Diseases of the kidney Flashcards
what are the functions of the kidney
regulates BP filter toxins electrolyte balance production of renin and EPO acid base balance activates vit D
what are the classical presentations of renal diseases: AKI nephrotic syndorme CKD nephritic syndrome glomerulonephritis haematuria/proteinuria
unwell - rapid rise in creatinine and urea
proteinurea, hypoalbuminemia, odeama
slow decline in renal function
oedema, proteinuria, haemturia, renal failure
nephritic syndrome with rapid decreases in GFR
blood or protein
describe the mricocirculation of the nephron
two capillary beds
frist glomerulus then leave via efferent arteriole and enters secondary network - peritubular network where fluid and solutes are reabsorbed by the tubules and returned to circulation
what are 4 causes of immunological glomerular injury
complement activation
neutrophil activation
ROS
clotting factors
what are the two types of tubular injury
ischameic - redcued perfusion from shock/hypotension, blood vessel damage, glomerular damage
toxic - direct toxins (drugs, printer ink, heavy metals)
hypersensitivity, Crystals (calcium oxalate ro urates)
what are the symptoms, complications and pathogenesis of nephrotic syndrome
proteinuria greater than 3.5g/24 hours
symps- hypoalbuminaemia, odema, hyperlipidaemia, lipidura
increased glomerular permeability to albumin and other plasma proteins
associated with infection, thromboembolism, aki, anaemia
what is a method of checking for nephrotic syndrome
jones methenamine silver - hard on end pattern of sub epithelial spikes of GBM
what is the most common cause of nephrotic syndrome in adults
membranous nephrophathy via autoantibodies
what is FSGS in renal pathophysiology
focal segmental glomerulosclerosis - common cause of nephrotic syndrome (idiopathic)
what is the most common cause of nephrotic syndrome in children
minimal change disease
what is nephritic syndrome - what are the symptoms
haematuria, proteinuria, elevated creatinine, hypertension, odeama
loss of function due to decreased glomerular blood low and salt retention
what are 4 common aetiologies of nephritic syndrome
PIGN - post-infectious glomerulonephritis (neutrophils damage to GBM from infection)
IgA nephropathy - most common cause of glomerulonephritis and in young adults
vasciculitis - ANCA-associated glomerulonephritis - present with neutrophils and fibrin
SLE - lupus nephritis - autoimmune
what are two causes of nephritic syndrome in children
henoch-schonlein Purpura - IgA
haemolytic uraemic syndrome - E coli enteritis
what is the presentation of acute renal failure and complications
anuria with raised creatinine and urea, fatigue, nausea, vomiting, electrolyte imbalance
associated with GI bleeding, jaundice, cardiac failure and arrhythmias
what causes renal artery stenosis and what can it lead to
atherosclerosis
ischamiea of the kidney and atrophy which leads to activation of RAAS and hypertension
what is chronic renal failure and the stages
permanently reduced GFR - reduced number of functional nephrons 1 = normal more than 90 ml/min/1.73 2 = 60-80 3 = 30-59 4 = 15-29 5 = less than 15 - requires dialysis
what are the effects of chronic renal failure
reduced: excretion of water and electrolytes = hypertension and oedema excretion of toxins - poisoning production of EPO = anaemia renal bone disease
what is the most common consequence of chronic renal failure
diabetes
what is the normal nephrotic protein range
3-3.5g/24 hours
what is isolated proteinuria and what is it caused by
less than nephrotic range
pyrexia and exercise
may indicate SLE or diabetes
what is isolated haematuria and what is it associated with
normal renal function
inherited thin basement membrane
alport’s disease - inherited type 4 collagen weak
what are the risk factors of acute vs chronic pyelonephritis
inflammation of kidney due to bacterial infection - fever and flank tenderness
acute - female, diabetes, UTI
chronic - UT obstruction
what are the complication of acute and chronic pyelonephritis
acute - abscess formation
chronic - scarring, chronic renal failure
which kidney disease displays flea bitten surface (petechial ahemorrahegs)
hypertensive nephropathy
what is the most common cause of end stage renal disease in developing world
diabetic nephropathy - due to hyperglycaemia
what is light chain case nephropathy (myeloma kindey)
cytotoxic and obstructive accumulation of monoclonal light chain casts in distal nephron segments
what is the most common protein excreted
uromodulin
tamm-horsfall protein
