WorksheetsRenal Pathophysiology (exam 2)
Total questions: 98
Worksheet time: 56mins
Choose kidney functions
filtration, reabsorption, secretion
removes composition and volume of extracellular fluid
regulates electrolyte/ion concentrations
maintains acid/base chemistry
secretes a variety of substances to regulate a number of bodily functions
The ____________ is a network of capillaries known as a tuft, located at the beginning of a nephron in the kidney.
glomerulus
renal corpuscle
_____________: the blood-filtering component of the nephron of the kidney. It consists of a glomerulus and Bowman's capsule
renal corpuscle
loop of Henle
___________: the portion of a nephron that leads from the proximal convoluted tubule to the dial convoluted tubule
Loop of Henle
renal corpuscle
____________ is a condition characterized by large amounts of dilute urine and increased thirst.
Diabetes insipidus
Central DI
Nephronic DI
Dipsogenic DI
Which type of DI is due to a lack of the hormone vasopressin? (vasopressin= antidiuretic hormone)
CDI
NDI
Dipsogenic DI
Which type of DI occurs when the kidneys do not respond properly to vasopressin?
CDI
NDI
Dipsogenic DI
Which type of DI is due to abnormal thirst mechanisms in the hypothalamus?
CDI
NDI
Dipsogenic DI
Kidney filtration- _________ branch into capillaries within the renal corpuscle
afferent arterioles
efferent arterioles
Kidney filtration-__________ are surrounded by smooth muscles that regulate bp entering the capillary system within the capsule
arterioles
capillaries
Kidney filtration- ____________ within the capillary system of the glomerulus forces fluid from the capillaries into the urinary space
blood pressure
pressure from fluid build up
Kidney filtration- filtered fluid exits through the _________ tube to be further processed in the tubules
proximal
distal
Kidney filtration- filtered blood exits through the __________ arterioles
afferent
efferent
Kidney filtration- ________________ are specialized cells in the kidney that make up the mesangium of the glomerulus and can be categorized as either extra-glomerular or intra-glomerular
mesangial cells
macula densa
What is the primary function of mesangial cells?
to remove trapped residues and aggregated protein from the basement membrane keeping the filter free of debris
to increase the volume of fluid being filtered by the kidney
What does GFR stand for?
Glomerular Filtration Rate
Goin (down) For Real
_________________: a specialized structure formed by different types of cells at the junction of the distal convoluted tubule and the glomerular afferent arteriole
Juxtaglomerular apparatus
macula densa
What does the Juxtaglomerular apparatus do?
main function is to regulate bp (55 mm Hg) and the filtration rate of the glomerulus
removes material that is blocking the filter
The macula densa is an area of closely packed specialized cells lining the wall of the distal tubule and is the thickening where the distal tubule touches the glomerulus
true
false
What are the cells of the macula densa sensitive to?
sodium chloride
potassium
calcium
What are the two effects from the macula densa that a decrease in sodium chloride initiates?
decrease in resistance to blood flow in the afferent arterioles which raises glomerular hydrostatic pressure and helps return the GFR to normal
increases renin release from the juxtaglomerular cells of the afferent arterioles, which are the major storage sites for renin (renin-angiotensin-aldosterone system)
increase in resistance to blood flow in the afferent arterioles which raises glomerular hydrostatic pressure and helps return the GFR to normal
decreases renin release from the juxtaglomerular cells of the afferent arterioles, which are the major storage sites for renin (renin-angiotensin-aldosterone system)
What 2 factors regulate filtration? (GFR)
size permeability: selective for water and small substances
electrical charge: the overall negative charge of the filtration apparatus and most proteins have a negative charge (excluded from filtration)
size permeability: selective for water and large substances
electrical charge: the overall positive charge of the filtration apparatus and most proteins have a positive charge (excluded from filtration)
Glomerular disease results in large excretion of __________ (urine analysis detects this)
plasma proteins
sodium chloride
During urine formation is filtration selective or non-selective?
selective
non-selective
During urine formation is reabsorption selective or non-selective?
selective
non-selective
There are both passive and active parts to reabsorption in the urine formation process. Match them.
Passive: water by osmosis
Active: solutes by transport mechanism
Passive: solutes by transport mechanism
Active: water by osmosis
During the urine formation step 3 (secretion), where do the substances get moved to and from?
to: nephron tubules
from: surrounding epithelial cells and capillary system
to: surrounding epithelial cells and capillary system
from: nephron tubules
Secretion transport mechanisms: anion-
penicillin
probenecid
chlorothiazide
histamine
quinine
Secretion transport mechanisms: cation-
penicillin
probenecid
chlorothiazide
histamine
quinine
Acid/base chemistry of secretion is regulated by what?
bicarbonate
H+
sodium chloride
potassium
Can drugs be secreted AND filtered?
yes, this is why GFR and urinary output affect the dosage of these drugs (renal dose adjustment may be required)
nope
Sodium reabsorption requires active transport (ATP) and is extremely important in the reabsorption of _________ and urinary function.
water
thiazide diuretics
sodium
Reabsorption in collecting ducts is regulated by what?
ADH (vasopressin)
aldosterone
renin
angiotensin
Potassium is freely filtered by the glomerulus.
true
false
Where is the bulk of filtered K+ reabsorbed?
proximal tubule
loop of Henle
glomerulus
collecting ducts
In the proximal tubule, K+ absorption is primarily _________ (paracellular diffusion and solvent drag)
active
passive
The rate of K+ secretion by the principal cells at the distal nephron varies and is increased by the following physiologic changes:
increased cellular K+ concentration
decreased luminal K+ concentration
most electronegative lumen
decreased cellular K+ concentration
increased luminal K+ concentration
Aldosterone stimulates K+ secretion through:
increasing intracellular K+ concentration by stimulating the activity of the Na+-K+-ATPase
stimulating Na+ reabsorption across the luminal membrane, which increases the electronegativity of the lumen, thereby increasing the electrical gradient favoring K+ secretion
a direct effect on the luminal membrane to increase K+ permeability
Where does water reabsorption occur?
collecting ducts
PCT
descending tubule
What is creatinine? Select any and everything that applies
non-protein nitrogenous breakdown product of creatine phosphate (phosphocreatine) from muscle and protein metabolism- phosphocreatine donates its phosphate group to convert ADP to ATP in the muscles
women tend to have higher concentrations of creatinine than men because of the greater mass of skeletal muscle
men tend to have higher concentrations of creatinine than women because of the greater mass of skeletal muscle
increased dietary intake of creatine or eating a lot of protein (meat) increases daily creatinine excretion
______________ is an indicator of the kidney function because creatinine is excreted unchanged by the kidneys. In renal diseases, these concentrations rise
serum creatinine
serum albumin
urine output
Can a serum creatinine clearance (CrCL) be used to calculated an estimated GFR (eGFR)?
yes
no
________: dilation of the ureter with fluid (lower obstructions) [may also be caused by UTIs and go away after treatment with abx]
hydroureter
hydronephrosis
_____________: distention of the renal calyces and pelvis with urine as a result of obstruction of the outflow of urine distal to the renal pelvis [may also be caused by UTIs and go away after treatment with abx]
hydroureter
hydronephrosis
_____________: the final common pathway for all kidney diseases leading to chronic renal failure
hydroureter
hydronephrosis
tubulo-interstitial fibrosis
______________: increase in size of an organ or tissue when called upon to do additional work or to perform the work of destroyed tissue of a paired organ
compensatory hypertrophy
post-obstructive diuresis
low bladder wall compliance
__________: a rare but potentially lethal complication associated with the relief of urinary obstructions; is a polyuric response initiated by the kidneys after the relief of a substantial bladder outlet obstruction; in severe cases this condition can become pathologic, resulting in dehydration, electrolyte imbalances and death
compensatory hypertrophy
post-obstructive diuresis
low bladder wall compliance
______________: compliance is a measure of stretch-ability of the bladder wall
compensatory hypertrophy
post-obstructive diuresis
low bladder wall compliance
What is the major sign of renal stones?
flank pain
urinary pain
blood in the urine
How are kidney stones classified?
alphabetically, like hurricanes
size, smallest to largest
size, largest to smallest
comprising minerals
Which type of kidney stone is assisted with the rare inherited disorder called cystinuria, which can be controlled but not cured?
cystine
calcium oxalate or calcium phosphate
uric acid stones
struvite
Mechanisms of kidney stone formation
supersaturation of one or more salts
precipitation of a salt from a liquid to a solid state
crystallization or aggregation
lower urinary tract obstruction- _____________ can press against the urethra and block the flow of urine, which irritates the bladder wall. As a result, the bladder begins to contract even when it contains small amounts of urine resulting in frequent urination
enlarged prostate
kidney stones
What is urethral stricture?
narrowing of the urethra due to scarring
the urethra tightens when the flow of urine is halting
Choose the most common pelvic floor disorders and what causes them
urinary incontinence
weak pelvic muscles and tissues
fecal incontinence
pelvic organ prolapse
benign prostatic hypertrophy
Renal adenomas
benign
malignant
Renal carcinomas
benign
malignant
Bladder papillary tumor
mushroom type tumor (non-invasive)
flat (non-invasive)
invasive: grow deep in the bladder wall and metastasize to lymph nodes, liver, bone, and lungs
Bladder non-papillary tumors
mushroom type tumor (non-invasive)
flat (non-invasive)
invasive: grow deep in the bladder wall and metastasize to lymph nodes, liver, bone, and lungs
Invasive bladder tumor
mushroom type tumor
flat
grow deep in the bladder wall and metastasize to lymph nodes, liver, bone, and lungs
_______ is inflammation of the urinary epithelium following invasion and colonization by some pathogen within the urinary tract
UTI
Bladder infection
Kidney infection
Select the most common pathogens pertaining to UTIs
E. coli
Staphylococcus saprophyticus
Enterobacter saprophyticus
Staphylococcus aureus
Campylobacter
Inflammation of the bladder is called what?
cystitis- a type of UTI
cholecystitis
Manifestations of cystitis (UTI)
urinary frequency
dysuria
urinary urgency
lower abdominal and/or suprapubic pain
oliguria
Treatment of cystitis (UTI)
antimicrobial therapy
increased fluid intake
avoidance of bladder irritants
urinary analgesics
antiviral therapy
Pyelonephritis
acute pyelonephritis: acute infection of the ureter, renal pelvis, and/or renal parenchyma
chronic pyelonephritis: acute infection of the ureter, renal pelvis, and/or renal parenchyma
chronic pyelonephritis: risk increases in individuals with renal infections and some type of obstructive pathologic condition
acute pyelonephritis: risk increases in individuals with renal infections and some type of obstructive pathologic condition
Nephrotic sediment
proteins only
both proteinuria and hematuria
waxy cast with granular cast; less protein and RBC
Nephritic sediment
proteins only
both proteinuria and hematuria
waxy cast with granular cast; less protein and RBC
Sediment of chronic glomerular disease
proteins only
both proteinuria and hematuria
waxy cast with granular cast; less protein and RBC
______________ demonstrates a sudden or insidious onset of HTN, edema, and an elevated BUN
glomerular disease
change in urine sediment levels
kidney disease
________ is caused by hypoalbuminemia which encourages plasma fluid to move into the interstitial space. Hypoalbuminemia is caused by increased glomerular capillary permeability and loss of negative ion charge barrier, which leads to plasma proteins passing into the urine.
edema
hypertension
What is the MOST COMMON reason for inflammation of the glomerulus? (hint- all of these can cause the inflammation)
immunologic abnormalities
drugs or toxins
vascular disorders
systemic diseases
viral causes
Select the mechanisms of injury for glomerulonephritis
deposition of circulating soluble antigen-antibody complexes, often with complement fragments
formation of antibodies against the glomerular basement membrane
streptococcal release of neuraminidase
histamine release by antibodies
__________: kidney disease that occurs when an antibody called immunoglobulin A (IgA) lodges in your kidneys. This results in local inflammation
Berger's disease
crescentic glomerulonephritis
goodpasture syndrome
chronic glomerulonephritis
_____________: not a specific disease but rather is a morphologic expression of severe glomerular injury that can be caused by many different etiologies and pathogenic mechanisms
Berger's disease (IgA neuropathy)
Crescentic glomerulonephritis
Goodpasture syndrome (antiglomerular basement membrane disease)
chronic glomerulonephritis
_____________: is an autoimmune disorder. It occurs when the immune system mistakenly attacks and destroys healthy body tissue. People with this syndrome develop substances that attack a protein called collagen in the tiny air sacs in the lungs and the filtering units (glomeruli) of the kidneys.
IgA neuropathy (Berger's disease)
Crescentic glomerulonephritis
Antiglomerular basement membrane disease (Goodpasture syndrome)
Chronic glomerulonephritis
Nephrotic syndrome is classified by excretion of _______ or more a day of protein in the urine per day
3.5g
7g
14g
1.2g
What is the most common cause of acute renal failure (ARF)?
pre-renal acute renal failure
intra-renal acute renal failure
post-renal acute renal failure
Characteristics of pre-renal ARF
most common cause of ARF
caused by impaired renal blood flow
GFR declines due to the decrease in filtration pressure
post-ischemic
nephrotoxic
Characteristics of intra-renal ARF
most common cause is acute tubular necrosis (ATN)
post-ischemic
nephrotoxic
occurs with urinary tract obstructions that affect the kidneys bilaterally
Characteristics of post-renal ARF
occurs with urinary tract obstructions that affect the kidneys bilaterally
most common cause of ARF
post-ischemic
nephrotoxic
Initiation phase of ARF
begins with initial insult
rise in serum urea, creatinine, K+ and Mg++; may last 1-3 weeks
kidney begins to recover
end of diuresis and recovery. usually within a month and up to 12 months (it is reversible)
Oligouric phase of ARF
begins with initial insult
rise in serum urea, creatinine, K+ and Mg++; may last 1-3 weeks
kidney begins to recover
end of diuresis and recovery. usually within a month and up to 12 months (it is reversible)
Diuretic phase of ARF
begins with initial insult
rise in serum urea, creatinine, K+ and Mg++; may last 1-3 weeks
kidney begins to recover
end of diuresis and recovery. usually within a month and up to 12 months (it is reversible)
Recovery phase of ARF
begins with initial insult
rise in serum urea, creatinine, K+ and Mg++; may last 1-3 weeks
kidney begins to recover
end of diuresis and recovery. usually within a month and up to 12 months (it is reversible)
Chronic kidney disease (chronic renal failure) is characterized by ___________ loss of renal function that affects nearly all organ systems
reversible
irreversible
What stage of CKD is characterized with normal or high GFR (GFR >90mL/min)
1
2
3A
3B
4
What stage of CKD is characterized with GFR = 60-89mL/min (also called mild CKD)
1
2
3A
4
5
What stage of CKD has a GFR = 45-59mL/min? (also called moderate CKD)
3A
3B
4
5
What stage of CKD is characterized with GFR= 30-44mL/min (also called moderate CKD)
1
2
3B
3A
What stage of CKD is characterized with severe CKD GFR= 15-29mL/min
3a
3b
4
5
What stage of CKD is characterized with end stage CKD GFR < 15mL/min
5
4
2
1
What is used to manage uremic diseases?
dialysis
diuretics
As the GFR declines, ________ excretion rate per nephron increases.
sodium
H+
____________ causes the adaptive increase of sodium excretion rate per nephron as that total GFR rate declines.
atrial natriuretic peptide (ANP)
CKD
As the GFR progressively __________ towards end stage renal disease, total renal sodium excretion eventually decreases, and extracellular volume expansion, HTN, and edema develop.
declines
inclines
In CKD, _______________ is one of the dangers that accompanies chronic renal failure, especially when GFR falls toward 20% of normal.
potassium retention (hyperkalemia)
sodium retention (hypernatremia)
Other body systems affected by CKD:
cardiovascular
neural function
hematologic alterations
