CP31 - Renal System 1 Flashcards

1
Q

what are some of the function of kidney?

A
  • eliminating metabolic waste products
  • regulating fluid and electrolyte balance
  • influencing acid-base balance (Renin - fluid balance, erythropoietin - stimulate RBC production)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are some symptoms for acute renal failure?

A

rapid rise in creatinine and urea, generally unwell

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are some symptoms for nephrotic syndrome

A

oedema, proteinuria (mostly albumin), hypoalbuminaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are some symptoms for acute nephritis (nephritic syndrome )

A

oedema, proteinuria, haematuria, renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is the course of blood through the renal system and back to central circulation?

A

branches of renal artery - afferent arteriole (going towards glomerulus) - glomerulus in bowmans capsule - efferent arteriole - proximal convoluted tubule (going towards renal medulla) - enter vasa recta - back in cortex in distal convoluted tubule - collecting duct - renal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is glomerulus

A

capillary bed - network of blood capillary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what are the 2 main mechanisms for glomerular damage?

A

damage to base membrane & damage to vessels through immunological and non-immunological causes

DM - altered BM as hyperglycaemia

Inherited disease - abnormal BM

deposition of protein

immune complexes, antigen, antibodies deposit in glomerulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what are some of the mechanism for tubular damage?

A

2 main mechanisms - toxic and ischaemic

direct toxin
hypersensitivity reactions to drugs
deposition of crystals and abnormal proteins in tubules

reduced blood supply to tubules

glomerular damages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what can cause vascular damage in the kidney

A
hypertension
DM
atheroma 
thrombotic mircoangiopathy  - thrombi in capillary and small arterioles 
vasculitis - inflammation of the vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what causes nephrotic syndrome?

A

always due to damages to glomerulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are some examples which cause nephrotic syndrome?

A

membranous nephropathy (most common)

focal segmenetal glomerulosclerosis (FSGS) -

minimal change disease

DM, lupus nephritis, amyloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what causes nephrotic syndrome in children?

A

minimal change disease (most common)

focal segemental glomerulosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what are some common causes for acute nephritis (nephritic syndrome) in adult?

A

post-infective glomerulonephritis - occur a few weeks after Streptococcal throat infection

IgA nephropathy
Vasculitis
Lupus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are some common causes for acute nephritis (nephritic syndrome) in children?

A

Post-infective glomerulonephritis
IgA nephropathy
Henoch-Schonlein purpura - specific type iGA nephropathy
- haemolytic-uraemic syndrome - E.Coli 0157

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are some of the clinical presentation for acute renal failure?

A

diagnosis - anuria/oliguria + raised creatinine and urea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the 3 main causes of acute renal failure?

A

pre-renal - reduced blood flow to kidney (most common) - severe d

renal - damage to the renal tissue

post-renal - obstructed urinary tract

17
Q

what will the biopsy of acute renal failure show?

A

ATN - acute tubular necrosis/ ATI/ATD/AKI

18
Q

what are some of the most common causes for acute renal failure in adult?

A

vasculitis

acute interstitial nephritis (tubular damage with inflammation, most commonly caused by drug reactions)

19
Q

what are some of the most common causes for acute renal failure in children?

A

Henoch-Schonlein purpura
Haemolytic uraemic syndrome
Acute interstitial nephritis

20
Q

what are some of the complications fro acute renal failure?

A
Cardiac failure (fluid overload)
Arrythmias (electrolyte imbalance)
GI bleeding
Jaundice (hepatic venous congestion)
Infection, especially lung and urinary tract
21
Q

what is chronic renal failure?

A

premanently reduced GFR - reduced number of nephrons

22
Q

what are the different staging of chronic renal failure

A

Stage 1: Kidney damage with normal or increased GFR (>90 mL/min/1.73 m2)

Stage 2: Mild reduction in GFR (60-89 mL/min/1.73 m2)

Stage 3: Moderate reduction in GFR (30-59 mL/min/1.73 m2)

Stage 4: Severe reduction in GFR (15-29 mL/min/1.73 m2)

Stage 5: Kidney failure (GFR

23
Q

what are some of the causes for chronic renal failure in adults/

A

Diabetes (commonest)

Glomerulonephritis

Reflux nephropathy -
Chronic reflux of urine up the ureter leading to repeated infections and scarring of the kidney

24
Q

what are some of the causes for chronic renal failure in children

A

Developmental abnormalities/malformations
Reflux nephropathy
Glomerulonephritis

25
Q

what can chronic renal failure do?

A

Reduced excretion of water and electrolytes: oedema, hypertension
Reduced excretion of toxic metabolites
Reduced production of erythropoietin: anaemia
Renal bone disease

26
Q

what are the likely cause of Haematuria +/- proteinuria with normal renal function

A

likely renal causes -

IgA nephropathy

Thin basement membrane disease (inherited)

Alport type hereditary nephropathy

27
Q

what are some likely causes for isolated proteinuria

A

May be benign e.g. Postural, related to pyrexia or exercise.

May be due to renal disease

Adults
FSGS
Diabetes
Lupus

Children
Henoch-Schonlein purpura
FSGS

28
Q

what is pyelonephritis?

A

infection of the kidney

29
Q

what are the 2 main of pyelonephritis?

A

acute and chronic

30
Q

what can cause acute pyelonephritis?

A
  • more common in women
  • instrumentation of urinary tract
  • DM
  • structural abnormalities of urinary tract
31
Q

what is the complication for acute pyelonephritis?

A

abscess forming in the kidney

32
Q

what can cause chronic pyelonephritis

A

most associated with obstruction of urinary tract and reflux of urine up ureter, leads to scarring of the kidney and can lead to renal failure

33
Q

what are some complication for chronic pyelonephritis?

A

scarring of kidney, chronic renal failure

34
Q

what are the 2 routes which can transmit.

A

haematogenous spread, ascending route from bladder

35
Q

what can cause renal artery stenosis

A

atheroma/arterial dysplasia - leads to ischaemia of the kidney, activation of renin-angiotensin-aldosteron system lead to hypertension - reducced renal function as loss of kidney

36
Q

how can vasculitis affect the kidney?

A

Inflammation can affect the glomerular vessels and lead to clotting with obliteration of capillary lumens and destruction of the glomerulus

Inflammation of larger arterioles within the kidney can lead to hypoxia of the tubules

37
Q

how can hypertension affect the kidney?

A

Hypertension damages renal vessels leading to thickening of the vessel wall and reduction in size of the lumen

This produces chronic hypoxia which leads to loss of renal tubules and reduced renal function

Reduced blood flow in the kidney leads to activation of the renin-angiotensin-aldosterone system which exacerbates hypertension

38
Q

how can diabetes affect the kidney?

A

Hyperglycaemia is the main cause of diabetic nephropathy by damaging the basement membrane

Basement membrane becomes thicker and the glomerulus produces excess extracellular matrix which forms nodules

Diabetes also damages small vessels leading to ischaemia and damage to renal tubules

39
Q

how can myeloma affect the kidney?

A

Tumour of plasma cells producing immunoglobulins

Excess immunoglobulins deposit in kidney tubules

Tubules become damaged

Inflammation and fibrosis of kidney occurs

Loss of renal tubules leads to declining kidney function