7. Renal Disease Flashcards

1
Q

Functions of the kidney?

A

Excretory functions

  - Metabolic wastes: urea and creatinine 
  - Bio active substances - hormones, dugs 
  - toxins 

Endocrine functions
- Eythopoitnn, renin, prostaglandins

Regulatory Functions

 - Water balance 
 - Electrolyte balance and acide base balance 

Metabolic Functions
- Vitamin D

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2
Q

Risk factors for Kidney disease?

A
  • pre-existing renal dysfuntion
  • sepsis
  • old age
  • diabetes
  • atherosclerosis
  • chronic hypertension

medications

  • Nonsterodial anti inflammatory drugs
  • angiotensin receptor blockers

Procedures

  • cardiopulmonary bypass
  • liver or kidney transplantation
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3
Q

Steps of urine formation?

A

Filtration
- Filtration only takes place in the renal corpuscle

Reabsorption
- Occurs when filtered material is moved back into the blood

Secretion
- While secretion removes selected material from the blood and places it in the filtrate

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4
Q

What is AKI

A

Acute kidney disease = Abrupt decline in renal function leading to an increase in serum concentrations of urea, creatinine and other substances (occurs over a period of days)

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5
Q

Categories of AKI?

A

Pre renal
= diseases characterized by sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness
• If caught in time this can be reversed

Intra renal orr Intrinsic
= diseases involving damage to kidneys by inflammation, toxins, drugs, infection or reduced blood supply

Post renal
= diseases associated with sudden obstruction of the urinary tract (i.e. ureters, urethra etc)

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6
Q

Renal function tests?

A
  • GFR is rate volume per unit time at which ultra filtrate is formed at the glomerulus
    o Primary measure of renal function
    o Normal is 100-120 mL/min
    o Endogenous markers: creatinine, urea
  • Creatinine clearance is considered the best overall index of renal function
    o Full 24 hrs urine collection to quantify creatinine
    o Cockcroft-gault provides an estimate of Cr Cl form age, weight, gender and serum creatinine
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7
Q

Drugs in Tripple Whammy ?

A
  • Loop diuretic –> block angiotensin II - lower blood volume
  • NSAID –> Block the prostaglandins
  • ACE inhibitor or Sartan (angiotensin-receptor blocker (ARB) –> Wash out what produced

This combo of drugs can lead to renal failure, especially in older people usually aim to remove one of these agents

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8
Q

Difference between Cockroft and eGFR renal function tests?

A

Crokroft

  • use weight into calculation
  • Most resources provide dosage adjustment based on CrCl

eGFR

  • can be obtained without the weight of the patient
  • used for categorisation of CKD
  • Main advantage is to identify CKD early as CKD is asympotamatic
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9
Q

Management of Anaemia?

A

= renal failure results in reduced absorption of iron to make RBC

Erythropoietin therapy
- Erythropoietin-stimulating agents (ESA) eg Darbepoetin (Asanesp)
o Monitor Hb 2-4 weekly
- ESA stimulates bone marrow to make RBC

  • Iron supplement if necessary
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10
Q

Management of Hyperkalaemia

A

In CKD potassium usually sits around 6-6.5

  • Diuretics
  • Risk 7 = immediate calcium gluconate - stabilise heart
  • Insulin + glucose - moves potassium back into cells
  • resonium
  • Stop ACEE inhibitors
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11
Q

Management of Renal Bone disease

A
  • Control Phosphate binders (eg. Calcium carbonate) reduce hyperphosphatasemia e.g. dietary phosphate restriction (avoid dairy)
  • Calcitriol improves hypocalcaemia
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12
Q

Drugs that are excreted by the kidneys:

A
  • Bisphosphonates
  • Colchicine
  • Allopurinol
  • Clexane
  • Antibiotics: gentamicin, aminoglycosides
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