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Path - chempath > Acute and chronic renal failure > Flashcards

Acute and chronic renal failure Flashcards

1
Q

define acute kidney injury?

A

Abrupt decline in GFR

inability to maintain electrolyte, acid-base and fluid homeostasis
Potentially reversible

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2
Q

define chronic kidney injury?

A

Longstanding decline in GFR

Irreversible

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3
Q

which serum protein measurement is used to classify AKI?

A

creatinine

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4
Q

what are the different stages of AKI and the KDIGO classification?

A

AKI Stage 1: Inc sCr by ≥26 µmol/L, or by 1.5 - 1.9x

AKI Stage 2: Inc sCr by 2.0 -2.9x

AKI Stage 3: Inc sCr by ≥3x
or inc ≥354 µmol/L

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5
Q

types of AKI?

A

1) pre-renal - most important
2] intrinsic renal
3] post-renal

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6
Q

in the Renin Angiotensin Aldosterone pathway, which hormone stimulates vasopressin?

A

Angiotensin II

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7
Q

what is the Normal response to reduced circulating volume?

A 
○ Activation of central baroreceptors 
		○ Activation of RAS 
		○ Release of vasopressin
		○ Activation of sympathetic system 
		○ This results in:
			§ Vasoconstriction 
			§ Increased cardiac output 
			§ Renal sodium retention
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8
Q

causes of pre-renal AKI?

A 
True volume depletion - haemorrhage
Hypotension
Oedematous states
Selective renal ischaemia - renal artery stenosis
Drugs affecting glomerular blood flow
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9
Q

Renal blood flow is able to stay constant over a huge range of pressures due to which TWO main mechanisms?

A

Myogenic stretch:
- arterioles constrict to reduce effect of high BP

Tubuloglomerular feedback:
- (Cl- )in DCT causing constriction of afferent arterioles

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10
Q

Name 4 drug groups affecting glomerular blood flow?

A

§ NSAIDs - decrease afferent arteriolar dilatation

§ Calcineurin inhibitors - decrease afferent arteriolar dilatation

§ ACE inhibitors/ ARBs - reduce efferent arteriolar constriction

Diuretics - affect tubular function, decrease preload

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11
Q

what is the difference between Pre-Renal AKI v Acute Tubular Necrosis?

A

Pre-Renal AKI is not associated with structural renal damage and responds immediately to restoration of circulating volume

ATN does not respond to restoration of circulating volume
Ischaemic injury
-> Epithelial cell casts

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12
Q

causes of post renal AKI?

A

physical obstruction to urine flow

(Intra-renal obstruction)
Ureteric obstruction (bilateral)
Prostatic / Urethral obstruction
Blocked urinary catheter
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13
Q

What causes reduced gfr in obstructive uropathy?

A

GFR is dependent on hydraulic pressure gradient

Obstruction results in INCREASED renal TUBULAR pressure

Immediate decline in GFR = long term consequences if unresolved

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14
Q

causes of intrinsic AKI?

which part of kidney affected

A

abnormality of any part of Nephron:

Vascular Disease e.g. vasculitis
Glomerular Disease e.g. glomerulonephritis
Tubular Disease e.g. ATN
Interstitial Disease e.g. analgesic nephropathy

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15
Q

causes of direct TUBULAR injury?

A

Endogenous toxins: Myoglobin, Immunoglobulins

Exogenous toxins - contrast, drugs: acyclovir

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16
Q

why can rhabdomyolysis lead to AKI?

A

Rhabdomyolysis – myoglobin leak has clogged up renal TUBULES

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17
Q

which conditions cause renal injury via Infiltration / Abnormal protein deposition?

A

Amyloidosis
Lymphoma
Myeloma-related renal disease

18
Q

which conditions cause renal injury via

Immune dysfunction causing renal inflammation

A

Glomerulonephritis

Vasculitis

19
Q

What two measures do we use to define severity of acute kidney injury?

A

Serum creatinine and urine output

20
Q

4 phases of wound healing?

A

Haemostasis
Inflammation
Proliferation
Remodeling

21
Q

Why do some cases of AKI resolve? And some not?

A

wound healing:

Replacement of renal tissue by scar tissue results in chronic disease

22
Q

How many Stages of CKD?

what is the last stage?

A

5 stages

stage 5 - end stage renal failure egfr < 15

23
Q

what is stage 1 ckd?

A

Kidney damage with normal GFR

above 90

24
Q

CKD is determined based on?

A

GFR

25
Q

Commonest causes of CKD?

A

similar to AKI:
Chronic Glomerulonephritis
Infective or obstructive uropathy

others:
Diabetes
Atherosclerotic renal disease
Hypertension
Polycystic kidney disease
26
Q

name some endocrine functions of the kidney?

A

EPO
RAS
Vit D

27
Q

in CKD, what is the consequence of a:

Progressive failure of homeostatic function?

A

Acidosis

-Hyperkalaemia

28
Q

in CKD, what is the consequence of a:

Progressive failure of hormonal function?

A

Anaemia - EPO

Renal Bone Disease - 1a hydroxyls; vit d etc

29
Q

effect on bone as consequence of renal acidosis?

A

Osteopenia due to mobilization of bone calcium

30
Q

treatment for renal acidosis?

A

oral sodium bicarbonate

31
Q

Cause of high K+ in CKD?

treatment for hyperkalaemia in CKD?

A

intake from DIET then kidney can’t clear it.

ACEi - captopril
Spironolactone - ’Potassium-sparing’ diuretics

32
Q

Anaemia of chronic renal disease is what type on blood film?

A

Normochromic, normocytic anaemia

33
Q

bone diseases resulting from Kidney disease?

A

Osteitis fibrosa - hyperPTH
Osteomalacia - vit d defic

Adynamic bone disease
Mixed osteodystrophy

34
Q

how does development of SECONDARY hyperparathyroidism occur in CKD?

A

CKD = PO4 retention and low 1,25 Vit D = consistent hypocalcaemia

this stimulates PTH secretion from parathyroids

= less vit d receptor expression, and Klotho- FGFR1 receptors too.

etc!

35
Q

Excessive suppression of PTH (from overtreatment) results in low turnover and reduced osteoid is a feature of?

A

dynamic bone disease

36
Q

in the treatment of renal bone disease, cincalcet works by?

A

Direct PTH suppression

by increasing the sensitivity of the calcium-sensing receptors

37
Q

in the treatment of renal bone disease, 1-alpha calcidol works by?

A

Vit D receptor activators

38
Q

in the treatment of renal bone disease Phosphate control

can be achieved by?

A

Diet

Phosphate binders - calcium chloride

39
Q

In CKD the risk of cardiac event is directly predicted by?

A

GFR

40
Q

which consequence of CKD causes the following;

Left ventricle (LV) hypertrophy
LV dilatation
LV dysfunction
A

Uraemic cardiomyopathy

41
Q

what are the treatment Options for People with Progressive CKD?

A

Transplantation
Haemodialysis
Peritoneal dialysis

42
Q

first line treatment algorithm for CKD?

A

ACE Inhibitor - lisnopril

+ Statin

glucose control, treat 2ndary HyperPTH, treat anaemia, treat acidosis

stage 5: Dialysis, transplant

Path - chempath (25 decks)

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