302 Why kidneys fail Flashcards
What disease and outcome does an electrolyte balance cause?
Hyperkalaemia
Hyper/hypo natraemia
Outcome:
Tented T waves - widens QRS - asystole
Confusion - coma - death
What disease and outcome does a fluid imbalance cause?
Oedema
Ascites
Pulmonary oedema
Outcome:
Breathlessness
Heart failure
Mitral regurgitation
What disease and outcome does a acid imbalance cause?
Acidaemia
Outcome:
Reduced cardiac output
Bone destruction
What disease and outcome does abnormal blood pressure cause?
Hypertension
Outcome:
Ischaemic heart disease
Stroke
Heart failure
AAA
What disease and outcome is caused by imbalanced haemoglobin?
Anaemia
Outcome:
Fatigue
Heart failure
What disease and outcome is caused by imbalanced vitamin D?
Hypoparathyroidism (secondary or tertiary)
Outcome:
Blood vessel wall calcification
What disease and outcome is caused by decreased toxin clearance?
Uraemia
Outcome:
Weight loss
Sub fertility
Anorexia
Bleeding
Pericarditis
Encephalopathy
What is kidney failure?
Loss of functioning nephrons
-Irreversible, slow, progressive….CKD
Urine output preserved
-Potentially reversible, rapid onset…AKI
Oliguria (low urine output)
Anuria (no urine output)
Degrees of failure
Stages 1-5 in CKD
Stages 1-3 in AKI
How can the kidney tubules be damaged?
-Acute tubular injury (from sepsis or hypovolaemia)
-Myeolma
-Rhabdomyolysis
What is myeloma?
Bone marrow cancer
How can the kidney glomeruli be damaged?
Diabetes
Vasculitis
SLE
Glomerulonephritis
What is SLE?
Systemic lupus erythematosus
How can the kidney blood vessels be damaged?
Diabetes
Renal vascular disease
Hypertension
HUS (haemolytic uremic syndrome)
What is HUS (haemolytic uremic syndrome)?
Infection with HUS causes destruction of red blood cells, which can then cause kidney failure
Mostly caused by E.coli
What can cause damage to the kidney interstitium?
Final common pathway tubulo-interstitial nephritis (chronic hypoxia in the tubulointerstitium)
What effects does diabetes have on the glomerulous?
Podocyte loss
Mesangial expansion
Mesangial matrix
Thickening of glomerular basement membrane (BGM)
Capillary loss
What is the function of podocytes?
They prevent plasma proteins from entering the urinary ultrafiltrate
What is the mesangial matrix?
It provides structural support for the mesangium, an extremely important component of the glomerulus, forming the supporting framework in which the glomerular tuft capillaries ramify
What is the pathogenesis of diabetic kidney disease?
- Podocyte damage leading to albuminuria
- High glucose environment— reactive oxygen species - vascular endothelial cell damage
- Tubulo-interstitial and glomerular fibrosis
What is Acute Tubular Necrosis?
Damage to the tubule cells of the kidneys, which can lead to acute kidney failure
In the first hours, it can be corrected with fluids/antibiotics
But once enough tubules are ischaemic, patient becomes unresponsive to fluids
What are the different types of ischaemic injuries that can cause acute tubular necrosis (ATN)?
-Diarrhoea, vomiting
-Bleeding
-Dehydration
-Burns
-Renal losses via diuretics or osmotic diuresis
-Third fluid sequestration (e.g nephrotic syndrome)
-Oedematous states such as heart failure and cirrhosis cause reduced kidney perfusion.
-Coagulopathy, such as disseminated intravascular coagulation
What are the different types of toxic injuries that can cause acute tubular necrosis (ATN)?
-Aminoglycosides
-Amphotericin B
-Acyclovir
-Cisplatin
-Cidofovir
-Uric acid (gout)
-Light chain accumulation (myeloma)
-Myoglobin (rhabdomyolysis)
-Ethylene glycol
What are the different types of septic injuries that can cause acute tubular necrosis (ATN)?
-Systemic hypoperfusion
-Endotoxins leading to vasoconstriction
-Inflammatory cytokines-ROS-injury
How is AKI treated?
-Hydration (0.9% saline)
-Prevent hypotension
-Avoid nephrotoxins
-Treat obstruction
-Specific treatment (mostly immunosuppression)
What is the interstitium of a kidney?
The intertubular, extraglomerular, extravascular space of the kidney
Which vessels does the renal artery divide into?
Interlobar arteries
Arcuate arteries
Interlobar arteries
What is renal vascular disease?
Affects the blood flow to kidney
Clinical presentations:
-Rapidly progressive
-Anuric
-Single kidney
-Treated with angioplasty
-Small vessel disease
-Low grade proteinuria
-Associated with vascular disease
elsewhere
What is the final common pathway of kidney damage?
Renal injury causes renal scarring and the whole process is exacerbated by systemic hypertension
What are the different types of dialysis?
Haemodialysis
-blood is directly dialysed and put back in the body
- 4 hours 3x a week
Peritoneal dialysis
-A cleansing fluid flows through a catheter into part of your abdomen. The peritoneum acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded
-Happens every day
What is the peritoneum?
The lining of the abdomen
