Renal
The Renal System ____
removes unwanted substances, maintains homeostasis, and regulate hormones
The kidneys are enclosed in a fibrous capsule of ___
connective tissue
Kidneys consist of a ___
outer cortex and inner medulla
The Kidneys cortex consist of the nephrons ___
glomeruli, proximal, and distal tubules
The Kidneys medulla consist of the nephrons ___
loops of henle and collecting ducts
The Glomerulus is the kidneys ___.
filter
The Proximal Convoluted Tubule
reabsorbs
The Loops of Henle
maintain pH through NaCL and water reabsorption
The Distal Convoluted Tubule
controls electrolyte and pH balance
The Collecting Ducts
Is the last place of possible reabsorption
The glomerulus consist of capillaries, each formed by ~ __ glomerular loops
40
The glomerulus has a ___ __ __ that is negatively charged to repel other vital substances such as proteins
semipermeable basement membrane
The Glomerulus' basement membrane has a size cutoff of ~ __kDa
66
The Glomerulus is surrounded by the ___.
Bowman's Capsule
The Glomerulus is supplied by an ___ and an ___ carries the blood out.
afferent arteriole, efferent arteriole
The __ __ is the most metabolically active part of the nephron
proximal tubule
the proximal tubule absorbs ~ __% of the bodys H2O, Na, and Cl
75
the proximal tubule absorbs ~ __% of the bodys glucose
100
the proximal tubule absorbs basically all of the bodys ___ __
amino acids
reabsorption in the nephrons require either ___ or ___ transport
active or passive
The __ ___ is the limit of how much of something can be reabsorbed
renal threshold
A secondary function of the proximal tubules is to secrete substances such as __ and __
drugs and acids
The loops of henle have a ____ and ____ limb
ascending and descending
The loops of henle is affected by many ____ and _____
diuretics and antidiuretics
The ascending limb of the loops of henle reabsorbs __ and ___
sodium and chloride
The descending limb of the loops of henle reabsorbs ___ (waterfall)
water
The distal tubules maintain ____ and _____ homeostasis
electrolyte and acid-base
In order to maintain homeostasis, the distal tubules use ___ and __
aldosterone and ADH/AVP
The ___ __ are the last possible site for concentrating or diluting urine and/or reabsorbing
collecting ducts
Urine has a normal pH of ____
4.7-7.8
Urine has a normal specific gravity of ______
1.003-1.035
Adequate homeostasis is maintained with ___ml/day of urine
500
If you have Anuria, you void < ___ ml/day of urine
100
If you have Oliguria, you void < ___ ml/day of urine
400
If you have Polyuria, you void > ___ L/day of urine
3
The primary function of the kidneys is the production of __, ____, and ____ (hormones; RED)
Renin, Erythropoietin, and 1,25 vitamin D3
____ boosts rbc production by acting on bone marrow cells
Erythropoietin
______ is the active form of vitamin D and it regulates phosphate and calcium balance as well as bone calcification
1,25 vitamin D3
Chronic renal insufficiency of 1,25 vitamin D3 could lead to ___
osteomalacia
The secondary function of the kidneys is to act upon or degrade hormones that arrive at the kidneys. Examples of hormones that are involved are _______
insulin, aldosterone, and ADH/AVP
___ is produced by the hypothalamus and stored in the posterior pituitary gland
ADH/AVP
ADH/AVP __ _ and ____
restricts water and vasoconstricts
ADH/AVP can stimulate the distal ____ __ to reabsorb more water
collecting tubules
Water intake is regulated by __
thirst
____ is produced by the cortex of the adrenal glands and triggers sodium reabsorption in the kidneys
Aldosterone
The ___ maintains systemic blood pressure and contains Renin inside granules
JGA
The ____ increases blood pressure and sodium reabsorption
RAAS
Describe the RAAS
Renin is released from the JGA in response to decreased afferent arteriole pressure or low sodium delivery to the macula densa. it then cleaves a plasma protein (Angiotensinogen) creating Angiotensin I, which is converted (using ACE) into Angiotensin II
_____ is a powerful vasoconstrictor (increases BP) that also stimulates Aldosterone release. As well as triggering ADH/AVP release and inhibits Renin release
Angiotensin II
Proteins get broken down into amino acids, which are turned into ammonia, which is converted to ___
urea
____% of Urea is passively reabsorbed in the collecting ducts
40-60
Accumulation of urea may cause ___ __
kidney disease
Elevated ammonia may impact your ___
CNS
To test urea, ____ ___ are the most frequently used method; specifically uses the coupled use of urease and glutamate dehydrogenase which is then measured at 340nm to see NADH disapperance.
enzymatic methods
Urea can use ___, ___, or __ for testing
plasma, serum, or urine
With plasma for Urea testing, _____ ____ tubes must be avoided
ammonium heparin
Specimen for urea testing should be _____ a few hours prior to testing if not able to be analyzed immediately
refrigerated
____ is the final product of creatine decomposition and is used as metabolic fuel for muscle contraction.
Creatinine
Creatine decomposition is catalyzed by ____ ____
Creatine Kinase
Creatinine is filtered and not reabsorbed, so it is a good reference to determine ____ ____ ___
Kidney function level
Testing methods for creatinine levels are _________
the Kinetic Jaffe Method, the Jaffe Reaction, and different Enzymatic methods.
The ____ _____ uses picric acid to turn creatinine present in a sample into a red-orange chromagen
Jaffe Reaction
The ____ ____ ____ mixes serum with an alkaline picrate and absorbance rate of change is measured.
Kinetic Jaffe method
The Kinetic Jaffe method is still routinely used despite possible positive interference from _____ ___ and ______
a-keto acids and cephalosporins
Creatinine also uses coupled enzymatic methods, using enzymes like _____, ____, and _____, for testing
creatininase, creatinase, and peroxidase
Creatinine may be measured in ____, ___, or __
plasma, serum, or urine
Urine samples for creatinine measurement should be refrigerated or frozen if it will be stored for _+ days
4
____ ____ is the primary waste product of purine metabolism
Uric Acid
The purines that are metabolised to create Uric Acid is ___ and ___
Adenine and Guanine
Uric Acid is constantly reabsorbed and excreted while traveling throughout the nephrons. To be exact ____% is actively reabsorbed in the proximal tubules and only ___% is finally excreted.
98-100; 6-12
Uric Acid can cause ____ ____ and ___
Kidney Stones and gout
Uric Acid is tested primarily by using ____ (enzyme causing oxidation of Uric Acid to Allantoin) (This is a highly specific testing method)
uricase
Uric Acid also is tested using ____ ____ ____ (using uricase with peroxidase/catalase) and measuring ____ ____ from uric acid oxidation
coupled enzyme methods; hydrogen peroxide
For Uric Acid testing, _____ ____, ___, or ___ are all acceptable
Heparinized plasma, serum, or urine
Some ___ may affect Uric Acid results
drugs
Uric Acid samples are stable once they have been _________
Seperated from RBC's
Uric Acid samples may be refrigerated for ___ days
3-5
___ and ______ additives must be avoided when testing Uric Acid
EDTA and Fluoride
____ is the clearance of different substances or markers
GFR
GFR is the most specific and sensitive measure of ______ _____
functioning nephrons
The ideal marker for GFR is _____ and testing for it is refered to as the "gold standard." It however is extremely expensive
Inulin
The most common test for GFR is _____ _____
Creatinine Clearance
Creatinine levels and kidney function have an ___ relationship
Inverse
_____ _____ is a quantitative measure of the amount of creatinine eliminated. It can also be used to determine kidney function.
Creatinine Clearance
For Creatinine Clearance, _____ is the ideal substance because it is an edogenous metabolic product that is not reabsorbed
Creatinine
In order to determine Creatinine Clearance. you compare ___ _____ ______ to ___ _____ _____
serum creatinine concentration to urine creatinine concentration
Sample for Creatinine Clearance testing is obtained from a _____ ____ ____ and a _____ ______that was collected during the 24-hour urine collection. (preferably at the 12 hour mark)
24-hour urine test and a serum sample
For the 24-hour urine test, you discard the ___ ____ ____ and collect all after, including the 2nd first morning void.
first morning void
Sources of error in the 24-hour urine test are from ____________
patient not following instructions, losing specimen, exercise, hydration (if good should have flow rate of ⪰ 2ml/min) , and also us using an incorrect referance value
_________ is small amounts of albumin (30-300mg) in the urine
Microalbuminuria
Microalbuminuria uses _______ or _________ _______ commonly for testing, as well as a random urine sample test.
nephelometry or immunoturbidimetry immunoassys
Measuring for albumin in urine from 24-hour urine samples is important for ______ ______ control
Diabetes mellitus
______ is a protein associated with acute skeletal and cardiac muscle injury (associated with rhabdomyolysis)
Myoglobin
Myoglobin is easily and rapidly measured by _______
Immunoassays
______ provides an in depth assessment of renal status
Urinalysis
The specimen for a urinalysis test is collected in the _____ and analyzed within 1 hour or else refrigerated at 2-8 ℃ for no more than 8 hours
morning
A Urinalysis test includes a physical characteristic examination, chemical analysis, and a ______ ______ ______
microscopic sediment examination
The darker the urine color, the more ______ it is
concentrated
Urine should be an ___ color and other colors represent different conditions
amber
The more cloudy a urine sample is, the ____ __ ___; also could show hematuria or bacteria present
higher the pH
______ _____ is the density of a fluid
Specific gravity
A low urine SG can occur with ______ ______
Diabetes Insipidus
A high urine SG can occur with ______ ______
Diabetes Mellitus
The most common testing method of SG is a direct method using a ________. Another method however is an indirect method using a ______.
refractometer; dipstick
An ______ measurement is more valid than a SG measurement
Osmolality
Osmolality is a physical property based on the concentration of ________ _____ _______. (Osmolality values in urine may vary depending on the problem)
Osmotically active particles
Dispticks measure for ________________
Glucose, Protein, Nitrite, Leukocyte Esterase, Bilirubin, and blood
Glucose on a dipstick indicates ______
Diabetes
Protein on a dipstick indicate _____
casts
Nitrite on a dipstick indicate the presence of _____
bacteria
On a Dipstick, Leukocyte Esterase indicates _____ and possible UTI if present along with Nitrite (bacteria)
WBC's
Hemoglobin being positive on a dipstick show ___ presence and may be of Renal Injury origin
RBC
When centrifuged, urine leaves behind a sediment that can be microscopically examined to detect ___, _____, ___, and _____
cells, bacteria, casts, and crystals
Having more than _ RBCs are considered abnormal on a sediment examination
2
Having more than _ WBC is considered abnormal on a sediment examination
1
_____ ____ are normal but there still should not be a lot on a sediment examination
Epithelial cells
Having more than __ bacteria are considered abnormal on a sediment examination
20
A ____ is a cylindrical impression of the nephrons
cast
Casts consist of ____ and some _____ which holds them all together
cells and some protein
___ and ___ casts are always pathologic
RBC and WBC
A RBC cast may be present with _____
Hematuria
A WBC cast may be present with ____ _____
Nephron inflammation
With kidney disease, it goes from Acute to chronic in __ months
3+
Early recognition of kidney disease is vital, but ~ __% of patients see a clinician too late
30
If your GFR drops below __ml/min/1.73m², then kidney damage is present
60
___ ____ ____ is a sudden sharp decline in renal function throughout hours to days
Acute Kidney Injury
Causes of AKI are from Acute Toxic sources (______________) and also from hypoxic damage (__________)
Hemolytic transfusion reactions, rhabdomyolysis, antifreeze ingestion, NSAIDS OD | Shock, or cardiac failure
______ _____ directly damage the renal glomeruli
Glomerular Disease
Acute Glomerulonephritis present rapid onset of _____, _____, and __ ____
hematuria, proteinuria, and RBC casts
Chronic Glomerulonephritis leads to _____ development
uremia
____ ____ injures and increases the permeability of the glomerular basement membrane
Nephrotic Syndrome
Nephrotic syndrome yields massive ____ and ______
proteinuria and hypoalbuminemia
______ diseases decrease excretion/reabsorption
Tubular
____ ____ (kidney stones) are caused by a reduced urine flow rate and a high saturation of insoluble substances in the urine
Renal Calculi
The final diagnosis of kidney stones is usually made through _____ _____ (x-rays)
Radiologic Imaging
____ ____ ____ is a decline in Renal Function over atleast 3 months
Chronic Kidney disease
The main cause of chronic kidney disease is _____ (45% of cases)
diabetes
_____ ______ is the second most common cause of CKD
Renal Hypertension
A GFR < __mL/min/1.73m² indicates renal failure
15
_____ _____ is risky so should only be used if absolutely necessary
Emergency Dialysis
______, _______, and _____ _____ are all forms of dialysis/filtration
hemodialysis, hemodiafiltration, and peritoneal dialysis
All forms of dialysis/filtration use a semipermeable membrane surrounded by a ______ ___
dialysate bath
_____ _____ uses a synthetic membrane to filter outside the body
Traditional Hemodialysis
_____ _____ uses the patients peritoneal wall as a dialysis membrane to filter inside of the body
Peritoneal Dialysis
______ provides the best chance for a full recovery from kidney failure, however only 30% of patients are eligible
Transplantation