Question

1. Describe (physiologically) how Hypertension can lead to chronic renal failure.
2. List some initial and late signs & symptoms of adenocarcinoma of the kidney.
3. Identify the major functions of the kidney.
4. List two causes of respiratory acidosis and metabolic alkalosis. AND how do the lungs and kidneys respond to each condition.

Answer 1

1. Pathophysiology of how hypertension can lead to Chronic Renal Failure

Hypertension is one of the leading causes of Chronic Renal Failure due to the harmful effects that increased BP has on kidney vasculature

The relationship between CKD and HTN is cyclic, as CKD can contribute to or cause HTN.                Elevated BP leads to damage of blood vessels within the kidney, as well as throughout the body.         This damage impairs the kidney’s ability to filter fluid and waste from the blood, leading to an increase of fluid volume in the blood, thus causing an increase in BP.

Long-term, uncontrolled, high BP

High intraglomerular pressure, impairing glomerular filtration

Damage to the glomeruli lead to an increase in protein filtration

Resulting in abnormally increased amounts of protein in the urine (microalbuminuria or proteinuria)

Microalbuminuria is the presentation of small amounts of albumin in the urine and is often the first sign of CKD

Proteinuria (protein-to-creatinine ratio ≥200 mg/g)

Develops Chronic Renal Failure

2. List some initial and late signs & symptoms of adenocarcinoma of the kidney.

Adenocarcinoma: A cancer that develops in the lining or inner surface of an organ and usually has glandular (secretory) properties.                                                                                                                                Initial Signs:   Low back pain on one side (not caused by injury)

       Anemia (low red blood cell counts)

        Fatigue

Fever that is not caused by an infection and that doesn’t go away

Weight loss not caused by dieting

Late Signs:                                                                                                                                                          

Blood in the urine (hematuria)

A mass (lump) on the side or lower back

3. Major Functions Of Kidneys’:

The main role of the kidneys is maintaining homeostasis. This means they manage fluid levels, electrolyte balance, and other factors that keep the internal environment of the body consistent and comfortable.

They serve a wide range of functions.

1. Waste excretion: The kidneys remove a number of waste products and get rid of them in the urine. Two major compounds that the kidneys remove are Urea & Uric Acid

2. Reabsorption of nutrients: The kidneys reabsorb nutrients from the blood and transport them to where they would best support health. They also reabsorb other products to help maintain homeostasis. Reabsorbed products include: glucose, amino acids, bicarbonate, sodium, water, phosphate, chloride, sodium, magnesium, and potassium ions

3. Maintaining pH: The kidneys and lungs help keep a stable pH within the human body.

4. Osmolality regulation: Osmolality is a measure of the body's electrolyte-water balance.

5. Regulating blood pressure

6. Secretion of active compounds:

Erythropoietin: This controls erythropoiesis, or the production of red blood cells.

Renin: This helps manage the expansion of arteries and the volume of blood plasma, lymph, and interstitial fluid.

Calcitriol: This is the hormonally active metabolite of vitamin D.                                                                                       

4. List two causes of respiratory acidosis and metabolic alkalosis

Respiratory acidosis: is carbon dioxide (CO₂) accumulation (hypercapnia) due to a decrease in respiratory rate and/or respiratory volume (hypoventilation).

Conditions that impair CNS respiratory drive

Conditions that impair neuromuscular transmission and other conditions that cause muscular weakness

Obstructive, restrictive, and parenchymal pulmonary disorders   

The kidney can correct for a primary metabolic acidosis by excreting excess acid as ammonium chloride, usually through enhanced renal ammoniagenesis in the proximal convoluted tubules (primarily) of the kidney .This regenerates the bicarbonate being consumed in plasma, in fact 3 bicarbonate molecules are generated for each ammonia produced in the renal tubules from glutamate.

                                                                                  

Metabolic Alkalosis is increase in bicarbonate. Causes

Renal HCO₃⁻ retention

Regardless of initial cause, persistence of metabolic alkalosis indicates that the kidneys have increased their HCO₃⁻ reabsorption, because HCO₃⁻ is normally freely filtered by the kidneys and hence excreted.

Volume depletion (particularly when involving loss of gastric acid and chloride [Cl] due to recurrent vomiting or nasogastric suction)

Diuretic use

Renal acid loss

Bicarbonate excess

The kidneys will attempt to correct for a primary metabolic alkalosis. More bicarbonate is filtered through the kidneys in a metabolic alkalosis. Also, a subpopulation of intercalated cells (type B) in the cortical collecting tubules of the kidney will excrete the excess HCO₃^– in a metabolic alkalosis. This is accomplished by translocation of the basolateral (blood side) bicarbonate/chloride exchanger (pendrin) to the luminal surface so bicarbonate is pumped into the urine and chloride

1. Pathophysiology of how hypertension can lead to Chronic Renal Failure

Hypertension is one of the leading causes of Chronic Renal Failure due to the harmful effects that increased BP has on kidney vasculature

The relationship between CKD and HTN is cyclic, as CKD can contribute to or cause HTN.                Elevated BP leads to damage of blood vessels within the kidney, as well as throughout the body.         This damage impairs the kidney’s ability to filter fluid and waste from the blood, leading to an increase of fluid volume in the blood, thus causing an increase in BP.

Long-term, uncontrolled, high BP

High intraglomerular pressure, impairing glomerular filtration

Damage to the glomeruli lead to an increase in protein filtration

Resulting in abnormally increased amounts of protein in the urine (microalbuminuria or proteinuria)

Microalbuminuria is the presentation of small amounts of albumin in the urine and is often the first sign of CKD

Proteinuria (protein-to-creatinine ratio ≥200 mg/g)

Develops Chronic Renal Failure

2. List some initial and late signs & symptoms of adenocarcinoma of the kidney.

Adenocarcinoma: A cancer that develops in the lining or inner surface of an organ and usually has glandular (secretory) properties.                                                                                                                                Initial Signs:   Low back pain on one side (not caused by injury)

       Anemia (low red blood cell counts)

        Fatigue

Fever that is not caused by an infection and that doesn’t go away

Weight loss not caused by dieting

Late Signs:                                                                                                                                                          

Blood in the urine (hematuria)

A mass (lump) on the side or lower back

3. Major Functions Of Kidneys’:

The main role of the kidneys is maintaining homeostasis. This means they manage fluid levels, electrolyte balance, and other factors that keep the internal environment of the body consistent and comfortable.

They serve a wide range of functions.

1. Waste excretion: The kidneys remove a number of waste products and get rid of them in the urine. Two major compounds that the kidneys remove are Urea & Uric Acid

2. Reabsorption of nutrients: The kidneys reabsorb nutrients from the blood and transport them to where they would best support health. They also reabsorb other products to help maintain homeostasis. Reabsorbed products include: glucose, amino acids, bicarbonate, sodium, water, phosphate, chloride, sodium, magnesium, and potassium ions

3. Maintaining pH: The kidneys and lungs help keep a stable pH within the human body.

4. Osmolality regulation: Osmolality is a measure of the body's electrolyte-water balance.

5. Regulating blood pressure

6. Secretion of active compounds:

Erythropoietin: This controls erythropoiesis, or the production of red blood cells.

Renin: This helps manage the expansion of arteries and the volume of blood plasma, lymph, and interstitial fluid.

Calcitriol: This is the hormonally active metabolite of vitamin D.                                                                                       

4. List two causes of respiratory acidosis and metabolic alkalosis

Respiratory acidosis: is carbon dioxide (CO₂) accumulation (hypercapnia) due to a decrease in respiratory rate and/or respiratory volume (hypoventilation).

Conditions that impair CNS respiratory drive

Conditions that impair neuromuscular transmission and other conditions that cause muscular weakness

Obstructive, restrictive, and parenchymal pulmonary disorders   

The kidney can correct for a primary metabolic acidosis by excreting excess acid as ammonium chloride, usually through enhanced renal ammoniagenesis in the proximal convoluted tubules (primarily) of the kidney .This regenerates the bicarbonate being consumed in plasma, in fact 3 bicarbonate molecules are generated for each ammonia produced in the renal tubules from glutamate.

                                                                                  

Metabolic Alkalosis is increase in bicarbonate. Causes

Renal HCO₃⁻ retention

Regardless of initial cause, persistence of metabolic alkalosis indicates that the kidneys have increased their HCO₃⁻ reabsorption, because HCO₃⁻ is normally freely filtered by the kidneys and hence excreted.

Volume depletion (particularly when involving loss of gastric acid and chloride [Cl] due to recurrent vomiting or nasogastric suction)

Diuretic use

Renal acid loss

Bicarbonate excess

The kidneys will attempt to correct for a primary metabolic alkalosis. More bicarbonate is filtered through the kidneys in a metabolic alkalosis. Also, a subpopulation of intercalated cells (type B) in the cortical collecting tubules of the kidney will excrete the excess HCO₃^– in a metabolic alkalosis. This is accomplished by translocation of the basolateral (blood side) bicarbonate/chloride exchanger (pendrin) to the luminal surface so bicarbonate is pumped into the urine and chloride

1. Pathophysiology of how hypertension can lead to Chronic Renal Failure

Hypertension is one of the leading causes of Chronic Renal Failure due to the harmful effects that increased BP has on kidney vasculature

The relationship between CKD and HTN is cyclic, as CKD can contribute to or cause HTN.                Elevated BP leads to damage of blood vessels within the kidney, as well as throughout the body.         This damage impairs the kidney’s ability to filter fluid and waste from the blood, leading to an increase of fluid volume in the blood, thus causing an increase in BP.

Long-term, uncontrolled, high BP

High intraglomerular pressure, impairing glomerular filtration

Damage to the glomeruli lead to an increase in protein filtration

Resulting in abnormally increased amounts of protein in the urine (microalbuminuria or proteinuria)

Microalbuminuria is the presentation of small amounts of albumin in the urine and is often the first sign of CKD

Proteinuria (protein-to-creatinine ratio ≥200 mg/g)

Develops Chronic Renal Failure

2. List some initial and late signs & symptoms of adenocarcinoma of the kidney.

Adenocarcinoma: A cancer that develops in the lining or inner surface of an organ and usually has glandular (secretory) properties.                                                                                                                               

Initial Signs:   Low back pain on one side (not caused by injury)

       Anemia (low red blood cell counts)

        Fatigue

Fever that is not caused by an infection and that doesn’t go away

Weight loss not caused by dieting

Late Signs:                                                                                                                                                          

Blood in the urine (hematuria)

A mass (lump) on the side or lower back

3. Major Functions Of Kidneys’:

The main role of the kidneys is maintaining homeostasis. This means they manage fluid levels, electrolyte balance, and other factors that keep the internal environment of the body consistent and comfortable.

They serve a wide range of functions.

1. Waste excretion: The kidneys remove a number of waste products and get rid of them in the urine. Two major compounds that the kidneys remove are Urea & Uric Acid

2. Reabsorption of nutrients: The kidneys reabsorb nutrients from the blood and transport them to where they would best support health. They also reabsorb other products to help maintain homeostasis. Reabsorbed products include: glucose, amino acids, bicarbonate, sodium, water, phosphate, chloride, sodium, magnesium, and potassium ions

3. Maintaining pH: The kidneys and lungs help keep a stable pH within the human body.

4. Osmolality regulation: Osmolality is a measure of the body's electrolyte-water balance.

5. Regulating blood pressure

6. Secretion of active compounds:

Erythropoietin: This controls erythropoiesis, or the production of red blood cells.

Renin: This helps manage the expansion of arteries and the volume of blood plasma, lymph, and interstitial fluid.

Calcitriol: This is the hormonally active metabolite of vitamin D.                                                                                       

4. List two causes of respiratory acidosis and metabolic alkalosis

Respiratory acidosis: is carbon dioxide (CO₂) accumulation (hypercapnia) due to a decrease in respiratory rate and/or respiratory volume (hypoventilation).

Conditions that impair CNS respiratory drive

Conditions that impair neuromuscular transmission and other conditions that cause muscular weakness

Obstructive, restrictive, and parenchymal pulmonary disorders   

The kidney can correct for a primary metabolic acidosis by excreting excess acid as ammonium chloride, usually through enhanced renal ammoniagenesis in the proximal convoluted tubules (primarily) of the kidney .This regenerates the bicarbonate being consumed in plasma, in fact 3 bicarbonate molecules are generated for each ammonia produced in the renal tubules from glutamate.

                                                                                  

Metabolic Alkalosis is increase in bicarbonate. Causes

Renal HCO₃⁻ retention

Regardless of initial cause, persistence of metabolic alkalosis indicates that the kidneys have increased their HCO₃⁻ reabsorption, because HCO₃⁻ is normally freely filtered by the kidneys and hence excreted.

Volume depletion (particularly when involving loss of gastric acid and chloride [Cl] due to recurrent vomiting or nasogastric suction)

Diuretic use

Renal acid loss

Bicarbonate excess

The kidneys will attempt to correct for a primary metabolic alkalosis. More bicarbonate is filtered through the kidneys in a metabolic alkalosis. Also, a subpopulation of intercalated cells (type B) in the cortical collecting tubules of the kidney will excrete the excess HCO₃^– in a metabolic alkalosis. This is accomplished by translocation of the basolateral (blood side) bicarbonate/chloride exchanger (pendrin) to the luminal surface so bicarbonate is pumped into the urine and chloride