Chapter 26

Question 1

In order to maintain homeostasis, the kidneys do what?

Answer 1

fluid volume, electrolytes, acid-base balance

Question 2

Kidneys secret:

Answer 2

renin, Erythropoetin, Calcitrol (active form of vitamin D)

Question 3

kidney functions (4)

Answer 3

1. Filtration
2. Reabsorption
3. Secretion
4. Excretion

Question 4

when kidneys fail:

Answer 4

1. less waste is removed
2. can’t regulate fluid, electrolyte, PH balance
3. Nitrogenous waste builds up (BUN, creatinine)

Question 5

Renal function is approximated by testing the blood levels of what?

Answer 5

1. BUN levels (blood urea nitrogen)

2. Creatinine levels (metabolic waste from muscle breakdown)

Question 6

Acute Kidney Failure is usually ___

Answer 6

secondary to another disease or cause.

heart failure, dehydration, etc

Question 7

What is secondary to diabetes and ^BP?

Answer 7

chronic kidney disease

* destroys nephrons and cant filter GFR

Question 8

The most common form of AKI is?

Answer 8

Prerenal injury

• caused by decreased blood flow and is usually reversible
• shock, dehydration, vasoconstriction

Question 9

Which type of kidney injury is caused by obstruction of some form?

Answer 9

Postrenal Injury

• obstruction below kidney: ureter, bladder, urethra
• enlarged prostate, tumors, stones

Question 10

Intrinsic or Intrarenal injury is a result of what?

Answer 10

Acute Tubular necrosis
*death of epithelial cells in kidney tubules
Ischemia, toxins, intratubular obstruction

Question 11

What are the 3 phases of ATN (acute tubular necrosis)

Answer 11

1. Initiating phase- damage has happened
2. Maintenance phase- oliguria, ^waste products, edema
3. Recovery phase - tissue remodeling

Question 12

What happens in tubular obstruction during acute tubular necrosis?

Answer 12

• castes are made

- clumping together of dead epithelial cells obstructs tubules

Question 13

There are ___ stages of kidney disease

Answer 13

5
Stage 1: still able to compensate
Stage 5: GFR <15mL/minute

Question 14

Chronic Kidney Manifestation

Answer 14

• Uremia/Azotemia #1
• altered fluid/electrolyte/ acid-base balance
• cardiovascular problems
• GI disorders

Question 15

In chronic kidney disease, the kidneys lose their ability to reabsorb ____

Answer 15

Sodium: Salt water wasting

Question 16

In CKD you also can’t filter ___ out of blood

Answer 16

Potassium: Hyperkalemia

Question 17

With CKD, you lose your ability to regulate your PH. What does this cause?

Answer 17

• Metabolic Acidosis-

* heart palpitations, muscle weakness, bone pain*

Question 18

Patients with CKD are more likely to die from ___ than CKD itself

Answer 18

Heart failure

Question 19

in a healthy kidney, calcitrol does what?

Answer 19

helps the kidneys maintain blood calcium levels and promotes the formation of bone.

Question 20

When the kidneys do not function properly, extra ______ is released into the blood to move ___ from inside the bones into the blood.

Answer 20

parathyroid hormone

calcium

Question 21

when the kidneys aren’t functioning correctly they do what 2 things to end up leaching calcium fro bones?

Answer 21

1. stop activating calcitriol. The low levels of calcitriol in the body create an imbalance of calcium in the blood.
2. do not remove the phosphorus in the blood properly, so phosphorus levels rise in the blood. The extra phosphorus pulls calcium out of the bones, causing them to weaken.

Question 22

Decreased Vitamin D activation increases: ___ and impairs ____

Answer 22

Parathyroid hormone (PTH) 
and impairs Osteoblasts

Question 23

low bone turnover in osteoblasts

Answer 23

Osteomalacia

Question 24

^ bone turnover in osteoclasts

Answer 24

Osteodystrophy

Question 25

chronic kidney disease primarily effects what 2 systems:

Answer 25

blood and bone

Question 26

Hematologic complications from CKD

Answer 26

- Anemia- hemolysis, bone marrow suppresion, decreased erythropoeitin - decreased platelets- bleeding

Question 27

the build up of nitrogenous waste products (uremia) suppresses ___ and the creation of __-

Answer 27

bone marrow and the creation of megarkyocytes: platelets

Question 28

CKD manifestations: (4)

Answer 28

1. Suppressed immune response 2. Sexual Dysfunction 3. Neurological Alterations- Restless leg syndrome 4. Skin disorders- flakey skin, Terry Nails