Chronic Renal Failure PATHOMA/FA

Question 1

What are the clinical features of CHRONIC RENAL FAILURE?

Answer 1

‘MAD HUNGER’
MA - Met Acidosis, D - Dyslipidemia (TAG), H - Hyperkalemia, Hypocalcemia, U- Uremia, N- Na+/H2O retention resulting in HTN, G-Growth retardation and dvlm delays, E-EPO failure and anemia, R-renal dystrophy

Question 2

What are the signs of UREMIA (i.e. AZOTEMIA) of CHRONIC RENAL FAILURE?

Answer 2

GEN:Weight loss - Early satiety/anxiety
HEENT: Encephalopathy + Asterixis (Liver flap tremor)
CARDIO: Pericarditis + Platelet Dysfn (hypocoagulable state)
GI: Nausea/Anorexia
SKIN: Pruritis (Deposition of urea crystals in skin)

Question 3

What are the reasons of HYPOCALCEMIA in CHRONIC RENAL FAILURE?

Answer 3

REASON 1: Deficient VitD hydroxylation to become its active form CALCITRIOL due to deficient enz CYP27B in Proximal Tubule -> HYPOCALCEMIA
REASON 2: PTH-resistant kidney -> No PTH-mediated phosphaturia -> Hyperphosphatemia -> Phosphate binds up free Ca2+ -> HYPOCALCEMIA

Question 4

What are the 3 means of RENAL OSTEODYSTROPHY seen in CHRONIC RENAL FAILURE?

Answer 4

1. OSTEITIS FIBROSIS CYSTICA - Due to secondary HYPERPARATYROIDISM (Hypocalcemia -> INCREASED PTH -> Ca2+ resorption from bone -> CYST and fibrosis formation in bone)
2. OSTEOMALACIA - Osteoblasts lay down osteoid in response to hypocalcemia, but can not be mineralized by Ca2+ with deficient VitD
3. OSTEOPOROSIS - Met Acidosis -> Continuous buffering by bone -> Bone becomes porous

Question 5

What are the 3 most common causes of CHRONIC RENAL FAILURE?

Answer 5

DIABETES + HTN + GLOMERULAR DISEASE 
Congenital abnormalities (FA)

Question 6

Where is EPO normally produced?

Answer 6

RENAL PERITUBULAR INTERSTITIAL CELLS