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PATHO Test 4

Terms in this set (56)

Functions of the kidney
Filter the blood
Remove water-soluble wastes
Help control blood pressure
Help maintain red blood cell levels
Convert vitamin D
GFR
(defines the health of the kidney) 125 ml/minute
How would GFR change if efferent arterioles are constricted?
GFR increases
How would GFR change if afferent arterioles are constricted?
GFR decreases
How would GFR change if BP decerased?
GFR decreases
Prostaglandins
vasodilates
NO
vasodilates
Epiniphrine
vasoconstriction
Endothelin
vasoconstriction
Parasympathetic nervous system controls [assoc. w/ bladder]
bladder emptying (contractions)
Sympathetic nervous system controls [assoc. w/ bladder]
relaxation and storage
Three neurological centers of micturition
spinal cord reflex centers
pontine micturition center
cortical and subcortical centers
Spinal cord reflex centers
S1 - S4 parasympathetic input
T11 - L2 sympathetic input
Proliferative glomerular damage
number of cells increase
Membranous glomerular damage
glomerular basement membrane thickens
Sclerotic glomerular damage
amount of extracellular matrix increases [hardens]
Acute nephritic syndrome
inflammatory process that occludes glomerular capillary lumen and damages capillary wall
s/s - hematuria, protein loss, diminished GFR
Acute post infectious glomerulonephritis
Occurs following infection with group a beta-hemolytic streptococci
s/s - Edematous, cola colored urine (RBC casts)
Rapid progressive glomerulonephritis is
goodpasture syndrome
Goodpasture syndrome
Type II hypersensitivity, due to antibodies in the glomerular basement membrane
Nephrotic syndrome
increased glomerular permeability
at risk for clots, infection, edema, hypothyroidism
Membranous glomerulonephritis
Type III hypersensitivity, caused by thickening of basement membrane due to circulating antibody-antigen complexes
(most common cause of primary nephrosis in adults)
Pyelonephritis
renal disease affecting the tubules, interstitium, and pelvis of the kidney
Acute Pyelonephritis
involves a bacterial infection; E. coli (80%) or papillary necrosis (assoc w/ DM)
Chronic Pyelonephritis
more complex, involving issues such as reflux and infection leads to scarring and deformation of renal calyces and pelvis
What prevents stone formation
magnesium, potassium, pyrophosphate
Stress incontinence
decreased ability to vesicourethral sphincter to prevent the escape of urine during activities, such as lifting, coughing, that raise bladder pressure above external sphincter pressure
Urge incontinence
caused by disorders that result in hyperactive bladder contractions
Overflow incontinence
caused by overfilling of the bladder with the escape of urine
Nonurologic conditions predispose the elderly to urinary incontinence
dementia, infection, atrophic vaginitis, pharm, psych, endocrine, restrictive mobility, stool impaction
Ureterovesical junction
closes to prevent reflux of urine into ureters and kidneys
UTI protective mechanism in women
mucus secreting glands trap bacteria before they can ascend from urethra to the bladder
UTI protective mechanism in men
length of male urethra prevents against infection
Elderly response to UTIs
anorexia, fatigue, weakness, confusion
Prerenal acute kidney injury
blood supply decreased
shock, dehydration, vasoconstriction
Postrenal acute kidney injury
urine flow blocked, obstruction
stones, tumors , enlarged prostate
Intrinsic acute kidney injury
kidney tubule function decreased
ischemia, toxins, intratubular obstruction
Acute tubular necrosis (ATN)
destruction of tubular epithelial cells with acute suppression of renal function
ATN pathogenesis
sloughing/necrosis of tubular epithelial cells lead to obstruction and increased intraluminal pressure [decreasing GFR]
afferent arteriolar vasoconstriction results in decreased glomerular capillary filtration pressure
tubular injury and increased intraluminal pressure cause fluid to move from the tubular lumen into the interstitium
ATN medical conditions
occurs most frequently in persons who have major surgery, severe hypovolemia, or overwhelming sepsis, trauma, or burns.
ATN cellular substances
The presence of multiple myeloma light chains, excess uric acid, hemoglobin, or myoglobin in the urine is the most frequent cause of ATN due to intratubular obstruction
ATN drugs
Many drugs are nephrotoxic, causing tubular injury by inducing varying combinations of renal vasoconstriction, direct tubular damage, or intratubular obstruction.
Stage 1 kidney damage
GFR ≥90; Kidney damage with normal or increased GFR
Stage 2 kidney damage
GFR 60-89; Kidney damage with mild decrease in GFR
Stage 3 kidney damage
GFR 30-59; Moderate decrease in GFR
Stage 4 kidney damage
GFR 15-29; Severe decrease in GFR
Stage 5 kidney damage
GFR <15 (dialysis); kidney failure
Azotemia
Elevated levels of nitrogenous wastes in the blood
Uremia
Accumulation of nitrogenous waste products in the blood; characterized by signs and symptoms of altered CNS, GI, immune disturbances
Pernicious anemia
macrocytic anemia; vitamin B12 deficiency (lack intrinsic factor)
Manifestations of pernicious anemia
paresthesias of the feet and fingers; neuro symptoms from nerve demyelination
Folate is essential for
RNA/DA synthesis within maturing RBC
Clinical manifestations of folate deficiency
severe cheilosis, stomatitis, dysphagia, flatulence, watery diarrhea
Folate deficiencies are common with...
alcoholics or chronic malnourished
Microcytic Hypochromic anemias
RBCs are small & contain reduced amounts of hemoglobin
Causes of microcytic hypochromic anemias are
Disorders of iron metabolism
Disorders of porphyrin and heme synthesis
Disorders of globin synthesis
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