Chronic Kidney Disease Flashcards
What does pre-renal disease refer to?
Problems with arterial supply (and venous drainage).
What does renal disease refer to?
Problems with the renal interstitial/tubules.
What does post-renal disease refer to?
Problems with the outflow tract of the kidney.
State 3 possible pre-renal problems.
Hypovolaemia. Heart failure. Vasodilation. Arterial dissection. Renal artery sclerosis. Atherosclerosis.
State 3 renal problems.
Acute glomerulonephritis. Acute interstitial nephritis. Acute tubular necrosis.
State 3 post-renal problems.
Obstruction of collecting system (or extra-renal drainage) - bladder-outlet obstruction.
Name 3 causes of Interstitial nephritis.
Drugs e.g. antibiotics, penicllins, NSAIDs. Infections e.g. pyelonephritis, viral, fungal/parasitic. Autoimmune e.g. SLE, Sjoren, Sarcoid. Alloimmune (transplant rejection).
Name 3 causes of post-renal outflow tract obstruction.
Ureteric e.g. stones, retroperitoneal fibrosis, gynae malignancy. Bladder outflow e.g. stones, bladder cancer, prostatic. Urethral e.g. stones, urethral stricture.
How is kidney function measured?
Measured using isotopic EDTA-GFR. Creatinine clearance. Inulin clearance (filtering capacity of the glomeruli, measured at rate at which inulin cleared from blood plasma).
State 3 of Vander’s 7 functions of the kidney.
Regulation of water and electrolyte balance.
Excretion of metabolic waste (hydrogen ions)
Excretion of bioactive substances that affect body function
Regulation of arterial blood pressure
Regulation of red blood cell production
Regulation of vitamin D production
Gluconeogenesis
Renal disease results in an increase in which hormone?
Parathyroid hormone (PTH).
What happens to calcium levels in the blood during renal disease?
Increase.
How hormones reverses Parathyroid hormone (PTH)?
Calcitriol - it increases blood calcium levels (Ca2+) by promoting absorption of dietary calcium from the gastrointestinal tract..
What is the effect of the Parathyroid hormone (PTH) on serum phosphate levels?
PTH reduces the reabsorption of phosphate from the proximal tubule of the kidney, which means more phosphate is excreted through the urine.
However, PTH enhances the uptake of phosphate from the intestine and bones into the blood. In the bone, slightly more calcium than phosphate is released from the breakdown of bone.
High calcium levels in the blood can lead to Calciphylaxis, what is it?
It’s when calcium accumulates in small blood vessels of the fat and skin tissues.
It can cause blood clots, painful skin ulcers and may cause serious infections that can lead to death.
