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Medicine - Year 2 > Block 10 - Kidney function and failure > Flashcards

Block 10 - Kidney function and failure Flashcards

1
Q

Define hydronephrosis

1 possible cause

A

Urine builds up in the kidneys

Rapid weight loss causing the kidneys to drop

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2
Q

What are the two types of nephrons?

What is their percentage?

A 
Corticol nephron (85%) mainly in the cortex
Juxtamedullary nephron (15%) mainly in the medulla
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3
Q

Explain the myogenic mechanism of blood pressure control

A

The afferent arteriole smooth muscle adapts to systemic blood pressure
To increase blood pressure it constricts to decrease filtration
To decrease blood pressure it dilates to increase filtration

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4
Q

Explain how the macula densa cells control blood pressure

A

Macula densa cells in the ascending loop

Increase the GFR = high blood pressure
Increase GFR = more NaCl in tubule
NaCl detected by macula densa cells = release vasoconstrictive agents = less blood to glomerulus = lower GFR and less NaCl in the tubule

Less macula densa mediators if a low blood pressure

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5
Q

Draw the RAAS pathway

A

Renin –(angiotensinogen)–> ANG1 –(ACE)–> ANG2 –> Aldosterone

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6
Q

Can sodium be secreted?

A

NO - only filtered

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7
Q

What is it called when there is glucose in the urine?

A

Glycosuria

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8
Q

How are sodium and glucose reabsorbed by the kidney?

A

Glucose and Na co-transported into the nephron cell

Glucose into the blood via a GLUC transporter
Na into the cell via an ATP pump (3 Na in and 2K out)

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9
Q

What does progesterone act as?

A

A diuretic

Blocks aldosterone

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10
Q

Give 2 hormones which are similar to aldosterone

A

Oestrogen

Corticosteroids

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11
Q

What parts of the heart produce naturietic peptides?

A

Atrial NP produced by overstretched cardiomyocytes in the atria
N-Type NP produced by overstretched cardiomyocytes in the ventricles

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12
Q

Explain how bicarbonate is reabsorbed and hydrogen ions are secreted in the PCT
Which enzyme is involved

A

In the filtrate H+ + HCO3- –> H2CO3 (impermeable)
H2CO3 –> H20 + CO2 (enter the cell)

In the cell they recombine and separate again
H+ (re-enters tubule in exchange for Na+ using ATP)
HCO3- (enters capillary in exchange for Cl-)

CARBONIC ANHYDRASE

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13
Q

Why do you need to take care with using loop diuretics with heart and kidney failure?

A

Can lose sodium and potassium

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14
Q

Which transporter is found in the Loop of Henle?

A

Na/K/Cl

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15
Q

Which 3 things act on the DCT?

A

Na/Cl transporter
PTH
Thiazide diuretics

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16
Q

What are the 2 cells found in the CD?

What are their roles?

A

Principal cells: Water and sodium balance

Intercalated cells: Acid base balance

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17
Q

How much potassium is absorbed in the PCT?

What happens when levels in the body increase/decrease?

A

90% reabsorbed regardless of need

Principal cells absorb or excrete it in exchange for sodium

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18
Q

What is it called when there is too much water in the urine?

A

Diabetes insipidus

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19
Q

Give two methods to assess kidney function

A

Glomerular filtration rate (eGFR)

Renal clearance

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20
Q

What is renal clearance?

How is it measured?

A

Volume of plasma cleared of a substance in 1 min

Clearance = (urine conc x urine vol) / plasma conc

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21
Q

What is renal clearance standardised against

How can you tell if a substance is all reabsorbed or secreted

A

Standardised against a substance which is not secreted or absorbed (all is filtered) e.g. inulin (or creatinine)

If glucose level is LOWER than the inulin standard then it is all REABSORBED
(higher = secreted)

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22
Q

Does the blood pressure increase or decrease if you have renal disease?

A

Increase

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23
Q

Where does pain from the kidney radiate to?

A

Groin

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24
Q

6 causes of haematuria from the kidneys

A

Polycystic, tumour, scarring, cystitis

Glomerular nephritis, vessels

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25
Q

What age group suffers from LUTS?

A

Elderly

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26
Q

What does it mean if the urine is a brown/red colour?

A

Increased myoglobin

Breakdown product of muscles

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27
Q

What does it mean if the urine is cloudy?

A

Infection (increased WBC)

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28
Q

What does it mean if the urine is gravely?

A

Stone fragments

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29
Q

What does it mean if the urine is airy?

A

Vesico-colic fistula

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30
Q

What does it mean if there are debris in the urine?

A

Infection, vesico-colic fistula, infarction

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31
Q

3 causes of anuria

A

Severe acute kidney injury
Longstanding end stage renal failure
Post renal obstruction

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32
Q

2 causes of oliguria

3 examples

A

Acute kidney injury (reversible)

Usually drug induced (NSAID, steroid, antibiotic)

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33
Q

2 causes of polyuria

A

Early chronic kidney disease (can’t concentrate urine)

Osmotic diuretic

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34
Q

Define Nephrotic and Nephritic syndrome
3 symptoms of nephrotic
2 symptoms of nephritic

A

Nephrotic: PrOtein in the urine
(increased lipids, decreased albumin, oedema)
Nephritic: Protein and blood in the urine
(inflammation of the glomeruli, oliguria)

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35
Q

Define oliguria

A

Reduced urine output

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36
Q

What is angiography used to look at in the kidneys?

A

Chronic kidney injury

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37
Q

5 biochemical markers of renal failure

Are they increased or decreased?

A

Increased urea, creatinine and phosphate

Decreased calcium and albumin

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38
Q

What happens to the levels of protein bound drugs in chronic renal disease

A

Decreased albumin means decreased protein bound drugs

Side effects may occur

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39
Q

What defines chronic kidney failure?

A

GFR less than 6 ml/min for more than 3 months

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40
Q

4 pre-renal causes of AKD

A

Decreased perfusion
Heart failure
Decreased blood pressure (shock)
Hypovolemia

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41
Q

4 renal causes of AKD

A

Ischaemia
Nephrotoxic drugs
Nephron disorders
Sepsis

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42
Q

2 post-renal causes of AKD

A

Urethral/bladder obstruction (tumour or prostate)

Kidney/bladder stones

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43
Q

6 causes of chronic kidney disease

A 
Diabetes
Increased blood pressure
Glomerular disease
Hereditary 
Nephritis
Tumours
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44
Q

What are the 5 stages of chronic kidney disease?

A
  1. Normal GFR (more than 90)
  2. Mild decrease (60-89)
  3. Moderate decrease (30-59)
  4. Severe decrease (15-29)
  5. End stage renal disease (less than 15)
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45
Q

One major advantage for genetic screening

A

Know if they will pass it on to any children

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46
Q

What is the name of the main genetic kidney disease?

When are the two types diagnosed?

A

Autosomal dominant polycystic kidney disease

T1: 30-40 yrs
T2: 70+ yrs

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47
Q

How can CKD lead to metastatic calcifications in vessels?

A

Decreased GFR decreases Vitamin D synthesis so decreases Ca absorption from the GI tract

Decreased Ca increases PTH so increases the amount of Ca released from bones causing vessel calcifications

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48
Q

How does heart failure cause kidney disease?

A

Heart failure –> Decreased CO –> Decreased blood to the kidney –> Renal hypoxia and necrosis

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49
Q

What are the 3 systems which regulate blood pH?

A

Seconds: Chemical buffers
Minutes: Respiratory centres
Days: Renal system

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50
Q

What are the 3 main kidney buffering systems?

A

Bicarbonate
Phosphate
Ammonia

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51
Q

What is the main intracellular buffering system?

A

H+ + Hb HHb

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52
Q

Explain the bicarbonate buffer system

A

H20 + CO2 –> H2CO3 –> H(+) + HCO3(-)

H(+) secreted
HCO3(-) reabsorbed in the PCT

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53
Q

Explain the phosphate buffer system

A

HPO4(2-) + H(+) –> H2PO4(-)

H2PO4(-) excreted in the urine

54
Q

Explain the ammonia buffer system

A

(Glutamine metabolism)

IN THE PCT:
Glutamine –> NH3 + HCO3(-)
NH3 + H(+) NH4(+)

IN THE CD:
NH4(+) reabsorbed then excreted again into the urine

55
Q

When do you excrete H+?

A

You use the buffer systems first but after the buffer systems have been ‘used up’ you then excrete H+

56
Q

What happens if there is a problem with the kidney (in regards to ammonia metabolism)

A

Ammonia re-enters the blood and is converted to urea in the liver causing toxicity

57
Q

5 causes of metabolic acidosis

A

Ingestion of acid
Increased lactic acid (exercise, diabetic ketoacidosis)
Increased ketone bodies (diarrhoea, diabetes, alcohol, increased protein)
Aspirin overdose
Starvation

58
Q

5 causes of metabolic alkalosis

A 
Antacid
Fruit
Vomiting
Hypokalemia 
Steroids
59
Q

6 causes of respiratory acidosis

A

Respiratory depression (narcotic drugs, anaesthetic)
CNS disease, depression, brain trauma
Interference with respiratory muscles (disease, drug, toxin)
Restrictive/obstructive lung disease

60
Q

4 causes of respiratory alkalosis

A

Hyperventilation
Overventilation on a mechanical ventilator
Altitude
Fever

61
Q

What do the kidneys do if the pH is low?

A

Intercalated cells secrete H+

Principal cells make new bicarbonate

62
Q

What do the kidneys do if the pH is high?

A

Principal cells do not reabsorb filtered bicarbonate

63
Q

5 reasons why infants are at an increased risk of acid-base imbalance?

A 
Decreased volume on the lungs
Increased metabolic rate
Increased rate of water loss
Inefficient kidneys
Excessive fluid shift (increased intake and output)
64
Q

2 reasons why the elderly are at an increased risk of acid-base imbalance?

A

Unresponsive to thirst cues

Slow homeostasis

65
Q

Is the patient compensating if:

  1. CO2 and HCO3 are BOTH increased/decreased?
  2. One value is increased and the other is normal?
  3. One value is increased and the other decreased?
A
  1. Yes - compensating
  2. No - not compensating
  3. Would never be seen
66
Q

Give 8 examples of organic anions excreted by the kidney

A

Urea, Ketoacids, Bile salts
Penicillin, Diureitcs, Cephlasporin, Aspirin
Investigative contract

67
Q

Give 4 examples of organic cations excreted by the kidney

A

Creatinine

Quinidine, Trimethoprim, Cimetidine

68
Q

How can you increase the therapeutic effect of the drug by using the PCT?

A

The PCT is competitive so adding specific drugs may decrease re absorption so other drugs stay in the plasma for longer and increase their therapeutic effect

69
Q

2 things that the urine concentration of a drug is dependent on?

A

Entrance of the drug into the tubule

Reabsorption of the drug from the tubular fluid

70
Q

What does the drugs ability to remain in the tubule depend upon?

A

Its charge

Ionised (charged) drugs stay in the tubule more effectively (e.g. acid drug alkaline urine)

71
Q

What are the three layers of the bladder?

A

Outer connective tissue
Middle smooth muscle (detrusor)
Inner transitional cell epithelium (elastic)

72
Q

Define urodynamics

A

Investigation of micturition

73
Q

Define cytometry

A

Measuring the pressure-volume relationships of the bladder

74
Q

What can failure of the detrusor muscle cause?

How is it worsened?

A

Voiding symptoms

Patients push against resistance = more over-stretched

75
Q

Why might you not notice an enlarged prostate to begin with?

A

In the early stages increased detrusor pressure maintains flow but eventually this muscle weakens causing voiding symptoms

76
Q

Give 1 cause of a acute urinary retention - who is it most common in?
Give 3 causes of chronic urinary retention

A

Acute: Surgery (men)
Chronic: Prostate obstruction, urethral structure, LMN lesion affecting the bladder

77
Q

Who does incontinence affect?

A

Women of all ages

78
Q

Most common incontinence in men?

Most common cause of incontinence in men?

A

Overflow

Neuropathic problems

79
Q

What are the two types of incontience involved in mixed incontinence?

A

Stress and urge

80
Q

Give 8 risk factors for incontinence

A 
Pregnancy
Menopause
Chronic cough
Obesity
Pelvic organ prolapse
Constipation
Lifting weights/strenuous aerobic exercise
81
Q

4 treatments for female stress incontinence

A

Support of the bladder neck
Increasing urethral resistance
Injection of a bulking agent to the urethra (urethral sphincter augmentation)
Urethral and vaginal slings

82
Q

Main cause of an overactive bladder

A

Idiopathic

83
Q

4 treatments of an overactive bladder

A

Sacral nerve stimulation
PTNS (percutaneous tibial nerve stimulation)
Urinary diversion
Interstim therapy (implantable neuromodification)

84
Q

Give 3 examples, other than E.coli, of bacteria which can cause UTI

A

S. aureus
S. epidermidis
P. mirabilis

85
Q

What can cause a UTI after a kidney transplant?

A

BK and JC virus

86
Q

What is another name for a descending UTI?

Where are they mainly found?

A

Haematogenous

Common in ICU

87
Q

What UTI is a major problem in pregnancy?

What would usually happen if a patient had this type of UTI?

A

Asymptomatic UTI - screened for during pregnancy

UTI’s are otherwise only treated if the patient shows symptoms and has an immune response

88
Q

3 host immune defences to prevent UTI

A

Secretory IgA: binds to inactivate bacetria
Lactoferrin: binds to Fe to prevent bacteria using it
Mucopolysacchrides: prevent bacetria from binding

89
Q

2 bacterial virulence factors needed for UTI

A

Type 1 fimbriae: projections to mannose membranes –> colonisation
Type P fimbriae: K antigen (capsule) prevents phagocytosis

90
Q

6 risk factors for UTI

A

Female, Pregnancy, Anatomical abnormalities (residual urine)

Catheter, Stones, Surgery

91
Q

Define dysuria

A

Pain or difficulty urinating

92
Q

5 things that work and 3 things that don’t work when trying to prevent catheter associated UTIs

A

Works: Not catheterising, Decreasing duration, Aseptic insertion, Closed Drainage, Silver bonded catheters

Doesn’t work: Antiseptic to urethral meatus, Disinfectants in drainage bag, Antiseptic/antibiotic irrigation of the bladder

93
Q

4 causes of urethral syndrome

A

Reduced bacterial count
Bacteria don’t grow on that culture
Non-infective (other inflammation)
STI

94
Q

How long do you give antibiotic prophylaxis for UTI treatment?

A

6 months

95
Q

What do you give to help recurrent UTIs in post-menopausal women

A

HRT

96
Q

What, in the family history, can increase a child’s risk of UTI?

A

Renal abnormalities

97
Q

What is found in the upper and lower urinary tract?

A

Upper: Kidneys and ureters
Lower: Bladder and urethra (prostate and genitals)

98
Q

What cancers are under the heading ‘uro-oncology’

A

Kidney, bladder, prostate, testicular, penile

99
Q

Define andrology

A

Problems with the male genitalia

100
Q

What are the 2 types of kidney transplant?

A

Cadeveric or live donor

101
Q

What indicates infection on histology?

A

Black dots

102
Q

Give 4 examples of congenital problems with the kidneys

A

Horse-shoe kidney
More ureters/larger ureters (infection and stones)
Vesicouretic reflux (air from a hole)
Penile chordae (bent)

103
Q

What histological changes are found in BPH?

A

Stromal-glandular hyperplasia

104
Q

3 treatments for BPH

A

Anti-androgen drugs
Core-ing
Catheter (in acute situations to release fluid and prevent renal failure)

105
Q

4 causes of epididymitis

A

STI
E.coli
Mumps
Orchitis

106
Q

3 causes of chemical cystitis

A

Ketamine, Mitomycin, BCG

107
Q

What are kidney stones called?

A

Urolithiasis

108
Q

4 causes of urethral stricture

A

Neoplasm
Infection
Trauma
Compression

109
Q

4 risk factors of kidney stones

A

Male
Dehydration
Diet
Genetic

110
Q

What type of carcinoma is renal?
1 risk factor
When does it present?

A

Clear cell
Smoking
Presents late as you have two kidneys

111
Q

2 types of testicular cancer

2 risk factors

A

Seminomas
Non-seminomas (carcinomas of the embryological membranes)

Family history and undescended testes

112
Q

What are the 3 types of bladder cancer?

6 risk factors

A

Transitional cell carcioma
Squamous cell carcinoma
Adenocarcinoma

Chronic irritation, Smoking, Asbestos, Crude oil, Rubber, Plastic

113
Q

What type of cancer is prostate cancer?
3 risk factors
Problem

A

Adenocarcinoma
Family history, age, ethncity
Overdiagnosed - surgery and hormones have side effects

114
Q

What type of cancer is penile cancer?

4 risk factors

A

Squamous cell carcinoma

HPV, Smoking, Poor hygiene, Smegma

115
Q

Give 2 congenital causes of protein loss?

A

NPHS1 gene: Finnish type –> nephrin between podocytes

NPHS2: Steroid resistant –> podicin in podocytes (children)

116
Q

2 problems that can occur with the glomerulus which can cause proteinuria

A

Podocyte injury

Loss of negative charge

117
Q

Causes of nephrotic syndrome:

  • Children (2)
  • Adults (7)
  • Both (2)
A

Children:
Glomerulonephritis (minimal change/ focal segmental)

Adults:
Glomerulonephritis (membranous)
Neuropathy (membranous, IgA, diabetic)
Amylodosis
SLE
Cancer

Both:
Minimal change disease
Viral infection

118
Q

Causes of nephritic syndrome:

  • Children (3)
  • Adults (4)
A

Children:
Haemolytic uraemic syndrome
Hensoc-schonein purpura
Post-strep glomerulonephritis

Adults:
Goodpasture's
ANCA vasculitis
SLE
Primary or secondary mesngio-capilalry glomerulonephritis
119
Q 
Explain the pathophysiology of kidney injury caused by:
SLE
Goodpasture
Infections
Diarrhoea
A

SLE: Antigen-antibody complex deposit in basement membrane
Goodpasture: Abnormal antigen on basement membrane
Infections: Bacterial antigens bind to basement membrane
Diarrhoea: Toxin on the capillary membrane

Complement –> inflammation and cell injury

120
Q

What is vital for a diagnosis of end stage renal failure?

A

Bilateral insult

121
Q

Define azotemia

1 possible cause

A

Abnormally high compounds containing nitrogen in the blood (e.g. urea, creatinine)
Caused by a reduced GFR

122
Q

How can renal failure cause polyuria?

A

When water is filtered but nothing else is

123
Q

Example of a pre-renal cause of renal failure (2)

A

Blood vessel issues

e.g. clot, hypovolemia

124
Q

Give 3 classes (6 examples) of intra-renal renal failure

A

Glomerular injury: Diabetes, Glomerulonephritis
Tubular injury: Pyelonephritis scarring, Drugs
Vascular injury: Hypertension, Vasculitis

125
Q

Define uraemia

12 symptoms

A

Increased levels of uric acid

Anorexia , Breathlesness, Chest pain, Cognitive impairment, Coma, Fatigue, Itching, Metallic taste, Nausea, Smelly breath, Seizures, Vomiting

126
Q

What does sodium and water retention do to the JVP?

A

Increases it

127
Q

Explain the underfill model of oedema

Who is it more common in?

A

Reduced oncotic pressure = more water into tissues
Reduced plasma volume activates RAAS
Increased hydrostatic pressure = more water out

Children

128
Q

Explain the overfill model of oedema

A

Kidney damaged = Na + H2O retained but protein lost

Increased hydrostatic pressure and reduced oncotic pressure

129
Q

2 causes of primary oedema (related to the kidney)

A

Glomerulonephritis

Membranous neuropathy

130
Q

4 causes of secondary oedema (related to the kidney)

A

Diabetic neuropathy
SLE
Cancer
Chronic viral infection

Medicine - Year 2 (19 decks)

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