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