patho final II. CH. 36
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- what is the most common indicator of renal failure?
- azotemia
- define azotemia?
- an accumulation of nitrogenous wastes in the blood: urea nitrogen, uric acid, creatinine
- what are the 3 main causes/categories of renal failure?
- pre renal, intrinsic, post-renal
- what is the MC cause of acute renal failure?
- pre-renal failure. a marked decrease in renal blood flow
- what percentage of blood from the heart to the kidneys normally receive?
- 20 to 25%
- what are the main manifestations of acute renal failure?
- sharp decrease in urine output and disproportinate elevation of BUN.
- what is the most common underlying problem of postrenal failure?
- prostatic hyperplasia
- what are the major causes of intrarenal failure?
-
-ischemia associated with prerenal failure
-toxic insult to the tubular structures of the nephron
-intratubular obstruction
-glomerulonephritis
-pyelonephritis
-acute tubular necrosis - in acute renal failure, the GFR is decreased. T/F
- true. as a result, excretion of nitrogenous wastes is reduced, and fluid and electrolyte balance cannot be maintained.
- what are some of the conditions that can lead to acute renal failure?
-
-decrease in blood flow w/o ischemic injury
-ischemic, toxic or obstructive tubular injury
-obstruction of urinary tract flow - a condition in which the kidneys fail to remove metabolic end products from the blood, regulate fluid, electrolyte, and pH balance of the ECF?
- renal failure
- what causes acute renal failure?
- conditions that produce an acute shutdown in renal function; ie decreased blood flow to the kidney, disorders that disrupt the structures in the kidney or disorders that interfere with the elimination of urine.
- obstruction of urine outflow from the kidneys leads to what type of renal failure?
- postrenal failure
- name of the disorder that is characterized by destruction of tubular epithelial cells with acute suppression of renal function?
- acute tubular necrosis.
- what are some causes of ATN?
- ischemia, nephrotoxic effects of drugs, tubular obstruction, toxins from a massive infection
- what type of cells in the tubules are particularly sensitive to ischemia and vulnerable to toxins?
- tubular epithelial cells
- which patients are especially vulnerable to ischemic ATN?
- persons with major sx, severe hypovolemia, overwhelming sepsis, trauma and burns.
- what are the two major causes of acute tubular necrosis?
- ischemia and toxin exposure
- what is the largest single cause of kidney failure in the U.S.?
- Diabetic kidney disease
- what conditions can cause chronic kidney failure?
- a number of conditions that cause permanent loss of nephrons, including Diabetes, HTN, glomerulonephritis and polycystic kidney disease.
- what is the best measure of overall function of the kidney?
- GFR. for YA, healthy is approx. 120-130 mL/minute
- what is one of the earliest symptoms of renal insufficiency?
- isosthenuria; polyuria with urine that is almost isotonic with plasma.
- what can be used as an indirect method for assessing the GFR adn the extent of renal damage?
- serum creatinine
- what is the term for urine found in the blood?
- uremia
- once 2/3 of the nephron has been destroyed, what clinical manifestation can be observed in renal failure?
- uremia
- how does uremia differ from azotemia?
- azotemia merely describes the nitrogenous wastes accumulating in the blood, while uremia "blood in urine" includes a host of signs and symptoms.
- what are the signs and symptoms of the uremic state?
- altered fluid: electrolyte and acid-base balance; alterations in regulatory functions (htn, anemia, osteodystrophy) and the effects of uremia on body function