Exam IV: Chapter 26, 27, 28, 29 Pathophysiology
what is the role of the kidney in fluid, electrolyte, and acid-base balance?
kidneys participate in acid-base regulation through secretion of excess hydrogen ions and reabsorbing and creating bicarbonate. Urine buffers HPO4 and NH3 bind to excess hydrogen ions and increase the ability of kidney to excrete the additional acid.
Serious renal impairment generally does not occur until ____ of the total nephrons have been damaged.
80%
Counter current exchange in the ____________________allows the kidneys to preserve a hyperosmotic interstitial fluid through the passive movement of solutes and water.
loop of henle
The oliguric stage of Acute Kidney Injury is characterized by?
oliguria and progressive uremia and decreased GFR. hypervolemia
Urine movement is due to _______ movement of the ureters
peristaltic
Primary dysfunction in the nephrons along with dysfunction in renal tubules or glomerular is indicative of what?
acute kidney injury
what is the most common cause of acute kidney injury?
acute tubular necrosis
Blood enters the glomerulus through the _________ arteriole
afferent
Where can obstruction of urinary tract occur?
at any point
The process that maintains blood flow when arterial blood pressure changes is called
autoregulation
what are risk factors of pyelonephritis?
pregnancy, diabetes mellitus, anatomical abnormalities of urinary tract and obstructive causes because pyelonephritis is typically due to Upper UTI
AKI is classified into three types according to the site of disruption:
prerenal, postrenal, and intrinsic
what is indicative of an upper UTI?
presence of WBC
where does reabsorption of glucose occur?
proximal tubule
T/F: aldosterone increases sodium, water and potassium reabsorption
false: aldosterone increases sodium and water reabsorption. potassium flows oppositely of sodium
very young and very old that have decreased renal function are at increased risk for a. concentrating urine b. fluid and electrolyte imbalance c. increased WBC d. drug toxicity
fluid and electrolyte imbalance and drug toxicity
mixed incontinence
form of stress and other stuff *****
How is blood supplied to the kidney's?
renal artery
What is the cortex composed of?
glomeruli and nephron tubules
Filtration occurs at the
glomerulus
uric acid calculi can be caused by hyperuricosuria associated with:
gout, acute leukemia, excessive intake of meat, fish and poultry, obesity or type II diabetes mellitus
glomerular damage can be due to
hematuria, proteinuria, abnormal casts, decreased GFR, edema and hypertension
Glomerular filtration rate is greatly influenced by glomerular capillary _____________pressure.
hydrostatic
proteinuria leads to:
hypoalbuminemia and generalized edema as a result of decreased blood colloid osmotic pressure
cortical micturition centre is______________
in charge of delivering message by conscious control
UTI is typically diagnosed by:
increase in WBC and RBC in urine
complete obstruction results in hydronephrosis, what causes decreased GFR and ischemic kidney damage?
increased intraluminal pressure.
acute glomerulonephritis is caused by
infection
what is cystitis?
inflammation of the bladder lining
What regulates blood supply as well as renin release?
the kidney
how are solutes and water transported across renal tubular epithelium?
the two routes: transcellular and paracellular. Transcellular uses apical and basolateral membranes of tubular cells to move substances from filtrate to interstitium. Paracellular allows passive transport of ssubstances between tubular cells
how are neoplasms detected?
ultrasound and CT scan
crescentic glomerulonephritis is caused by
unknown causes
What is the pelvis composed of?
urinary collecting structures: Calices
struvite calculi are associated with
UTI's
what is the most common kidney cancer in children?
Wilms tumor or Nephroblastoma
what are stones composed of
calcium crystals or uric acid or struvite or cystine
micturition requires ______________ nervous system functioning
central, autonomic, and peripheral
chronic glomerulonephritis progresses to
chronic kidney disease
Antidiuretic hormone acts on the_______________ to cause reabsorption of _______________
collecting tubules; water
If infants have decreased renal function what are they unable to make?
concentrated urine due to the immaturity of the kidney
Prerenal kidney injury is due to
conditions that impair renal blood flow such as hypovolemia, hypotension, cardiac failure, and renal artery obstruction
In what way do mesangial cells respond to glomerular capillary stretch?
contracting to reduce surface area for filtration
Where is renal pain perceived?
costovertebral angle, dermatomes of T10 L1.
urination is contraction of _______ and relaxation of _________
detrusors and internal sphincter
Filtration rate in an individual nephron occurs in ______________
distal tubule
Aldosterone acts on the_____________to cause reabsorption of _________________.
distal tubule; sodium and water
how can renal caniculi form?
due to hypercalcemia and/or hypercalciuria (hyperparathyroidism
Stress incontinence:
due to weakening of pelvic muscles or intrinsic urethral sphincter deficiency
what is the common outcome of chronic glomerulonephritis?
end-stage renal disease which dialysis and kidney transplant is necessary
process of kids wetting the bed
enuresis
T/F: glucose transporters are not sodium dependent
false, they are indeed sodium-dependent
T/F: during recovery stage of AKI, the urine volume increases but tubular function remains impaired.
false: during the recovery stage it is characterized by gradual normalization of serum creatinine and BUN
what are some clinical manifestations of Cystitis?
frequency, urgency, dysuria, suprapubic pain, and cloudy urine
what is vesicoureteral reflux due to?
incompetence of valvular mechanism at the ureter-bladder junction
When blood volume is low our fluid conservation rate is a. decrease b. increase c. same
increased
why does nephrotic syndrome occur?
increased glomerular permeability to proteins which means proteinuria
what does a urinalysis provide?
kidney function by detecting solutes, concentration and presence of infection.
What happens to the serum creatinine and BUN levels when there is reduced GFR?
levels increase
Countercurrent Multiplication occurs within the _____________ to concentrate urine.
loop of henle
What structure is used to pick up interstitial fluid?
loop structure of the vasa recta
When blood volume is high our filtration rate is a. low b. same c. high
low
How do individual nephrons regulate their glomerular filtration rates?
macula densa cells sample NaCl in distal tubule and signal juxtaglomerular apparatus to make adjustments in GFR
Urge incontinence:
may be idiopathic, due to infection, radiation, tumors or stones or CNS damage
Why does hyperlipidemia and hypercoagulability occur in response to nephrotic syndrome?
occurs because of the increase liver activity due to hypoalbuminemia which occurs because of the proteinuria, and the proteinuria occurs because of the increased glomerular permeability to proteins
How is GFR determined?
permeable surface area, capillary pressure, and bowman capsule oncotic pressure.
Much of the water and sodium from the glomerular filtrate is reabsorbed in the
proximal tubules
How can we evaluate kidney structure and function?
radiography, pyelography, radionuclide, ultrasound, CT and MRI
vesicoureteral reflux:
reflux of urine from bladder to the ureter and renal pelvis
What is the medulla composed of?
renal pyramids
where is the sodium-potassium pump? what regulates it?
sodium-potassium pump is on the basolateral cell membrane. In the distal tubule the pumps are regulated by aldosterone.
A UTI can lead to infection in:
urethra (urethritis), bladder (cystitis), and kidneys (pyelonephritis)
what is the purpose of urine buffers?
urine buffers: HPO4 and NH3 bind to excess H+ and allow kidneys to filter out excess acid
ANP and urodilatin inhibits the reabsorption of:
water and sodium
ADH increases permeability to:
water in the collecting tubule
It is true that glucose reabsorption in the tubules
Occurs in the proximal convoluted tubule.
most of the reabsorption is where________________
PCT
An important sign of glomerular basement membrane dysfunction is
Proteinuria.
Approximately two-thirds of the water and electrolytes filtered by the kidney are reabsorbed by the
Proximal tubule.
The primary function of the vasa recta is to
Reabsorb interstitial fluid.
Why does a patient with kidney disease also have an insufficiency of calcium?
The kidney secretes erythropoietin and active vitamin D, this is necessary for calcium reabsorption in the intestines
The primary selectivity barrier for glomerular filtration is the
Glomerular basement membrane.
Long loops of Henle help to __________
concentrate urine
Renin is released from
Juxtaglomerular cells
The glucose transporter in the proximal tubule
May be saturated at high filtered glucose loads.
urine retention is release of _______. relaxation of ________ and contraction of ______________
Norepinephrine. Bladder and bladder neck
urethritis is caused by__________ and is confined to__________
STD's; urethra
Which finding on urinalysis should prompt further evaluation?
White blood cells 20 per high-power field.
neurogenic bladder
broad spectrum of voiding dysfunction but specific cause is a pathology that produces disruption of nervous system
If adults have decreased renal function what is most likely to occur?
decreased ability to reabsorb water and sodium, reduced renal blood flow and GFR, reduced number of nephrons
The main driving force for glomerular filtration is
Hydrostatic pressure in glomerular capillaries.
what ion is not directly reabsorbed by renal epithelium and is first converted to CO2 by carbonic anhydrase?
HCO3-
How can one acquire pyelonephritis?
an infection of the parenchyma and renal pelvis is due to ascending UTI
inflammation & infection are typically in what direction?
ascending
what is the main difference between the two forms of polycystic kidney disease?
autosomal recessive: symptoms are present at birth autosomal dominant: symptoms occur later in life. associated with cysts in abdominal organs, berry aneurysms in circle of willis cerebral circulation, prolapse of mitral valve and increased risk of renal neoplasm. they both have expanding cysts disrupting urine formation and flow. Ending in renal failure.
azotemia is
build up of uria