63 terms

Renal okogbaa

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in kidney disease we can use BUN alone
false- other things can increase BUN, (GI bleed)
what increases serum creatinine?
decreased blood flow

decreased glomerular surface area
what is creatinine?
a muscle protein used to determine kidney function
what relationship is between creatinine clearance and serum creatinine?
inverse
when people develop kidney disease, they also develop?
cardiac disease
what are some signs of glomerulonephritis?
^ plasma creatinine

^ BUN

low CrCl

HTN, Edema

decrease GFR
what is nephrogenic syndrome?
patient spills 3-5 g of protein in urine/day
what 2 major disease states cause kidney failure?
diabetes

htn
what can cause glomerulonephritis?
immunologic abnormalities

drugs/toxins

vascular disorders

systemic diseases

viral causes
example of drugs that cause glomerulonephritis?
antibiotics
example of vascular disorders that cause glomerulonephritis?
Diabetes
example of systemic diseases that cause glomerulonephritis?
lupus
example of viral causes that cause glomerulonephritis?
HIV
What mechanisms can hurt the glomerulus?
antigen-antibody complexes

antibodies against glomerulous

release of neuramidase
How do the antigen-antibody complexes affect the glomerulus?
block blood flow--> toxin buildup--> increased creatinine, decreased CrCl
Symptoms of Nephritic glomerular disease?
Acute (sudden onset)

pee out blood (hematuria)
symptoms of Nephrotic glomerular disease?
Hypoalbuminuria

proteinuria > 3.5 g/day

chronic onset
what are common causes of nephrotic glomerular disease?
diabetes

lupus
What patients are mostly seen with nephrotic glomerular disease?
pediatric
what causes neprhotic glomerular disease?
super infections (viral HIV or IGA complement)
what is renal insufficiency?
kidney is not functioning correctly
what is ESRD?
patient needs a new kidney or is on dialysis
what is uremia?
a large amount of urine in the blood
what is azotemia?
nitrogen waste product in the blood
what does RIFLE stand for?
Risk, injury, failure, loss, ESRD
what criteria does RIFLE observe?
GFR

urine output

creatinine
what is GFR used for?
staging kidney disease

drug dosing
what is creatinine clearance used for?
drug dosing/adjustment for renal function
what are 3 types of Acute renal failure?
pre-renal- efferent and afferent arteriole

intra-renal- inside kidney

post-renal- ureter and bladder
what is the cause for Pre-renal ARF?
dehydration

impaired renal blood flow (hypoperfusion

decrease GFR due to decrease in filtration pressure
what are some signs and symptoms of Pre-renal ARF?
high hematocrit

decreased skin turgor
In pre-renal ARF, what does the kidney lose?
angiotensin II regulatory mechanism

tubulo-glomerular feedback
what are 2 types of intrarenal diseases?
acute interstitial nephritis

acute tubular necrosis
what causes acute interstitial nephritis?
allergic reaction to drugs/ environment
what causes acute tubular necrosis?
direct injury to nephrons

can be due to drugs: amphotericin B
In the mechanism of Intra-renal ARF, what happens when the release of inflammatory mediators causes vascular endothelial cell injury?
Vasoconstriction--> decreased blood flow--> decreased GFR--> oliguria
In the mechanism of Intra-renal ARF, what happens when the release of inflammatory mediators causes tubular epithelial cell injury?
cast formation--> obstruction--> decreased GFR--> oliguria
what causes post-renal ARF?
blockage--> tumor from BPH or nephrolithiasis (kidney stone)
Retention of nitrogenous waste products
azotemia
< 100 ml of urine / day
Anuria
100-400 ml of urine/day
oliguria
>400 ml of urine/day
non-oliguria
What Urine Na+ reading is Prerenal? ATN?
<20

>40
what FENa+ reading is Prerenal? ATN?
<1%

>1%
what BUN/Plasma creatinine reading is Prerenal? ATN?
>15:1

<15:1
what urine/plasma creatinine reading is prerenal? ATN?
>40

<20
What specific gravity reading is Prerenal? ATN?
>1.020

<1.015
the irreversible loss of renal function affecting all organs
CKD
During CKF, reduced renal reserve happens. what is it?
leftover nephrons work harder--> hypertrophy and hyperfiltration
what are the steps of CKF?
reduced renal reserve

renal insufficiency

renal failure

ESRD
what criteria determine CKD?
kidney damage > 3 months

GFR <60 for > 3 months
what are some monitoring parameters in CKD?
acid-base balance

K+ balance

Ca++ and Phosphate Balance

Na+ and H2O balance

Cr and CrCl
complications of CKD?
bone changes

heart and lungs

brain

endocrine and reproduction

blood
most calcium is located in the bone as?
hydroxyapatite
Calcium is necessary for?
bones and teeth

clotting

hormone secretion

cell receptor function
Phosphate is necessary for?
creatine phosphate and ATP (high energy bonds)

anion buffer
Relationship between Phosphate and Ca+?
inverse
Ca+ X Phosphate-->?
K constant, < 55
what 3 hormones regulate calcium/phosphate?
PTH- ^ Ca+

Vitamin D- ^ Ca+

Calcitonin- decrease Ca+
What is happening in Renal Osteodystrophy?
As renal function drops, nephrons slowly die off

GFR drops below 30, u get uremia--> increased nitrogenous waste, urea, phosphate in blood--> decreased calcium

Release PTH--> sPTH disease--> takes calcium from bone to bind phosphate

u get weak bones.
how do we get anemia in CKD?
less erythropoietin production

uremic environment (decreases lifespan of blood)

folic acid or iron deficiency
Explain what happens during Erythropoiesis
Anemia

Erythropoietin--> E-progenitor cells in bone marrow--> make RBC

kidney senses increased tissue oxygenation

kidney decreases erythropoietin production
List the Stages of CKD
stage 1: > 90 (^ GFR)

Stage 2 60-89 ( drop in GFR)

stage 3 30-59 (drop in GFR)

stage 4 15-29 (drop in GFR)

stage 5 < 15 (kidney failure)
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