Introduction Flashcards
Proximal means close to, proximal tubule is therefore:
It’s the closet to the Bowman’s capsule,
Which drug works at the proximal tubule
SGLT-2
ADH is also called
VASSOPRESSIN
Synthesis of Vitamin D3:
Active vitamin D3 is not found in food or sunlight. Which oragns produce active D3?
Two organs; the kidney and the liver, produce active vitamin D3 (Calcitriol) in the body.
Body recieves Vitd3 in what form? From where?
Cholecalciferol
From sun or food
What form of VitD3 is produced at the liver ?
25-hydroxycholecalciferol
What form is produced at the kidney after hydroxylation at C-25 at the liver?
1,25- dihydrocholecalciferol
Kidney produces :1, a- hydroxycholecalferiol
State the types preferred in Liver or kidney impairment.
-Calcitriol (1,25-dihydroxycholecalciferol) ; both
- Alphadol i.e. Alfacalcidol (1α-hydroxycholecalciferol) - Renal impairment
-25-hydroxycholecalciferol (Calcifediol) is used in liver impairment
Liver produces how much EPO? KIDNEY?
10% erythropoietin (EPO) is produced by the liver
peritubular cells of the kidney produce the remaining 90%.
The type of anemia in kidney disease?
Anemia of chronic disease . Linked to EPO production
Liver does not produced Anemia of chronic dis
Anaemia of chronic disease
is described
normocytic normochromic anaemia.
Functions of the kidney is divided into
(Remember TEA)
- Tubular function
- Endocrine function
- Autocrine function
Tubular function
- Reabsorption of nutrients or electrolytes in the filtrate
• Excretion of waste
• Fluid balance or homeostasis
• pH regulation.
Endocrine function
• BP regulation (RAAS activation)
• Vitamin D synthesis.
• Production of erythropoietin
Autocrine function
Autocrine function
• Production of renal natriuretic peptide
• Production of prostaglandins
• Production of endothelin
How does the kidney produce prostaglandins?
The kidney produces prostaglandins from arachidonic acid by the help of the cyclooxygenase (COX) enzymes. There are two (2) COX isoenzymes; COX-1 and COX-2
COX-1 is said to be
COX-1 is said to be constitutive (i.e. it is found always in the system).
Which prostaglandin is the first to be produced from the Arachidonic pathway?
Prostaglandin H2 (PGH2)
PGH2 is an unstable prostaglandin that produces other prostaglandins such as
Two main lab markers to estimate kidney function are
-BUN
- Creatinine
BUN measures
The amount of nitrogen in the blood that comes from UREA, a waste product of protein metabolism.
As kidney function declines, BUN
Increases
Creatinine is
A waste product of muscle metabolism, mostly filtered by the glomerulus
As kidney function declines creatinine
Increases , normal range 0.6- 1.3mg/dl
Investigations of kidney problem
Main parameters are
• Urea
• Creatinine
Other parameters include
• Protein in urine
• RBCs in urine
- Microscopy
- Imaging
Dip stick detects what?
- ketone
-NITRITES
Nitrites come from?
Why is it need?
Nitrates
Nitrates we take in food (as preservatives) appear in urine. Certain organisms conver nitrates to nitrites and for that reason,
if nitrites are not detected in the urine, it does not
It does not indicate the absence of UTIs since not all organism have the ability to convert nitrates to nitrites.
Organisms that covert nitrates to nitrites
• Escherichia coli
• Lactobacillus plantarum
• Neisseria gonorrhoeae
• Rothia mucilaginosa
• Veillonella parvula
• Actinomyces
• Corynebacterium
Significance of leukocyte esterase
the absence of leucocyte esterase indicates the absence of UTI. When WBCs fight against microbes, some (WBCs) get destroyed in the process and release the leucocyte esterase enzymes. This explains why they are indicators of UTIs.
Clinical presentations of CKD
.Clinical presentations of CKDPeripheral oedema
• Anaemia
• Osteoporosis
• Volume depletion in terms of urine output
(Oliguria or anuria)
• Metabolic acidosis
• Uremic encephalopathy
• Uremic gastritis
• Hyperphosphatemia
Metabolic acidosis & its management
Metabolic acidosis is managed using Sodium bicarbonate (NaHCO3). Sodium bicarbonate comes as a powder or capsule. The capsules come in 500mg while
the powder is packaged in 1g quantities to be given T.I.D at the ward.
Management of hyperkalemia in CKD how many ways
two (2) ways of managing hyperkalemia; temporary and permanent.
three (3) temporary ways of managing hyperkalemia.
- 5 IU regular insulin in 50mL of 5% dextrose
- Sodium bicarbonate (NaHCO3)
- Nebulization using salbutamol
push K+ ions back into the cells.
Regular insulin is also known as
soluble insulin / short-acting insulin / rapid-acting insulin.
Long-acting insulin cannot be used in the management of hyperkalemia.
