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Year 2 Medicine @ Lancaster Uni > 2.08 - Kidney diseases, CKD and AKI > Flashcards

2.08 - Kidney diseases, CKD and AKI Flashcards

1
Q

What is the function of the kidneys?

A
  • Act as a filter for the body
  • Helps to excrete waste products and drug metabolites from the body
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2
Q

At what vertebral level does the left kidney sit at?

A
  • T11
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3
Q

At which vertebral level does the right kidney sit at?

A
  • T12
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4
Q

From which artery do the renal arteries arise from?

A
  • Abdominal aorta
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5
Q

What are the different subsections of the renal arteries?

A
  1. Renal arteries
  2. Ant/Pos divisions
  3. 5 segmental arteries
  4. Interlobar arteries (Pyramids)
  5. Arcuate arteries
  6. Interlobular arteries
  7. Afferent arterioles
  8. Capillaries (Glomerulus)
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6
Q

What vessels drain the kidneys?

A
  • Left and right renal vein
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7
Q

Which lymph nodes drain the kidneys?

A
  • Lateral aortic
  • Para-aortic
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8
Q

Where is the site of filtration within the kidneys?

A
  • The nephron
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9
Q

How much blood is filtered daily by the kidneys?

A
  • 180L of blood each day
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10
Q

How much urine is excreted by the kidneys each day?

A
  • 1.5L - 2.0L
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11
Q

What is the structure of the glomerulus?

A
  • Loop of capillaries twisted into a ball shape
  • Surrounded by the Bowman’s capsule
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12
Q

What cells make up the filtration barrier of the glomerulus?

A
  • Capillary endothelial cells
  • Basement membrane
  • Podocytes
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13
Q

How does blood enter the glomerulus?

A
  • Via afferent arterioles
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14
Q

How does blood exit the glomerulus?

A
  • Via efferent arterioles
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15
Q

What is the relationship between filtration and molecular weight?

A
  • Inversely related
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16
Q

What are the different parts of the nephron?

A
  1. Glomerulus
  2. PCT
  3. Descending loop
  4. Ascending loop
  5. DCT
  6. Collecting duct
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17
Q

What is the function of the PCT (Proximal convoluted tubule)?

A
  • Has a high capacity for reabsorption
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18
Q

What is reabsorbed by the PCT (Proximal convoluted tubule)?

A
  • 65% of water and ions
  • 100% of glucose and amino acids
  • 85% of bicarbonate
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19
Q

What are the two routes of reabsorption in the PCT (Proximal convoluted tubule)?

A
  • Paracellular
  • Transcellular
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20
Q

Which ion is the driving force behind reabsorption?

A
  • Na+ (Sodium)
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21
Q

What is the ratio of sodium to potassium that is reabsorbed/excreted?

A
  • 3 x Na+ moves out
  • 2 x K+ moves in
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22
Q

What are the different segments of the PCT (Proximal convoluted tubule)?

A
  • S1
  • S2
  • S3
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23
Q

What two sections make up the loop of henle?

A
  • Descending loop
  • Ascending loop
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24
Q

Which part of the descedning limb is highly permeable to water?

A
  • Thin descending limb
  • Contains many aquaporin-1 channels
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25
Q

What is reabsorbed by the thin descending limb of the nephron?

A
  • Water (Highly permeable)
  • Some Na+, Urea and other ions also reabsorbed
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26
Q

What is reabsorbed by the thin ascending limb of the nephron?

A
  • Na+ and Cl- are reabsorbed
  • No water as it is impermeable
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27
Q

What is reabsorbed by the thick ascending limb of the nephron?

A
  • Primary site of Na+ reabsorption
  • Impermeable to water
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28
Q

What drives the reabsorption of Na+ in the thick ascending limb of the nephron?

A
  • Na+/K+ ATPase
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29
Q

What system allows for 99% of filtered water to be reabsorbed?

A
  • Counter-current multiplication
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30
Q

What is the function of the early distal convoluted tubule (DCT)

A
  • Absorption of ions and calcium whilst being impermeable to water
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31
Q

What is the function of principal cells in the DCT (Distal convoluted tubule)?

A
  • Uptake of Na+ and excretion of K+
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32
Q

What is the function of intercalated cells in the DCT (Distal convoluted tubule)?

A
  • Acid base control (H+/HCO3-)
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33
Q

What is the main function of the collecting duct of the nephron?

A
  • Reabsorption of water through the action of ADH and aquaporins
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34
Q

Where is ADH produced and stored?

A
  • Produced in hypothalamus
  • Stored in posterior pituitary gland
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35
Q

How does ADH work?

A
  • Increases the number of aquaporin-2 channels
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36
Q

What effect does ADH have on urea levels?

A
  • Increases urea reabsorption in medullary collecting duct
  • Urea recycling
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37
Q

What happens when there is increased levels of ADH?

A
  • Less urine output due to increased water reabsorption
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38
Q

What happens in SIADH?

A
  • Excess ADH is released
  • As a result there is increased aquaporin expression
  • Excess water retention
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39
Q

What are the consequences of SIADH?

A
  • Excess water retention
  • Excessive blood dilution
  • Leads to hyponatremia
  • Less aldosterone
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40
Q

What is paraneoplastic syndrome?

A
  • Ectopic release of ADH from a SCC in the lungs
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41
Q

What is the main role of the urinary system?

A
  • Waste excretion
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42
Q

What are the muscles of the bladder?

A
  • Detrusor
  • Internal and external urethral sphincters
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43
Q

What provides sympathetic innervation to the bladder?

A
  • Hypogastric nerve (T12-L2)
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44
Q

What provides parasympathetic innervation to the bladder?

A
  • Pelvic nerve (S2-S4)
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45
Q

What provides somatic innervation to the bladder?

A
  • Puedendal nerve (S2-S4)
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46
Q

What is the function of the micturition reflex?

A
  • Body’s way of eliminating water, electrolytes and waste products
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47
Q

What are the two stages of the micturition reflex?

A
  1. Storage/continence phase
  2. Voiding phase
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48
Q

What type of receptor helps with parasympathetic contraction of the bladder?

A
  • M3
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49
Q

What type of receptor helps with sympathetic relaxation of the bladder?

A
  • B3
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50
Q

What type of receptor is found in the internal urethral sphincter?

A
  • Alpha 1 - Parasympathetic
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51
Q

What type of receptor is found in the external urethral sphincter?

A
  • Nicotinic - Sympathetic
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52
Q

Contraction of which muscle leads to the voiding of urine from the bladder?

A
  • Detrusor muscle
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53
Q

Co-ordination of which muscles allows the filling phase to occur?

A
  • Relaxation of detrusor muscle
  • Contraction of sphincters
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54
Q

What is incontinence and what are the different types?

A
  • Unwanted voiding of the bladder
    1. Stress
    2. Urge
    3. Overflow
    4. Mixed
    5. Functional
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55
Q

What is stess urinary incontinence?

A
  • SUI occurs due to weakened pelvic floor muscles +/- sphincters that control outlet
  • Leakage during activities that increase intra-abdominal pressure
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56
Q

What activities can cause stress urinary incontinence?

A
  • Laughing
  • Coughing
  • Sneezing
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57
Q

What is urge urinary incontinence?

A
  • Also called overactive bladder
  • Sudden, strong urge to urinate
  • Followed by involuntary urinary leakage
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58
Q

What is overflow urinary incontinence?

A
  • When bladder is unable to empty properly which leads to retention
  • Leads to constant/frequent dribbling of urine
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59
Q

What are some causes of overflow incontinence?

A
  • Bladder outlet obstruction
  • Neurogenic dysfunction
  • Weak detrusor muscle
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60
Q

What is mixed incontinence?

A
  • Has features of both stress and urge urinary incontinence in the same individual
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61
Q

What is functional incontinence?

A
  • Incontinence due to not being able to reach the toilet due to physical or cognitive impairment
  • Usually have bladder control
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62
Q

What are the main management options for incontinence?

A
  • Incontinence devices
  • Neuromodulation
  • Behaviour/lifestyle
  • Surgical interventions
  • Physical therapy
  • Medications
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63
Q

What medications can be given to help incontinence?

A
  • Anticholinergics
  • Beta 3 agonists
  • Topical estrogen
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64
Q

What primary investigation is likely to highlight electrolyte imbalances?

A
  • 12 lead ECG
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65
Q

What do electrolyte imbalances effect to cause changes in an ECG?

A
  • Cardiac membrane potentials and their subsequent conductional ability
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66
Q

What is seen on an ECG in hyperkalaemia?

A
  • Peaked T waves
  • Prolongation of PR interval
  • Widening of QRS
  • Loss of P waves
  • Sine wave appearance
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67
Q

What is seen on an ECG in hypokalaemia?

A
  • Flat/Inverted T waves
  • Apperance of a U wave
  • ST segment depression
68
Q

What is seen on an ECG in hypermagnesemia?

A
  • Prolongation of PR interval
  • Widening of QRS complex
  • Bradycardia
69
Q

What is seen on an ECG in hypomagnesemia?

A
  • Prolongation of QR interval
  • Torsades de pointes rhythm
70
Q

What is seen on an ECG in hypocalcaemia?

A
  • Prolongation of QT interval
  • ST segment depression
71
Q

What is seen on an ECG in hypercalacaemia?

A
  • Shortening of QT interval
72
Q

What is seen on an ECG in hypernatremia?

A
  • No specific changes seen
  • Contributes to underlying conditions
73
Q

What is seen on an ECG in hyponatremia?

A
  • ST segment depression
  • T wave inversion
74
Q

What is impotence?

A
  • Also known as erectile dysfunction
  • Involves problems relating to achieving and maintaing an erection
75
Q

What are the physical causes of impotence?

A
  • CV diseases
  • Diabetes
  • Neuro disorders
  • Surgery and trauma
  • Hormonal imbalances
  • Medications
  • Smoking and alcohol
  • Obesity
76
Q

What are the psychological causes of impotence?

A
  • Stress
  • Anxiety
  • Trauma
  • Depression
  • Low self esteem
  • Abuse
77
Q

What are the lifestyle factors that can cause impotence?

A
  • Unhealthy diet
  • Lack of exercise
  • Smoking
  • Alcohol/drug abuse
  • Fatigue/sleep disorders
  • Sedentary lifestyle
78
Q

What is the prevalence of impotence?

A
  • Around 1 in 10 have problems with having sex
79
Q

What are the three main types of impotence?

A
  1. Erectile dysfunction
  2. Premature ejaculation
  3. Loss of sex drive
80
Q

What is involved in erectile dysfunction?

A
  • When an erection can’t be achieved or maintained
  • Effects men over 40 in particular
  • Treatment focuses on adressing the potential causes
81
Q

What is involved in premature ejaculation?

A
  • When a male ejaculates sooner than desired during sex
  • Can cause anxiety and stress regarding sex
  • Can cause relationship issues
82
Q

What is involved in the loss of sex drive?

A
  • Also known as low libido
  • A reduced interest in sexual activity or sexual thoughts
  • Variety of causes
83
Q

What are the lifestyle management options for impotence?

A
  1. Healthy diet and exercise
  2. Smoking cessation
  3. Limiting alcohol intake
  4. Stress management
84
Q

What are the pharmacological options for managing impotence?

A
  1. Oral medications
  2. Hormone therapy
  3. Injections/Suppositories
  4. Vacuum devices
  5. Implants
85
Q

What are examples of oral medications that can be given to help manage impotence?

A
  • Sildenafil
  • Tadalafil
  • Helps to increase blood flow
86
Q

What is an acute kidney injury (AKI)?

A
  • Seen as a sudden decline in renal function over days or hours
  • Also known as acute renal failure
87
Q

What are the different stages of acute kidney injury (AKI)?

A
  • Stage 1
  • Stage 2
  • Stage 3
88
Q

Which two measurements are looked at when classifying an acute kidney injury (AKI)?

A
  • Serum creatinine
  • Urine output
89
Q

What is the epidemiology behind an acute kidney injury (AKI)?

A
  • Up to 15% of emergency hospital admissions
90
Q

What is the mortality associated with a severe acute kidney injury (AKI)?

A
  • Between 30%-40%
91
Q

What measurements are seen in stage 1 of acute kidney injury (AKI)?

A
  • SC = 1.5-1.9 x baseline
  • UO = < 0.5 ml/kg/hr for 6-12 hours
92
Q

What measurement are seen in stage 2 of acute kidney injury (AKI)?

A
  • SC = 2.0-2.9 x baseline
  • UO = < 0.5 ml/kg/hr for ≥ 12 hours
93
Q

What are the measurements seen in stage 3 of acute kidney injury (AKI)?

A
  • SC = ≥ 353.6 micromol/L
  • UO = < 0.3 ml/kg/hr for ≥ 24 hours or anuria for ≥ 12 hours
94
Q

What is the annual incidence of acute kidney injury (AKI) in the UK?

A
  • Around 125,000 incidences a year
95
Q

What are the symptoms associated with acute kidney injury (AKI)?

A
  • Usually non-specific and relate to the underlying cause
  • Dry membranes
  • Thirst
  • Dizziness
  • Anuria
  • Hypotension
  • Raised JVP
  • Ascites
96
Q

What are three different types of cause relating to acute kidney injury (AKI)?

A
  1. Pre-renal
  2. Intrinsic renal
  3. Post-renal
97
Q

What are the causes of pre-renal acute kidney injury (AKI)?

A
  • Occurs secondary to renal renal hypoperfusion
  • Can result in renal ischaemia
98
Q

What are the symptoms associated with pre-renal acute kidney injury (AKI)?

A
  • Hypovolemia
  • Dehydration
  • Decreased capillary refill
  • Dry mucous membranes
  • Reduced turgor
  • Dizziness
  • Reduced urine output
  • Orthostatic hypotension
99
Q

What are the causes of intrinsic renal acute kidney injury (AKI)?

A
  • Structural damage to:
  • Vasculature
  • Glomerular
  • Tubulointerstitial
100
Q

What are the symptoms associated with intrinsic renal acute kidney injury (AKI)?

A
  • Dependant on specific aetiology
  • May present with features of nephritic or nephrotic syndrome
  • Proteinuria
  • Haematuria
  • Oliguria
  • HTN
101
Q

What are symptoms relating to tubulointerstital disease?

A
  • Arthralgia
  • Rashes
  • Fever
  • Eosiophilia is frequently seen
102
Q

What are the symptoms associated with post-renal acute kidney injury (AKI)?

A
  • Features depend on site and chronicity
  • Classic loin -> groin pain
103
Q

What are common types of obstructions seen in post-renal acute kidney injury (AKI)?

A
  • BPH
  • Kidney stones
104
Q

What are the causes of post-renal acute kidney injury (AKI)?

A
  • Renal outflow obstruction
  • Anywhere in the renal tract
105
Q

What are the risk factors associated with acute kidney injury (AKI)?

A
  • CKD
  • History of AKI
  • +65 years old
  • Sepsis
  • Urogenital history
  • Cardiac failure
  • DM
  • Hypovolemia
  • Nephrotoxic drugs
  • Contrast agents used in scans
106
Q

What are the main elements involved with management of an acute kidney injury (AKI)?

A
  1. Regular assessment and monitoring
  2. Volume dysregulation
  3. Electrolyte abnormalities
  4. Metabolic acidosis
107
Q

What are some examples of nephrotoxic drugs?

A
  • NSAID’s
  • ACEi
  • Spironolactone
108
Q

What should be measured to obtain a baseline reading in the management for acute kidney injury (AKI)?

A
  • Baseline creatinine
109
Q

What are some potential complications associated with an acute kidney injury (AKI)?

A
  • Hyperkalaemia
  • Metabolic acidosis
  • Fluid overload
  • Uraemia
  • Arrhythmias
  • Hypocalcaemia
  • Hyperphosphataemia
110
Q

What is the pathophysiology behind an acute kidney injury (AKI)?

A
  • Largely dependant on the underlying cause
  • Common cause is avascular necrosis
111
Q

What are the three stages involved in the progression of acute tubular necrosis?

A
  1. Initiation
  2. Maintenance
  3. Recovery
112
Q

What clinical feature is seen in an acute tubular necrosis

A
  • Reduced eGFR
113
Q

What bedside investigations can be done for acute kidney injury (AKI)?

A
  • Urine dipstick
  • Urine microscopy
  • Urine osmolality
  • Electrolytes
  • ECG
114
Q

What blood investigations can be done for acute kidney injury (AKI)?

A
  • Creatinine kinase
  • Vasculitis screen
  • Clotting
  • Ig’s
  • Virology
115
Q

What is the assessment tool used for acute kidney injury (AKI)?

A
  • DRS 26
116
Q

What imaging can be performed for an acute kidney injury (AKI)?

A
  • CXR (Signs of overload)
  • Renal dopplers
  • MR angiography
  • USS
117
Q

What is chronic kidney disease (CKD)?

A
  • Prescence of kidney damage or reduced kidney function for three or more months
118
Q

What feature is a hallmark of chronic kidney disease (CKD)?

A
  • Reduction of GFR
119
Q

What are two key measurements used in the diagnosis of chronic kidney disease (CKD)?

A
  • GFR
  • Albumin:creatinine ratio
120
Q

What is the epidemiology behind chronic kidney disease (CKD)?

A
  • Increasingly common with advancing age
  • Stages 3-5 affect up to 8.5% of the population
121
Q

What are some symptoms seen in chronic kidney disease (CKD)?

A
  • Frequently asymptomatic in early stages, only start to show in later stages
  • Anorexia
  • Nausea
  • Fatigue
  • Weakness
  • Pruritis
  • Dyspnoea
  • Oedema
122
Q

What are the clinical features associated with chronic kidney disease (CKD)?

A
  • Pallor secondary to anaemia
  • HTN
  • Fluid overload
  • Raised JVP
  • Oedema
  • Skin pigmentation
  • Excoriation marks
  • Peripheral neuropathy
  • Coma
  • Seizures
123
Q

What can been seen in severe cases of chronic kidney disease (CKD)?

A
  • High urea levels which can manifest as:
  • Uraemic encephalopathy
  • Pericarditis
  • Defective platelet function
124
Q

What are the majority of cases of chronic kidney disease (CKD) secondary to?

A
  • DM
  • HTN
  • Glomerulopathies
125
Q

What are some causes and risk factors for the development of chronic kidney disease (CKD)?

A
  • HTN nephropathy
  • Diabetic nephropathy
  • Glomerulopathies
  • Inherited diseases (PCKD)
  • Nephrotoxic drugs
  • Tubulointerstitial disease
126
Q

How is renoprotective therapy used in chronic kidney disease (CKD)?

A
  • Aimed at slowing progression of chronic kidney disease (CKD)
  • Centered around BP control and reducing proteinuria
127
Q

What is the BP target in chronic kidney disease (CKD)?

A
  • < 140/90
128
Q

What pharmacological options are there for the treatment of chronic kidney disease (CKD)?

A
  • ACEi or ARB
  • SGLT-2i
  • Statins
  • Antiplatelets
129
Q

What are some complications that can arise from chronic kidney disease (CKD)?

A
  • Normocytic normochromic anaemia
  • Hyperkalaemia
  • Acidosis
  • Mineral and bone disorders
  • Hypocalcaemia
  • Fluid overload
130
Q

What are the different types of renal replacement therapy?

A
  1. Haemodyalysis
  2. Peritoneal dialysis
  3. Renal replacement
131
Q

What is the pathophysiology behind chronic kidney disease (CKD)?

A
  • Progressive loss of renal mass and structural changes
  • Lead to a decline in renal function
  • Progressive worsening leads to further abnormalities
132
Q

When is the peak of renal function seen?

A
  • In the third decade of life
133
Q

What are some indications for testing for chronic kidney disease (CKD)?

A
  • Diabetes
  • HTN
  • AKI
  • Obesity
  • CVD
  • Structural renal tract disease
  • Proteinuria
  • Haematuria
  • FHx
134
Q

What are urinary tests that can be done for chronic kidney disease (CKD)?

A
  • Urine dipstick
  • Urine microscopy
  • uACR (Spot test)
  • ACR 24hr collection
  • Electrophoresis
135
Q

What blood tests can be done in chronic kidney disease (CKD)?

A
  • FBC
  • U&E
  • Bone profile
  • Bicarb
  • LFT’s
  • Lipid profile
  • PTH
  • Myeloma screen
  • Autoimmune screen
136
Q

Which test can be useful for determining intrinsic causes of chronic kidney disease (CKD)?

A
  • Renal biopsy
137
Q

What imaging can be done in chronic kidney disease (CKD)?

A
  • Renal USS
  • MR angiography
  • Echocardiogram
  • ECG
138
Q

What is the genetic heritability of chronic kidney disease (CKD)?

A
  • 30% - 75%
139
Q

What is a urinary tract infection (UTI)?

A
  • Refer to infection at any point in the urinary system
140
Q

What is an upper urinary tract infection (UTI)?

A
  • Infection that involves the kidneys
141
Q

What is a lower urinary tract infection (UTI)?

A
  • Infection of the bladder and urethra
142
Q

What is a complicated urinary tract infection (UTI)?

A
  • UTI in with comorbidities that increase risk of treatment failure
  • Such as diabetes or a catheter
143
Q

What is an uncomplicated urinary tract infection (UTI)?

A
  • A UTI with no co-morbitites
144
Q

What is the epidemiology behind urinary tract infection (UTI)?

A
  • Around 50%-70% of all women will get a UTI at sometime during their life
  • 20%-30% will get recurrent UTI’s
145
Q

What are the typical symptoms of a urinary tract infection (UTI)?

A

-Dysuria
- Polyuria
- Urgency
- Incontinence
- Suprapubic pain
- Haematuria
- Nausea/Vomiting

146
Q

What are some clinical features associated with a urinary tract infection (UTI)?

A
  • Fever
  • Rigors
  • Flank pain
  • Confusion
  • Costoverterbral angle tenderness
147
Q

What is the pathophysiology behind a urinary tract infection (UTI)?

A
  • Colonisation and ascending of microorganisms from urethra to bladder and kidney
  • Usually sterile therefore any growth can causes a UTI
148
Q

What is the most common microorganism seen in a urinary tract infection (UTI)?

A
  • E. Coli seen in 75% of cases
  • Gram-negative bacillus bacteria
149
Q

Excluding E. Coli what are some other common microorganisms that can cause a urinary tract infection (UTI)?

A
  • Proteus mirabilis
  • Klebsiella pneumoniae
  • Staphylococcus saprophyticus
150
Q

What are a growing number of urinary tract infections (UTI) being caused by?

A
  • Secondary to extended spectrum beta lactamase producing E. Coli (ESBL)
  • Highly resistant to antibiotics
151
Q

What are some risk factors that contribute to the development of a urinary tract infection (UTI)?

A
  • Recent sexual intercourse
  • Diabetes
  • Spermicide use
  • History of UTI’s
  • Catheter use
152
Q

What is required for a confirmed lab diagnosis of a urinary tract infection (UTI)?

A
  • Typical clinical features
  • Pyuria +/- bacteriuria
153
Q

What is the common management for a urinary tract infection (UTI)?

A
  • Prescription of appropriate antibiotics according to local guidelines
  • Also related to blood culture results
154
Q

What is the management of an uncomplicated urinary tract infection (UTI)?

A
  • Trimethoprim
  • Nitrofurantoin
  • Fluroquinolones
  • 7-14 day course depending on severity
155
Q

What is the management for a complicated urinary tract infection (UTI)?

A
  • Oral fluroquinolone
  • IV Co-amoxiclav
  • Ceftriaxone
  • Broad spectrum antibiotics
156
Q

What are some potential complications of a urinary tract infection (UTI)?

A
  • Pyelonephritis
  • Urosepsis
157
Q

What is the probability of a positive diagnosis in a young female with typical features?

A
  • Around 90%
158
Q

What urinary tests can be done in a urinary tract infection (UTI)?

A
  • Urine dipstick
  • Urine MC&S
159
Q

What can be seen on a urinary dipstick that can be indicative of a urinary tract infection (UTI)?

A
  • Leucocyte esterase
  • Nitrites
160
Q

What blood tests are performed in a suspected urinary tract infection (UTI)?

A
  • FBC
  • U&E
  • CRP
  • Renal function
161
Q

What imaging can be done in a suspected urinary tract infection (UTI)?

A
  • MRI
  • CT
  • USS
162
Q

Is there a genetic component to the development of a urinary tract infection (UTI)?

A
  • Seems to be a familal genetic predisposition behind recurrent UTI’s in women
163
Q

How does urinary flow prevent a urinary tract infection (UTI)?

A
  • Mechanical flushing of the urinary system by urine helps to wash bacteria
164
Q

How does urinary pH prevent a urinary tract infection (UTI)?

A
  • The acidity of urine helps to prevent bacterial growth
165
Q

How does the urinary tract epithelium help to prevent a urinary tract infection (UTI)?

A
  • Provides physical barrier against adhesion and subsequent invasion of pathogens
166
Q

How does the UJV valve help to prevent a urinary tract infection (UTI)?

A
  • One way valve that prevents retrograde flow of urine
167
Q
A

Year 2 Medicine @ Lancaster Uni (15 decks)

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