Introduction to nephrology

Question 1

What vessel supplies the kidney with blood?

Answer 1

Renal artery

Question 2

What vessel drains the kidney with blood?

Answer 2

Renal vein

Question 3

Where does the urine travel?

Answer 3

Down via the ureter to the bladder

Question 4

What are the units that make up the kidney called?

Answer 4

Nephrons

Question 5

How does the renal artery divide?

Answer 5

Renal artery -> capillary loop -> glomerulus

Question 6

The capillary walls are specialised for transport of fluid and salt

TRUE or FALSE

Answer 6

True

Question 7

Where does the fluid collect once it is filtered in the glomerulus?

Answer 7

In the Bowman’s Capsule

Question 8

How many litres of blood are filtered a day?

Answer 8

180 L

Question 9

How many litres of urine are produced a day?

Answer 9

2 L

Question 10

Everyone starts with the same number of nephrons

TRUE or FALSE

Answer 10

FALSE

Not everyone starts with the same number of nephrons

Danish adults have less mean number of nephrons than Americans and Australians

Question 11

What difference does nephron number make in the health of a kidney?

Answer 11

Nephron number accounts for differences in susceptibility to kidney disease

Premature babies = less nephrons and higher susceptibility to hypertension/ renal disease

Question 12

What are the functions of the kidney?

Answer 12

Salt and water regulation

Maintains acid-base balance

Synthesises EPO

Activates vitamin D

Question 13

Why is it important to regulate salt and water in the blood?

Answer 13

Maintains blood pressure

Question 14

How do the kidneys maintain acid-base balance?

Answer 14

Absorbs and secretes electrolytes/ salts/ sugars

Question 15

What is the role of EPO?

Answer 15

Stimulates RBC production

Question 16

What does vitamin D regulate?

Answer 16

Calcium and phosphate concentration

Question 17

What are methods by which we can measure kidney function?

Answer 17

Clearance of compounds

Filtration of water and electrolytes

Concentration of macromolecules in the urine

Production of vitamin D/ EPO

Question 18

Whic compounds can we use to measure the clearance by the kidneys?

Answer 18

Urea and serum creatinine

Question 19

What is creatinine?

Answer 19

Molecules formed by the breakdown of creatinine phosphate in the muscle

Produced at a constant rate by the body

Excreted unchanged by the kidneys

Question 20

Why is measuring the filtration of water or electrolytes not practical to determine kidney function?

Answer 20

Have to collect urine over time to eradicate minute to minute alterations

Question 21

Why is measuring the concentration of macromolecules in the urine a good way to determine kindey function?

Answer 21

A healthy filtration barrier should not let macromolecules pass through

Question 22

What are examples of macromolecules?

Answer 22

Proteins

RBC

Question 23

What are the 2 ways in which production of vitamin D or EPO can be measured in the blood?

Answer 23

Measure directly in blood

Can also measure indirectly - calcium phosphate balance or RBC count

Question 24

Do men or women have higher GFR?

Answer 24

Men

Higher muscle mass - higher GFR needed

Question 25

Do old or young people have higher GFR?

Answer 25

Young Have higher muscle mass

Question 26

What is the relationship between GFR and serum creatinine?

Answer 26

Non-linear relationship Large change in GFR leads to a small change in serum creatinine Large change in serum creatinine leads to a small change in GFR

Question 27

How does renal function change with age?

Answer 27

GFR declines as we age - scarring of kidneys over time Decline in GFR isn't enough to lead to kidney disease

Question 28

What is the average decline of GFR as we age?

Answer 28

0.4 ml/min/1.73m2

Question 29

What are the symptoms of kindey failure?

Answer 29

Dirty blood - inadequate filtration Fluid accumulation High blood pressure Anaemia Bone disease Lipid abnormalities

Question 30

Why does fluid accumulate in kidney disease?

Answer 30

Acid-base balance is disrupted Oncotic pressure is created Causes water to build up in body tissues

Question 31

Why does kidney disease lead to anaemia?

Answer 31

Imbalance in EPO synthesis

Question 32

Why does kidney disease lead to bone disease?

Answer 32

Bones attempt to maintain serum calcium levels Bone resorption = osteomalacia

Question 33

Why does kidney disease lead to lipid abnormalities?

Answer 33

Disruption in the metabolism of lipids

Question 34

What is the difference between acute and chronic kidney disease?

Answer 34

Acute - sudden loss of kidney function Chronic - level of function is reduced but patients maintain health

Question 35

Patients with CKD often maintain health TRUE or FALSE

Answer 35

True

Question 36

What are causes of kidney dysfunction?

Answer 36

Developmental/ genetic - may not grow normally, malformed Acquired problems

Question 37

What are examples of acquired problems that lead to kidney disease?

Answer 37

Blood supply problems Blockage of urinary flow Diseases (systemic or kidney-specific) that interfere with nephron function

Question 38

What are the treatments of kidney disease?

Answer 38

If drug toxicity or infection - treat underlying cause If immunological disease - immunosuppression

Question 39

What can be done to slow down the progression of CKD?

Answer 39

Controlling blood pressure This makes sure funcitoning nephrons last longer

Question 40

What happens if you can't treat the underlying cause of kidney disease?

Answer 40

Patient may develop end-stage kindey failure

Question 41

What are the treatments for end-stage kindey failure?

Answer 41

Transplant Maintenance hemodialysis - replaces kidney function

Question 42

Why should we care about kidney disease?

Answer 42

Affects up to 3 million people in the UK Increasing due to increases in disease - diabetes, aging population Dysfunction is often unknown due to few symptoms