ischemia can result, causing intrinsic renal failure |
|
|
Term
| Decreased renal perfusion can occur in one of three ways -- what are they? |
|
Definition
Decrease in intravascular volume
Change in vascular resistance
Low cardiac output |
|
|
Term
| would urine sodium be less or more in prerenal asotemia? |
|
Definition
|
|
Term
| when does postrenal azotemia occure? |
|
Definition
Occurs when urinary flow from both kidneys, or a single functioning kidney, is obstructed…usually a urologic problem
Each nephron has an elevated intraluminal pressure, causing decrease in GFR |
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Term
| MC cause of postrenal azotemia in men/ |
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Definition
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|
Term
pt is polyuric and c/o lower abdominal pain. PE showed distended bladder, and mass palpable with pelvic exam.
what kind of renal failure. pre, post or intrinsic. |
|
Definition
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|
Term
| FEna and Una for post renal azotemia would be? |
|
Definition
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|
Term
| intrinsic renal disease account for what? |
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Definition
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|
Term
| what are 4 sites that could be injured in intrinsic renal diease? |
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Definition
Sites of injury are the tubules, interstitium, vasculature, and glomeruli.
Three examples are acute tubular necrosis, acute interstitial nephritis, and acute glomerulonephritis. |
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Term
| this pt present with acute renal insufficiency and has granular casts with some epithelial cells in urine sedimentation. what do you think he has? |
|
Definition
Acute tubular necrosis. pt may have hx of toxin exposure.
Pts may present with generalized swelling, n/v, oliguria, decreased LOC, anorexia, muscle weakness. Check for pulm. edema |
|
|
Term
| what are two major causes of Acute tubular necrosis? |
|
Definition
| ischemia and nephrotoxin (endogenous or exogenous) |
|
|
Term
| in which cases ischemic acute tubular necrosis happens? |
|
Definition
Ischemia
Causes tubular damage from states of low perfusion and is often preceded by a state of prerenal azotemia. Ischemic ARF characterized not only by inadequate GFR but also by renal blood flow inadequate to maintain parenchymal cellular formation. Occurs in setting of prolonged hypotension or hypoxemia such as dehydration, shock, sepsis, major surgery, or trauma |
|
|
Term
give me name of
antibiotic
antineoplastic
heavy metal
and other 3 causes of exogenous nephrotoxins |
|
Definition
Exogenous nephrotoxins
Aminoglycosides, Vancomycin, and several cephalosporins
Radiographic contrast media
Cyclosporin
Antineoplastics, such as cisplatin
Heavy metals, such as mercury, cadmium, and arsenic |
|
|
Term
| what are some endogenous toxins that could casues Acute tubular necrosis? |
|
Definition
Endogenous nephrotoxins
Heme-containing products
Myoglobin, hemoglobin
Uric acid
Paraproteins
Bence Jones |
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|
Term
| muddy brown casts main noticed in? |
|
Definition
| acute tubular necrosis: in urine smapleHyperkalemia and hyperphosphatemia common |
|
|
Term
| what happens in maintenance phase of A. tubular necrosis? |
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Definition
| Maintenance phase is either oliguric or nonoliguric. Nonoliguric ATN has better outcome. This phase is 1-3 wks. Cellular repair and removal of debris occur |
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|
Term
| why do people die from A. tubular necrosis? |
|
Definition
Mortality rate varies 20-70%
Most common cause of death is infection |
|
|
Term
| what are two major causes of Chronic renal failure? |
|
Definition
|
|
Term
| isosthenuria and broad casts are mainly noticed in what disease? |
|
Definition
| CRF -- on US: Bilateral small kidneys |
|
|
Term
| what is the GFR and how long it should be at that level to consider chronic renal failure? |
|
Definition
| GFR < 60 mL/min for 3 or more months |
|
|
Term
| what other than DM and HTN could cause CRF? |
|
Definition
| Other causes:GN, cystic diseases, and other urologic diseases account for another 12% |
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|
Term
| pt present with fatigue, malaise, and weakness. he also has metallic taste with uremic fetor (fishy breath) and hiccups with weight loss of 20 lbs over last yr. what could he have? |
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Definition
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|
Term
on lab value for UA you notice
GFR of <60 with waxy casts and broad casts.
+ protein
elevated BUN/crn
what must be in our DDx |
|
Definition
|
|
Term
| what lab value could be same for ARF and CRF? |
|
Definition
May see anemia, metabolic acidosis, hyperphosphatemia, hypocalcemia, and hyperkalemia…with both ARF and CRF
Further eval needed to differentiate between ARF and CRF
Evidence of previously elevated BUN and creatinine, abnormal prior UA, and stable but abnormal serum creatinine on successive days is most consistent with a chronic process |
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|
Term
what could be seen on EKG for Hyperkalemia
? |
|
Definition
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|
Term
| what is the MC complication of ESRD? |
|
Definition
HTN - tx -> control salt and H2O intake.
ACEI or ARB
goal BP <130/80 --if + protein uria,125/75 |
|
|
Term
| what kind of anemia could CRF pt present with? |
|
Definition
Normochromic, normocytic
Due to decreased erythropoiesis and RBC survival |
|
|
Term
| what kind of neurologic sx CRF present with? |
|
Definition
Uremic encephalopathy does not occur until GFR falls below 10-15 mL/min
Symptoms begin with diff. concentrating and can progress to lethargy, confusion, and coma
Neuropathy found in 65% of pts on or nearing dialysis but not until GFR is 10% of normal |
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|
Term
| what is the MC mineral metabolism D/O in CRF? |
|
Definition
| Most common d/o is osteitis fibrosa cystica – the bony changes of secondary hyperparathyroidism…affecting 50% of pts nearing ESRD |
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|
Term
| when should dialysis be started on CRF pt? |
|
Definition
Dialysis should be started when pt has GFR of 10 mL/min or serum creatinine of 8 mg/dL
Diabetics should start when GFR reaches 15 mL/min or serum creatinine is 6 mg/dL
Uremic symptoms such as pericarditis, encephalopathy, or coagulopathy
Fluid overload unresponsive to diuresis
Refractory hyperkalemia…>7
Severe metabolic acidosis (pH < 7.20)
Neurologic symptoms such as seizures or neuropathy |
|
|
Term
| what is the MC complication of peritoneal dialysis? |
|
Definition
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