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Pathology (Guide) > Chemical Pathology - Renal Physiology > Flashcards

Chemical Pathology - Renal Physiology Flashcards

1
Q

What is the normal glomerular filtration rate?

A

120ml/hr

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2
Q

What is the approximate age-related decline of renal function (GFR) per year?

A

1ml/hr/yr

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3
Q

What is renal clearance?

A

The volume of plasma that can be completely cleared of a marker substance in a unit of time

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4
Q

What is GFR (glomerular filtration rate)?

A

Clearance, if a marker is not bound to serum proteins, freely filtered by the glomerulus + not secreted/reabsorbed by tubular cells

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5
Q

What is the gold standard measure of GFR and what does it rely on?

A

Inulin
- Requires steady state infusion

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6
Q

What causes insensible water loss?

A
  • High surface area
  • High skin blood flow
  • High metabolic/resp rate
  • High transdermal fluid loss
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7
Q

What causes fluid overload?

A
  • Bronchopulmonary dysplasia
  • Necrotising enterocolitis
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8
Q

What causes hypernatraemia?

A
  • Intraventricular haemorrhage
  • Sodium bicarbonate when treating acidosis
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9
Q

What causes hyponatraemia?

A
  • Congenital adrenal hyperplasia
  • Caffeine/theophylline when treating apnoea
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10
Q

What type of marker is creatinine?

A

An endogenous marker

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11
Q

What is creatinine used for in clinical practice?

A

To measure renal function

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12
Q

How is creatinine used in clinical practice to measure renal function, and why?

A
  • Monitor trend + use it to look for changes over time
  • Very variable between individuals
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13
Q

What is creatinine a by-product of?

A
  • Muscle turnover
    = muscular individuals have higher creatinine than others
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14
Q

How is a single sample of urine examined?

A
  • Dipstick testing
  • Microscope examination
  • Proteinuria quantification (PCR - protein:creatinine ratio)
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15
Q

How is a 24-hour collection of urine examined?

A
  • Proteinuria quantification (superseded by PCR)
  • Creatinine clearance estimation
  • Electrolyte estimation
  • Stone forming elements
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16
Q

What are the different elements observed on urine micropscopy and what do they signify?

A
  • Crystals (stones)
  • Red blood cells (stones, UTI)
  • White blood cells (UTI, glomerulonephritis)
  • Casts (glomerulonephritis)
  • Bacteria (UTI)
17
Q

What is an AKI defined as?

A
  • Rise in serum creatinine >26 within 48hr
  • 50% or great rise in serum creatinine known or presumed to have occurred within the past 7 days
  • Fall in urine output to less than 0.5mL/kg/hr for more than 6hrs
18
Q

What is an AKI defined as?

A
  • Rise in serum creatinine >26 within 48hr
  • 50% or great rise in serum creatinine known or presumed to have occurred within the past 7 days
  • Fall in urine output to less than 0.5mL/kg/hr for more than 6hrs
19
Q

What are pre-renal AKIs?

A
  • Reduced renal perfusion with no structural abnormality of the kidney; can become renal if ischaemia leads to necrosis
  • Responds to volume replacement
20
Q

What are renal AKIs?

A
  • Vascular, glomerular, tubular or interstitial
21
Q

What are post-renal AKIs?

A
  • Characterised by obstruction to urinary flow, glomerular filtration requires pressure gradient
  • Reversal can lead to scarring + permanent renal impairment
22
Q

What are 5 indications for dialysis?

A

AEIOU:
1. Acidosis
2. Electrolyte disturbance (e.g. refractory hyperkalaemia)
3. Intoxication (e.g. lithium, aspirin)
4. Overload (fluid) (e.g. pulmonary oedema)
5. Uraemic encephalopathy

23
Q

What are the different stages of chronic kidney disease and their approximate GFRs?

A
  1. Kidney damage with normal GFR (>90)
  2. Mild GFR (60-89)
  3. Moderate GFR (30-59)
  4. Severe GFR (15-29)
  5. End-stage kidney failure (<15 or dialysis)
24
Q

What are the commonest causes of chronic kidney disease?

A
  • Diabetes
  • Atherosclerotic renal disease
  • Hypertension
  • Chronic Glomerulonephritis
  • Infective or obstructive uropathy
  • Polycystic kidney disease
25
Q

What are the consequences of chronic kidney disease?

A
  1. Progressive failure of homeostatic function
    - Acidosis
    - Hyperkalaemia
  2. Progressive failure of hormonal function
    - Anaemia (loss of EPO synthesis)
    - Renal bone disease (secondary to hyperparathyroidism due to low Vit D)
  3. Cardiovascular disease
    - Vascular calcification + subsequent atherosclerosis (biggest mortality in CKD)
    - Uraemic cardiomyopathy
  4. Uraemia + death
26
Q

What are the two types of dialysis?

A
  • Haemodialysis
  • Peritoneal dialysis
27
Q

What are the features of haemodialysis in terms of renal replacement therapy?

A
  • Done via tunneled central line (TESSLO LINE) / ARTERIOVENOUS FISTULA
  • Usually done ~3x/wk depending on patient’s circumstances
  • Not ideal for ppl still working as time-consuming + hooked up to machine
28
Q

What are the features of peritoneal dialysis in terms of renal replacement therapy?

A
  • Undertaken via TENCKOFF CATHETER
  • Uses peritoneum as dialysis membrane, insert dialysate through catheter, leave for a few hrs + then drain
  • Can be done at home
  • Increased risk of peritoneal infections
29
Q

What are some features of a renal transplant in terms of CKD?

A
  • Only definitive cure
  • Requires lifelong immunosuppression with agents like tacrolimus/ciclosporin
  • Transplanted kidney usually in RIF (Rutherford Morrison = hockey stick scar; right mesocolon not fixed + therefore easier to access iliac vessels to connect transplant

Pathology (Guide) (84 decks)

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