6 - renal failure & function

Question 1

what are the 5 major functions of the kidney?

Answer 1

1. removal of water and wastes
2. maintains electrolyte balance
3. maintains acid-base balance
4. regulates BP by renin secretion
5. stimulates production of RBC by erythropoietin secretion

Question 2

what is GFR and what are the factors that determine GFR?

Answer 2

• it is a test to measure the level of kidney function & determine the stage of the kidney disease

1. total surface area available for filtration (number of nephrons
2. filtration membrane permeability
3. net filtration pressure

Question 3

what is oliguria?

Answer 3

<300-500ml/day of urine

Question 4

what is anuria?

Answer 4

<50ml/day of urine

Question 5

how does hypertension affect the kidneys?

Answer 5

it can cause impaired blood flow to the kidney causing hypertrophy

Question 6

what is renal failure?

Answer 6

is a decreased pr cessation of glomerular filtration

Question 7

what is chronic kidney disease?

Answer 7

is a progressive & irreversible decline in GFR

Question 8

what is acute kidney injury?

Answer 8

is an abrupt decrease or cessation of GFR or kidneys stop working
- it is reversible if patient gets correct and prompt treatment

Question 9

what are the causes of acute kidney disease?

Answer 9

• complication of surgery
• renal ischemia caused by blood clots
• drugs (antibiotics, NSAIDs)
• toxins (enviro)
• heatstroke
• multiple organ failure
• sepsis
• kidney stones

Question 10

what causes pre-renal kidney disease?

Answer 10

it is associated with lack of blood supply/low BP

Question 11

what causes renal kidney disease?

Answer 11

it affects the nephrons directly

Question 12

what causes post-renal kidney disease?

Answer 12

mostly due to back back pressure due to obstructions

Question 13

what are the causes of chronic kidney disease?

Answer 13

• diabetes
• hypertension
• obstructive nephronpathy caused by kidney stones
• kidney disease
• renal artery stenosis
• lead poisoning
• fatty plaque deposits

Question 14

what are the stages of chronic kidney disease?

Answer 14

1. diminished renal flow
2. renal insufficiency
3. end stage

Question 15

what occurs during stage 1 (diminished renal flow)?

Answer 15

• no signs and symptoms

Question 16

what occurs during stage 2 (renal insufficiency)?

Answer 16

• waste products build up
• inability to concentrate or dilute urine
• 75% or more nephrons are lost

Question 17

what occurs during stage 2 (end stage)?

Answer 17

• oliguria present
• waste product build up
• treatment required
• 90% or more nephrons are lost

Question 18

what are renal function tests?

Answer 18

• GFR: urine concentration X urine flow
  plasma concentration
• Creatinine clearance rate (CCr or CrCl):
  is the volume of blood plasma that is cleared of creatinine per unit time

Question 19

where is creatinine produced?

Answer 19

it is produced naturally by the body & is freely filtered by the kidneys

Question 20

what is the treatment in renal failure?

Answer 20

• continuous ambulatory peritoneal bypass (CAPD)
• haemodialysis
• renal transplant

Question 21

steps for getting a renal transplant?

Answer 21

• have a suitable donor so the blood groups match
• need regular checks for rejection of kidney
• need immunosuppressive medication

Question 22

what is the difference between haemodialysis and CAPD?

Answer 22

• CAPD is continous and machine free, 21 hour per week, $

- haemodialysis is a machine that takes about 18-30 hours of your week and is $$$

Question 23

what are some dietary interventions when on dialysis?

Answer 23

• decreased fluid intake
• decreased sodium
• decreased potassium
• decreased protein
• decreased carbohyrate/calorie intake

Question 24

how does salt (NaCl) effect your body?

Answer 24

• can increase BP, increase thirst

Question 25

how does potassium (K) effect your body?

Answer 25

• to high levels of K is bad for the heart

Question 26

how does phosphate effect your body?

Answer 26

• high levels can cause damage to blood vessels

Question 27

how does protein effect your body?

Answer 27

• essential nutrient to build muscle

- low levels can lead to fluid retenion and reduce the bodies ability to fight off infection

Question 28

what does hypocalcemia cause?

Answer 28

• increased capillary permeability
• neuromuscular excitability
• decreased blood coagulation

Question 29

what is chvostek’s sign?

Answer 29

contraction of facial muscle in response to light tap on facial muscle

Question 30

what is Trousseau’s sign?

Answer 30

carpal spasm induced by inflating BP cuff