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DU PA Kidney Disease

Duke PA Kidney Disease/ Kidney Function

stimulation of the renal sympathetic nerves stimulates the release of ___ thereby increasing angiotensin and alsosterone production renin
normaly ___ raises GFR pregnancy
GFR for men is usually ___mL/min 120
GFR for women is usually ___mL/min 100
the ____ reclaims at least 60% of the filtered load of Na+, Cl-, water, urea, K+ and fully 90% of the filtered HC03- proximal tubule
in the ___ organic acids such as uric acid and drugs such as penicillin are secreted straight portion of the proximal tubule
a significant portion of Ca+ reabsorption occurs within the loop of Henle
increased luminal acids and decreased Cl- concentration increase ___ secretion K+
increased contration of K+ in the plasma increases K+ secretion directly and by provoking ___ secretion aldosterone
Distal K+ secretion is decreased by metabolic acidosis
distal K+ secretion is increased by metabolic alkalosis
When ___ is present water passes across the collecting duct tubule wall readily ADH
___ impair distal water reabsorption through several mechanisms prostaglandins
____, by blocking prostaglandins, may impair renal free water excretion nonsteroidal anti-inflammatory drugs
normal daily GFR ___ L 180
essential hypertension may represent a primary defect in ___ excretion by the kidneys Na+
overproduction of ___ causes sever hypertension renin
decreased insulin catabolism by the kidneys in patients with diabetes and renal failure may lead to hypoglycemic episodes
the kidney is a major site of ___ production erythropoietin
___ production increases in states of decreased tissue oxygen delivery erythropoietin
a potent vasoconstrictor that is a stimulus to aldosterone secretion angiotensin II
promotes the formation of angiotensin II renin
stimulates renal Na+ absorption aldosterone
stimulates renal K+ and H+ excretion aldosterone
during prolonged starvation the kidney can contribute up to __% of plasma glucose 40
certain drugs such as cimetidine, trimethoprim, triamterene, and amiloride may interfere with ___ and cause false elevation in the blood creatinine secretion
is often used in conjunction with the serum creatinine level as a measure of kidney function BUN (Blood Urea Nitrogen)
The major end product of protein metabolism urea
the usual ratio of BUN:creatinine is __:1 10
a significant amount of ___ is reabsorbed during volume depletion states urea
___ is less dependant on volume status than urea serum creatinine concentration
may be more reliable than creatinine in determining GFR cystatin C
failure to acidify urine in the presence of systemic acidosis suggests distal renal tubular acidosis
a normal individual excretes less than ___ mg/day of protein 150
persistant proteinuria almost always idicates renal disease
defined as the excretion of 30-300 mg/24 hr of albumin microalbuminuria
for individuals with diabetes mellitus measuring ____ may help early identification of underlying kidney damage microalbuminuria
is associated with the progression of renal disease and with higher cardiovascular morbidity and mortality in patients with diabetes mellitus and hypertension microalbuminuria
blood detected by dipstick that cannot be accounted for by RBC's in the urine sediment is the result of either myoglobin or hemoglobin often associated with rhabdomyolysis
defined as more than 2 RBC's per high powered feild mircroscopic hematuria
prototypical cause of acute nephritic syndrome acute poststreptococcal glomerulonephritis
characterized by increased glomerular permeability in excess of 3.5g/day/1.73m(2)body surface area nephrotic syndrome
characterized by the relatively abrupt onset of kidney dysfunction accompanied by the presence of red blood cell casts and dysmorphic erythrocytes in the urine sediment, as well as varying degrees of proeitnuria acute nephritic syndrome
red blood cell casts associated with glomerulonephritis
red blood cell casts associated with vasculitis
WBC casts associated with interstitial nephritis
WBC casts associated with pyelonephritis
Epithelial cell casts associated with acute tubular necrosis
Epithelial cell casts associated with interstitial nephritis
Epithelial cell casts associated with glomerulonephritis
Granular casts associated with renal parynchymal disease
waxy, broad casts associated with advanced renal failure
hyaline casts associated with normal findings in concentrated urine
fatty casts associated with heavy proteinuria
calcium phosphate crystals are associated with alkaline urine
calcium oxalate crystals can be associated with ethylene glycol poisoning
squamous epithelial cells are associated with contamination
patients who have had more than 50% loss in kidney function over weeks to months rapidly progressive renal failure
abrupt decline in renal function over several days acute renal failure
decline in renal function over months to years chronic renal failure
decrease in renal blood flow prerenal azotemia
intrinsic parenchymal disease intrarenal azotemia
obstruction to urine flow postrenal azotemia
condition characterized by abnormal levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood. It is largely related to insufficient filtering of blood by the kidneys azotmia
in a patient with advanced renal failure, the presence of bilaterally small kidneys typically less than 8cm implies a chronic irreversible process
difference in kidney size by more than 2 cm may suggest ischemic damage such as renovascular disease
disadvantage of IVP is the requirment of ____ which may induce nephrotoxicity radiocontrast
Kidney is key in making 1,25 vit D
the leakage of protein across the glomerular capillary loop nephrotic syndrome
your kidneys process __L of filtrate per hour, most of which is reabsorbed 6
when the kidney is ischemic the ____ cells take the biggest hit b/c of their high oxygen demand convoluted tubular cells
these cells are responsible for reabsorbing water and other necessary ions convoluted tubular cells
increases with steroid treatment BUN
blood urea nitrogen BUN
generated in proportion to muscle mass Creatinine
lab abnormality of elevated BUN or creatinine azotemia
a syndrome of "autointoxication" that occurs with a GFR of 5-10% normal uremia
Produced by all nucleated cells at a constant rate, Filtered but not reabsorbed or secreted, Not affected by muscle mass, age, gender, Blood level proportional to GFR, expensive cystatin C
filtered, not reabsorbed, secreted: may over estimate GFR creatinine
filtered, reabsorbed, not secreted: may underestimate GFR urea
estimating creatinine clearance without a timed urine collection. This formula uses age, plasma creatinine, and weight Cockroft-Gault formula
most urinary excreted protein is Tamm Horsfall protein
normal albumin/creatinine ratio <__mg/gram Cr 30
microalbumiuria albumin/Cr ratio ___ mg/gram Cr 30-300
dipstick positive albumin/Cr ratio >__ mg/gram Cr 300
nephrotic albumin/Cr ratio >__ mg/gram Cr 3000
regulation of blood volume is the same as regulation of blood pressure
if blood is too dilute the brain will swell and herniate
if the blood is too concentrated the brain will shrink and pull away from the skull
high ADH will lead to concentrated urine
low ADH, or the inability to respond to ADH will lead to dilute urine
high ADH will lead to reabsorption of water from convoluted tubules
low ADH, or the inability to respond to ADH will lead to decreased reabsorption of water from convoluted tubules
body water volume __L intracellular 25
body water volume __L intravascular 6
body water volume __L extracellular 17
sensors for tonicity osmoreceptors
sesnors for volume baroreceptors
sense stretch baroreceptors
effectors for tonicity ADH,thirst
effectors for volume renin/angiotensin, sympathetic NS, natriuretic peptides, ADH
management of patients with low GFR and volume overload loop diuretic, low sodium diet
management of patients with low GFR and hyperkalemia Low potassium diet, Bicarbonate, Kayexalate
Management of Patients with Low GFR and hyperparathyroidism Phosphate binder, Calcium supplement, 1,25-vitamin D replacement
makes the patient lose potassium in the stool kayexalate
promotes calcium reabsorption from the gut 1,25-vitamin D
makes the patient lose too much calcium from bone hyperparathyroidism
good bedside methods of determining volume status turgor, neck veins, orthostatics
most common drug allergy proton pump inhibitors
third most common drug allergy NSAIDs
second most common drug allergy antibiotics
Created by: bwyche