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Case 10: Urinary System > Chemical Pathology: Renal Failure > Flashcards

Chemical Pathology: Renal Failure Flashcards

1
Q

What is the 3 functions of the kidney

A
  1. Maintain ECF volume & pH homeostasis
  2. Excretion of waste
  3. Endocrine functions
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2
Q

What is the 2 endocrine functions of the kidney

A

EPO
Vitamin D activation

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3
Q

What is GFR used for

A

Measurement of renal functional capacity & reflects the amount of functional nephrons
Highly specific & sensitive for change in renal function

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4
Q

What is the GFR definition

A

Volume of plasma that can be cleared of an ideal substance per unit of time corrected to body surface area

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5
Q

What is the definition for renal clearance

A

Rate at which kidneys clear blood plasma of substances

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6
Q

What is 3 criteria’s for an ideal substance

A
  1. Stable plasma concnetr & only in ECF
  2. Freely filterable through glomerulus
  3. Not reabsorbed or excreted by tubule
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7
Q

What is the clearance ratio & meaning

A

=1 freely filtered & not secreted
<1 not freely filtered & or reabsorbed
>1 freely filtered & secreted

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8
Q

What is creatinine

A

Cyclic anhydride of phospho-creatinine

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9
Q

Where is creatinine found & function thereof

A

Intra-cellular component of skeletal muscle
Storage & transfer of phosphate for muscle contraction

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10
Q

3 places where creatinine is synthesized

A

Liver, kidney & pancreas

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11
Q

What provides the stable production rate

A

Spontaneous conversions of muscle

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12
Q

Why is creatinine not an ideal substance to measure for renal function

A

High concentration secreted fat renal tubules & GIT

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13
Q

What is 3 ways in which GFR can be measured

A
  1. Creatinine
  2. S-cystatin C
  3. Exogenous tracers
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14
Q

What is the tools used to measure creatinine in adults & children

A

Adults KDIGO
Child IDMS traceable Schwartz

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15
Q

What is the 3 limitations of creatinine measurement

A
  1. People w/ extreme muscle mass
  2. People w/ extreme creatinine intake
  3. Unstable renal function (hospitalized)
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16
Q

What is cystatin C

A

Non glycosylated low molecular weight protein in all cells

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17
Q

What is the benefit of using cystatin C instead of creatinine for renal function measurement

A

Plasma concentration is less influenced by age, gender & muscle mass
Renal corpuscle filtration w/ near total reabsorption & catabolism w/ little to no excretion

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18
Q

When is exogenous tracers used testing for renal function

A

Pre & post transplant as it is more accurate

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19
Q

What 2 tracers are used exogenous tracers in kidney function testing

A

Cr51 EDTA (radioactive)
Lohexol (more expensive)

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20
Q

How does exogenous tracers work

A

Tracers injected w/ multiple blood samples to measure concentration of tracers cleared by glomerulus

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21
Q

What is acute renal failure

A

Renal pathology involving all nephrons with loss of function in glomerular & tubular

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22
Q

What is the 2 phases of acute renal failure

A
  1. Oliguria
  2. Polyuria
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23
Q

What is the relationship between creatinine/urea & acute renal failure

A

Urine excretion of urea & creatinine is less than produced & serum levels increase

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24
Q

What is the pathophysiology of acute renal failure

A
  1. Vasoconstriction & desquamation of tubular cells or death
  2. Slough off of viable or dead cells that can cause an obstruction
  3. There can either be proliferation & differentiation into normal tissue or inhibition of repair & progression leading to chronic renal disease
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25
Q

What is the 3 classifications of renal failure

A
  1. Pre renal failure
  2. Intrinsic renal failure
  3. Post renal failure
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26
Q

What does pre renal failure result in

A

Leading to hypoperfusion of the kidney & increased serum BUN & creatinine
Decrease blood pressure & decrease GFR causing accumulation of waste products in blood
The decrease in GFR leads to activation of RAAS leading to Na & water retention & urea follows Na retention

27
Q

What 8 people are at risk for acute renal failure

A

Advanced age
Female
Black
Underlying chronic kidney disease
DM
Cancer
Anaemia
Underlying chronic disease

28
Q

What is 4 things that causes pre renal failure

A
  1. Absolute fluid loss (V, D, burns & dehydration)
  2. Relative fluid loss (shock & cardiac failure)
  3. Renal artery stenosis & embolus (obstruction)
  4. Liver failure
29
Q

What equation is used in pre renal failure

A

Fractional excretion of Na (equation)

30
Q

Why is the fractional excretion of Na equation used for

A

Differentiate pre renal failure from ARF

31
Q

What is intrinsic renal failure

A

AKI w/ parenchymal damage (acute tubular necrosis or glomerulonephritis)

32
Q

What is the results of intrinsic renal failure

A

Increase nitrogenous compound in blood & decrease GFR

33
Q

What is 5 causes intrinsic renal failure

A
  1. Glomerulonephritis
  2. Tubular injury & obstruction
  3. Interstitial nephritis
  4. Glomerular endotheliopathy
  5. Prolonged pre or post renal failure
34
Q

What is post renal failure

A

Defect after the kidney

35
Q

What does post renal failure result in

A

Obstruction of urine outflow that increase nitrogenous waste & reverse of Starling Forces & pressure backs up to kidneys & tubules causing decrease in pressure & GFR

36
Q

What is 3 things that cause post renal failure

A
  1. Compression
  2. Obstruction
  3. Congenital abnormalities
37
Q

Causes of ARF & differentiation

A

USE TABLE

38
Q

Discuss the 2 phases of acute renal failure

A
  1. Oliguric phase:
    Increased blood urea, creatinine, K & P
    High anion gap & metabolic acidosis
  2. Polyuric phase:
    Rapid water & electrolyte loss causing dehydration, hypoNa & -Ka
39
Q

What is to predictors used for AKI

A
  1. Sepsis markers
  2. AKI measures
40
Q

What is sepsis markers

A

WCC, CRP & PCT (procalcitonin)

41
Q

What is the significance of pro calcitonin as sepsis marker

A

Cells produce w/i 4-12 hrs of systemic bacteraemia
Used as antibiotics indicator

42
Q

What is AKI markers

A

Neutrophils gelatinase associated lipocalin

43
Q

What is NGAL function

A

Inflammatory marker (protein) in urine released in tubular epithelial cells that binds to Fe

44
Q

What is the treatment of post-renal failure

A

Relieve obstruction & monitor for subsequent polyuria as waste products accumulated excreted

45
Q

What is the treatment of pre-renal failure

A

Restore perfusion

46
Q

What is 6 treatments for intrinsic renal failure

A
  1. Dialysis
  2. Protein restriction to reduce urea & hydrogen production
  3. Hydrogen given bicarbonate if severely acidotic
  4. Sodium if oliguric restrict intake if diuretic supplement
  5. Potassium if oliguric restrict intake & possibly dialysis if diuretic supplement
  6. Fluid replacement slowly if blood volume is low can cause fluid overload leading to cardiac failure
47
Q

How is fluid replacement calculated

A

500ml/day + previous day urine output w/ daily weight management

48
Q

What is the 2 types of RRT

A
  1. Haemodialysis fast, efficient but expensive
  2. Peritoneal dialysis slow, cheap & easy
49
Q

How is hyperK diagnosis

A

W/ changes in ECG

50
Q

What is the 3 treatment w/ hyperK

A
  1. Calcium to stabilize myocytes
  2. Insulin to shift potassium into cell
  3. B-agonists stimulate glycogenolysis generate phosphorylated glucose intermediates
51
Q

What is chronic renal failure

A

Permanent loss of nephrons

52
Q

What is the new steady state in chronic renal failure

A

Established by intact nephrons

53
Q

What does chronic renal failure result in

A

Increased blood urea & creatinine & remain stable unless disease progress

54
Q

What is the 3 causes of chronic renal failure

A
  1. Glomerulonephritis
  2. HPT renal disease
  3. Diabetic nephropathy
55
Q

What is the end morphology of chronic renal failure

A

Small sclerotic kidneys due to loss of nephrons

56
Q

What is the 3 CRF biochemical consequences

A
  1. Loss of endocrine function
  2. Too little of substances in urine
  3. Too much of substances in urine
57
Q

What is the 2 endocrine functions lost in chronic renal failure

A
  1. EPO causing anaemia
  2. Decrease vitamin D activation causing hypocalaemia & renal osteodystrophy
58
Q

What is 3 things lost in urine during chronic renal failure

A
  1. Phosphate as PCT excretion function is lost leading to hyperphosphataemia
  2. Potassium as DCT excretion function is lost leading to acidosis & hyperkalaemia
  3. Loss of compensatory mechanisms for acid load leading to chronic anion gap metabolic acidosis
59
Q

What is 2 things that are to high in urine excretion in chronic renal failure

A
  1. Na & water is lost leading to low osmolarity, polyuria & dehydration & later on not secretion of water & Na leading to overhydration/hyperNa
  2. Hyperglycaemia as renal threshold decrease for glucose & not secreted & can lead to dehydration
60
Q

What 2 things act as an osmotic diuretic

A
  1. Hyperglycemia
  2. Uraemia
61
Q

What is the 6 complications of chronic renal failure & treatment

A
  1. Na retention causing volume overload & treated w/ Na restriction & diuretics
  2. Hyperkalaemia treated w/ dietary restriction & avoid NSAIDS
  3. Metabolic acidosis treated w/ sodium bicarbonate
  4. EPO deficiency causing anaemia treated w/ EPO stimulating meds & Fe supplements
  5. Hyperphosphataemia treated w/ phosphate binders
  6. Low Ca levels treated w/ calcimimetics
62
Q

What is the pathogenesis of renal osteodystrophy

A
  1. Renal failure causes phosphate retention
  2. Stimulation of FGF23
  3. Vitamin D activation is inhibited
  4. Decrease in s-Ca & PTH is released
  5. PTH cause bone resorption
63
Q

What is another factor that leads to bone demineralization in chronic kidney failure

A

Chronic acidosis

64
Q

What is 3 biochemical measures of renal osteodystrophy

A
  1. Increased s-P
  2. Decreased s-Ca
  3. Increase in PTH

Case 10: Urinary System (8 decks)

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