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My Own Renal Biochem > Biochemistry of renal disease > Flashcards

Biochemistry of renal disease Flashcards

1
Q

Nephrons in kidney

A

600,00-1.5 million

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2
Q

Impaired function of a kidney is generally as a result of

A

decrease in the number of functioning nephrons and not decreased function of individual nephrons

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3
Q

What is the nephron dose

A

The number of nephrons an individual is born with

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4
Q

Nephron dose effect on developing renal dx

A

If youre born with a low nephron dose youre more succeptible to developing kidney dx and vice versa

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5
Q

Acute renal faluire

A

This is a condition where the kidneys suddenly stop working and cant filter waste from the body

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6
Q

Causes of renal failure

A

Prerenal- Disorders of renal perfusion
Renal- Conditions present in kidney itself
Postrenal- Conditions that cause an obstruction to renal outflow

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7
Q

Examples of preranal causes of ARF

A
  1. Severe blood loss and low blood pressure
  2. Medicines that interfere with blood supply to the kidney
  3. Severe dehydration
  4. Severe burns
  5. Vomiting, diarrhea
  6. Diuretics
  7. Sequestration of fluid in extravascular space i.e hypoalbuminemia, peritonitis
  8. Low cardiac output
  9. Infections causing systemic vasodilation
  10. Renal vasoconstriction i.e hypercalcemia
  11. Cirrhosis with ascites

Generally conditions that reduce blood flow to kidney

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8
Q

How intrinsic renal disease is expressed

A

Tubular necrosis
interstitial nephritis
glomerulonephritis
Vascular disorders

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9
Q

Post renal causes of renal failuire

A

Generally Blockage of urine outflow

Kidney stones in ureters
A bladder that wont empty properly
Enlarged prostate
Cancer of prostate,cervix etc
Stricture in urethra
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10
Q

Tubular necrosis will develop from

A

Ischemia
Toxins
Pigments

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11
Q

Is ARF reversible?

A

YES.

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12
Q

Prerenal ARF also known as

A

Prerenal azotemia

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13
Q

Renal parenchymal tissue is not damaged in ARF if

A

Perfusion is rapidly restored. If not ischemia and damage to renal parenchyma occurs

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14
Q

Prolonged hypoperfusion will cause

A

intrinsic renal azotemia or a problem with the kidney itself

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15
Q

How the kidney protects itself in hypoperfusion

A

Hypoperfusion—>Release of epinephrine, NE, endothelin, ADH, Angiotensin 2—> vasoconstriction of abdominal viscera—>constriction of afferent arteriole to increase blood flow and constriction of efferent to reduce blood outflow—>Intraglomerular pressure preserved

In severe hypoperfusion, these mechanisms prove inadequate and ARF sets in

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16
Q

Causes of intrinsic renal azotemia

A 
Renal artery obstruction
Renal vein obstruction
Diseases of glomeruli
Acute tubular necrosis
Interstitial nephritis
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17
Q

Toxins that cause acute tubular necrosis

A

Exogenous - Aminoglycosides, Amphotericin B, Chemotherapeutic agents (cisplatin), ethylene glycol

Endogenous- Uric acid, hemolysis, rhabdomyolysis,oxalate, plasma cell dyscrasia

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18
Q

Interstitial nephritis is caused by

A

Antibiotics i.e beta lactams,sulfonamides
Infections i.e acute pyelonephritis, cytomegalovirus,candidiasis
Infiltrations - lymphomasleukemias, sarcoidosis
idiopathic

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19
Q

Ischemic insult to kidney parenchyma causes

A

Tight junction disruption,
Apical basolateral polarity disruption
Microfilament disruption

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20
Q

Pathophysiology of prerenal azotemia

A

In case of obstruction–> continuous build up of materials due to constant filtration—-> swelling of proximal ureters, renal pelvis,calyces—> decreased GFR

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21
Q

Chronic renal failure

A

Longstanding disease of the kidneys leading to renal failure characterised by reduction of renal mass and compensatory hypertrophy of remaining nephrons

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22
Q

Causes of CRF

A

Glomerulonephritis
DM
Hypertension
Tubulointerstitial disorders

23
Q

Uremia

A

A clinical syndrome that results from profound loss of kidney function nd which depends on the extent in reduction of functioning renal mass and how fast renal function is lost.

There is high amounts of waste in body

24
Q

Toxins of uremia

A

By products of protein metabolism

Urea
Guanidinho compounds
Urates
Aliphatic amines
Peptides
Derivatives of aromatic amino acids- tryptophan, tyrosine, phenyl alanine
25
Extrarenal cause of fluid loss in CRF patient will cause
Loss of excessive RCF volume since there is no water and salt reabsorption low ecf will further deteriorate residual renal fxn
26
Serum K in CRF patients
normal till end stages of uremia due to adaptation in distal tubules and colon where aldosterone enhance k secretion
27
However hyperkalemia can still be caused by
abrupt disruption of adaptive measures like reduction in blood ph and oliguria
28
How is metabolic acidosis from CRF caused
Due to decreased production of bicarbonate and ammonia as a result of reduction in renal mass
29
Hypocalcemia in CRF
Impaired production of vitamin D due to impaired production of 1,25 dihydroxyvitamin
30
Hyperphosphatemia in CRF
due to decreased GFR and urine output, phosphate levels increase
31
Parathyroid hormone in CRF
Increased levels since vitamin D and calcium will be low
32
Lipid metabolism in CHF
lipoprotein lipase activity depressed in uremia-->increased triglycerides in system Decreased levels of hdl Normal cholesterol
33
Atherosclerosis in CRF patients
HIGH. it is premature and especially for those on premature dialysis
34
Symptoms of uremia
nausea vomiting lethargy
35
Symptoms of renal failuire
symptoms of uremia disorder of micturition i.e dysuria. nocturia. frequency disorders of urine volume Alteration in urine composition - i.e haematuria Pain Edema
36
When you should assess renal fxn
``` old age family history of ckd low birth weight atrophy of kidneys after taking some drugs diabetes mellitus hypertension blockade in ureters systemic infections autoimmune dx UTI Nephrolithiasis ```
37
First step in assessing kidney function
Screening test where urine is collected to be examined physically fr i.e color appearance, odor etc Chemically for protein, glucose, pH Microscopically for rbcs wbcs etc
38
Anuria
No passage of urine. | Or less than 100 ml of urine is produced in a day
39
Causes of anuria
Total obstruction of ureter by i.e prostatic hyperplasia and tumors Heart failure or hypotension leading to renal ischemia Glomerular nephritis Hemolytic reaction caused by blood transfusion can cause anuria
40
Oliguria
Reduction in urine volume
41
Causes of oliguria
Prolonged vomiting, diarrhea | Sweating, ascites,AKI,, Terminal phse of uremia/CKD, glomerulonephritis
41
Causes of oliguria
Prolonged vomiting, diarrhea | Sweating, ascites,AKI,, Terminal phse of uremia/CKD, glomerulonephritis
42
Polyuria
High urine output
43
Causes of polyuria
``` DM ADH deficit Diuretics High caffeine intake high alcohol inttake high protein intake Polydipsia ```
44
Specific gravity
A test that compares specific gravity of urine with water...
45
Normal specific gravity in adults
1005-1020
46
Normal specific gravity in a child
1001-1018
46
Normal specific gravity in a child
1001-1018
47
Urine concentration index
Urine to plasma ratio of creatinine levels
48
Urine concentration index is determined by
sodium chloride urea sulfates phosphates
49
Diseases causing high specific gravity or hypostenuria
ADH insufficiency diabetes insipidus pyelonephritis Glomerulonephritis
50
Hyperstenuria causes
``` DM Nephrosis increased ADH Heart dx Toximea in pregnancy Dehydration ```
51
hyperuriceamia
plasma uric acid concs of higher than 7.0 mg/dl in men and greater than 6.0 mg/dl in women
52
cistatin C produced by
nuclear cells better than creatinine

My Own Renal Biochem (7 decks)

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