How do Kidneys regulate the osmolality of the extracellular fluid?
Through the action of ADH
(secreted by the posterior pituitary causes water reabsorption)
TRUE or FALSE
Creatinine levels will increase the moment kidney damage starts (before too much damage has been done)
FALSE. Creatinine is not that sensitive in the beginning. Need to wait until the kidney is pretty damaged before you see rise in level.
TRUE or FALSE
Pre-renal failure is the most common cause of acute renal failure.
TRUE
What causes pre-renal failure?
caused by impaired renal blood flow leading to ischemia in the nephrons (from dehydration, hemorrhage, shock, HF, anaphylaxis, sepsis)
TRUE or FALSE
There is a decreased risk of pre-renal failure with anesthesia.
FALSE increased risk from increased blood flow!
Post-renal failure is caused by what?
Obstruction of the urinary collecting system anywhere from the calyces to the urethral meatus. (urethral or bladder cancer, renal calculi, BPH, urethral stricture)
Intrinsic renal failure is caused by what?
Actual tissue damage to the kidney caused by inflammatory or immunologic process (DIC) or from prolonged hypoperfusion. (Acute Tubular Necrosis, interstitial nephritis, nephrotoxic drugs)
Acute renal failure has an onset of ____ to ___
hours to days.
TRUE or FALSE
Acute renal failure is irreversible.
FALSE, it is reversable
Acute Tubular Necrosis (ATN) is an intrinsic type of renal failure. It has three phases, describe them.
Onset: precipitating event through tubular injury; hours to day; BUN and Creatinine gradually increase
Maintenance: ↓GFR. oliguria common, continue to ↑BUN, creatinine, K+ Metabolic acidosis. Weeks long. Can lead to HTN from prolonged oliguria
Recovery: gradual ↑ in UO & ↓ creatinine. May take 1 yr, may never recover 100% of nephron function.
ATN is characterized by destruction of ___ ___ ___.
Tubular epithelial cells, they slough off then cause obstruction which causes the back up. The filtrates in urine will go into intersistial space and get can cause damage.
What are some problems kids with chronic renal failure have (as opposed to adults)?
Growth impairment, developmental delay, delay in sexual maturation, bone abnormalities, & development of psychosocial problems.
Nephrotic syndrome is an increase in ____ ____.
Glomerular permeability. (allows proteins to fit through)
What are the characteristics of nephrotic syndrome?
proteinuria
hypoalbuminemia
hyperlipidemia (liver compensating for low protein)
Generalized edema (hallmark)
Primary causes of nephrotic syndrom are found in _____. While secondary causes of nephrotic syndrome (DM, malignancy) are found in ____.
Children.
Adults
The pathogenesis for Acute and chronic glomerulonephritis are the same. What is it?
Glomerular injury from antigen-antibody complexes. They cause inflammation damage, leukocytes, fibrin, lysosomal enzymes, and damage to membrane permeability.
In acute glomerulonephritis, what is the usual cause and s/s?
Cause: Group a post-streptococcal infection (can have 100% recovery)
S/S last 10-21 days:
hematuria
proteinuria
↓GFR
Edema
HTN
Oliguria
What is the usual cause of chronic glomerulonephritis?
Progessive course leading to CRF.
(DM, HTN, Chol) Tubular dilation and atrophy.
Glomerulonephritis vs nephrotic sydrome
GN: more blood in urine
NS: protein!
GN pt usually older than in nephrotic
Vesicoureteral reflux is usually caused by ___ ____.
structural compromise. Seen in people w/repeat UTI
TRUE or FALSE
Vesicoureteral reflux is more common in kids.
TRUE
What is the treatment of Vesicoureteral reflux?
Antibiotics. If severe, pt may need surgery. Could lead to renal failure.