Chronic renal failure Flashcards
The classification for chronic renal failure consists of the following categories: (1).
- diminished renal reserve, renal insufficiency, chronic renal failure, and end-stage renal disease
In (1) the patients are still asymptomatic and have (2) BUN and creatinine and (3) GFR
- diminished renal reserve
- normal
- 50% decrease in GFR
(4) presents with (1) and is found when GFR is (2). These patients can also have (3) from decreased urine concentrating ability.
- Renal insufficiency
- azotemia, anemia and hypertension
- reduced between 50-80% (20-50% of normal)
- polyuria and nocturia
asymptomatic, normal BUN and creatinine, 50% decrease in GFR
diminished renal reserve chronic renal failure
azotemia, anemia, hTN, 50-80% decrease in GFR, polyuria, nocturia
renal insufficiency
Chronic renal failure is present when GFR has fallen to less than (1)% of normal and the patients have (2).
- 20%
2. edema, metabolic acidosis and hyperkalemia
End-stage renal disease is present when the GFR is less than (1)% of normal.
- 5%
GFR 20-50% of normal
renal insufficiency
GFR less than 5% of normal
end stage renal disease
GFR less than 20% of normal
chronic renal failure
edema, metabolic acidosis, hyperkalemia
chronic renal failure
Chronic renal disease has a number of symptoms and findings which include (1)
- renal osteodystrophy (secondary hyperparathyroidism)
Secondary vs. primary hyperparathyroidism
calcium
PTH
phosphate
Secondary hyperparathyroidism with a low serum calcium but elevated PTH. Serum phosphate levels are usually elevated because of decreased phosphate excretion by the kidney whereas in primary hyperparathyroidism, serum phosphate levels are usually decreased and serum calcium is increased
In addition, there is less conversion to (1) by the diseased kidney.
1,25 vitamin D (Active vitamin D)
End stage renal patients also have (1), a white frost on the skin (from (2), (3) and (4) in part because less (5) is produced by the diseased kidney
- pericarditis
- elevated urea
- hyperkalemia, acidosis
- anemia
- erythropoietin
There are a number of types of (1) which can lead to renal failure.
- inherited renal cystic diseases
Medullary sponge kidney is not inherited and can lead to (1)
- nephrolithiasis
(1) is a consequence of amorphous undigestible acellular material in the (2).
- Amyloid nephropathy
2. mesangium or renal tubules
(1) is a non-specific term for proteins which have a beta-pleated sheet appearance and are (2) by electron microscopy and stain with (3) by light microscopy.
- Amyloid
- fibrillar
- congo red
There are two distinct types of amyloid proteins: the inflammatory type which is composed of (1) which is associated with inflammatory disorders such as (2); and (3) which are produced in the B cell malignancy called (4)
- serum amyloid A protein
- rheumatoid arthritis and chronic TB
- immunoglobulin light chains
- multiple myeloma.
The proteinuria in (1) is non-selective and includes (2) as well as (3)
- multiple myeloma light chain amyloid
- globulins
- albumin.
Immunoglobulin light chain amyloid themselves can be directly toxic to (1)
- renal epithelial cells.
A type of light chain protein known as (1) protein combines with the (2) protein under (3) conditions to form large dilated tubular casts of light chains which have a very distinctive appearance; this is sometimes called (4)
- Bence Jones
- Tamm-Horsfall
- acidic
- light chain cast nephropathy.
Another type of chronic renal disease are the renal tubular acidosis disorders. Type I is the (1) form, which is due to (2), so patients have a high urine pH.
- distal tubule
2. decreased acid secretion
There are a number of disorders such as (1) that are associated with distal tubular acidosis.
- Sjogren’s
Type II renal tubular acidosis is the (1) form, which is due to (2)
- proximal tubule
2. bicarbonate loss in the proximal tubule
There are a number of disorders such as (1) that are associated with proximal tubular acidosis.
(1) Fanconi
Chronic renal failure can be treated by (1) which uses a kidney machine and specifically defined fluids to remove waste products from the blood.
- hemodialysis
The fastest form of transplant rejection is hyperacute, which occurs within minutes to hours and can be caused by ?
ABO or class I MHC incompatibility.
In this case, (1) bind endothelial cells, activate complement and attract neutrophils and platelets which produce cell necrosis, thrombi, and hemorrhage within 12-24 hours.
- preformed antibodies
refers to hyperacute transplant rejection
Acute cellular allograft rejection histologically consists of either a (1) reaction with (2) or a (3) reaction with (4)
- tubuloinsterstitial
- tubulitis (inflammation of the tubules)
- vascular
- endarteritis.
Chronic cellular allograft rejection shows vascular changes of (1) and (2)
- thickening of peritubular capillary basement membranes
2. mesangial widening of glomeruli.
