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BS - Renal System > Introduction to Renal Medicine > Flashcards

Introduction to Renal Medicine Flashcards

1
Q

What other specialties are affected by renal medicine?

A
  1. endocrinology - diabetic nephropathy
  2. hepatology - hepatorenal failure
  3. cardiology - cardiorenal syndrome
  4. haematology - myeloma
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2
Q

What is cardiorenal syndrome?

A

Decreases blood supply to the kidneys

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3
Q

How does myeloma affect the kidney?

A

Protein is deposited in the kidney

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4
Q

What is a nephron?

How many are in each kidney?

A

A nephron is a filtering unit

There are around 1 million in each kidney, but the exact number is not known as nephrons are present from birth

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5
Q

What happens to urine produced in the kidneys?

A

It passes through the ureter into the bladder

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6
Q

What supplies the glomerulus?

A

Afferent arterioles coming from the renal artery

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7
Q

What happens to blood supply after it has entered venules?

A

The venules drain into the renal vein to be returned to the heart

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8
Q

How long would it be if nephrons from each kidney were placed end to end?

A

16 kilometers

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9
Q

What are the 2 broad functions of the kidney?

A
  1. homeostasis

2. hormone secretion (endocrine)

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10
Q

What is meant by homeostasis?

A

Maintenance of “milieu interieur”

This is a constant internal environment in the body

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11
Q

What types of hormones are secreted by the kidneys?

A

Erythropoietin

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12
Q

What is the role of erythropoietin?

A

It is secreted by the kidneys to stimulate red blood cell production

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13
Q

When may a patient inject erythropoietin?

A

To increase their red blood cell count if they are anaemic

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14
Q

How are the kidneys important in fluid and electrolyte balance?

A
  1. volume status
  2. electrolyte levels
  3. osmolarity
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15
Q

What is meant by volume status?

A

Kidneys regulate the fluid balance in the body through urine production

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16
Q

What electrolyte levels are the kidneys important in controlling?

A
  1. sodium
  2. potassium
  3. urea
  4. creatinine
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17
Q

What can very high potassium levels lead to?

What is this condition called?

A

It is a medical emergency which can lead to the heart stopping

It is called hyperkalaemia

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18
Q

What is meant by osmolarity?

A

The concentration of particles exerting an osmotic pressure

e.g. glucose

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19
Q

What is significant about the kidneys controlling osmolarity?

A

The blood usually runs at a certain osmolarity

That allows cells to function well

Confusion, seizures and coma result if osmolarity is not controlled well

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20
Q

How are the kidneys involved in maintaining acid-base balance?

A

They maintain an optimum pH for cellular function

The kidneys regenerate bicarbonate and bring it back into the blood stream

They remove acid

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21
Q

What can result from poor kidney function, affecting the pH?

A

Acidemia/acidosis

This is because not as much bicarbonate is being regenerated

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22
Q

How are the kidneys involved in removal of small molecules?

A

They remove sugars and amino acids

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23
Q

What may glucose in the urine indicate?

A

Disease of the kidneys

  1. diabetes mellitus

(caused by a high sugar concentration which the kidneys cannot deal with)

  1. tubular disorders

(caused by normal blood sugar level, but dysfunctional kidney)

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24
Q

When does loss of amino acids in the urine occur?

A

In disease of the proximal tubule

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25
Q

How is the kidney involved in excretion of waste products and drugs?

A

It is involved in the removal of nitrogenous waste from protein metabolism

  1. urea
  2. creatinine from muscle
26
Q

What is used to measure kidney function?

What is the drawback of this method?

A

The level of creatinine in the blood

It is not a good way to measure kidney disease as creatinine is not produced by the kidney

27
Q

What determines how much creatinine someone generates?

A

It depends on an individual’s muscle mass

28
Q

What may happen to creatinine when the kidneys aren’t functioning?

A

It accumulates in the blood as it is not being removed

However, the “normal” creatinine concentration depends on someone’s muscle mass

29
Q

What types of drugs are removed by the kidneys?

A
  1. antibiotics
  2. digoxin
  3. opiates
  4. lithium
30
Q

What happens when a drug is administered to someone with poorly functioning kidneys?

A

The drug begins to accumulate in the blood

This may lead to an overdose in the patient

31
Q

How are the kidneys involved in red blood cell production?

A

They produce erythropoietin, which stimulates red blood cell production

32
Q

What stimulates red blood cell production?

A

Hypoxia (low oxygen levels)

This may be at an increased altitude

33
Q

Why may recombinant erythropoietin be used?

A

It decreases the need for blood transfusions as it stimulates RBC production

34
Q

How are the kidneys involved in calcium and phosphate balance?

A
  1. secrete the active form of vitamin D3

2. this increases the absorption of calcium from the gut

35
Q

What is the activated form of vitamin D?

Where it is produced?

A

1,25 dihydroxycholecalciferol

The first stage occurs in the liver and the second stage occurs in the kidneys

36
Q

What happens to calcium absorption in kidney failure?

A

You cannot produce 1,25 dihydroxycholecalciferol

This means calcium is not absorbed from the gut

Calcium levels fall

37
Q

What can low calcium levels lead to?

A
  1. seizures

2. secondary hyperparathyroidism

38
Q

What is the action of the parathyroid glands when calcium levels are low?

A

They cause calcium release from the bones

This leads to bone disease
brittle bone disease

39
Q

If secondary hyperparathyroidism isn’t treated, what can happen?

A

The parathyroid hormones become autonomous and no longer respond to drugs that try and correct things

This is tertiary hyperparathyroidism

40
Q

What can tertiary hyperparathyroidism lead to?

A

Fibrosis in the bone marrow

This means red blood cells aren’t produced

Patients become anaemic and DO NOT respond to Epo

41
Q

What are the 3 stages involved in chronic kidney disease?

A
  1. decreased activation of vitamin D
  2. decreased calcium level
  3. this stimulates secretion of parathyroid hormone
42
Q

What happens once parathyroid hormone begins to be secreted?

A
  1. calcium is released from bones

2. this leads to bone disease and renal osteodystrophy

43
Q

How are the kidneys involved in blood pressure control?

A

They secrete renin

This converts angiotensinogen to angiotensin I

44
Q

What is blood pressure like in patients with kidney disease?

A

They often have high blood pressure

It is a cycle - as high blood pressure causes kidney disease

45
Q

What blood tests are used to assess kidney function?

A

Urea and electrolytes

  1. sodium
  2. potassium
  3. urea
  4. creatinine

Also bicarbonate and chloride levels

46
Q

What are normal Na+ levels?

A

133 - 146 mmol/L

47
Q

What are normal K+ levels?

A

3.5 - 5.3 mmol/L

48
Q

What are normal urea levels?

A

2.5 - 7.5 mmol/L

49
Q

What are normal creatinine levels?

A

Male: 64 - 104 micromol/L

Female: 60 - 93 micromol/L

50
Q

What are normal bicarbonate levels?

A

22 - 29 mmol/L

51
Q

What are normal Cl- levels?

A

95 - 108 mmol/L

52
Q

What aspects are looked at when performing a urinalysis test for kidney function?

A
  1. pH
  2. haematuria (blood)
  3. proteinuria (protein)
  4. glucose (diabetes)
  5. nitrites (infection)
  6. leucocytes (infection)
53
Q

What do nitrites and leucocytes in the urine indicate?

A

Urinary tract infection

Must take urine cultures to identify the organism before prescribing antibiotics

54
Q

What urine tests (other than urinalysis) are performed when looking at kidney function?

A
  1. protein/creatinine ratio
  2. albumin/creatinine ratio
  3. midstream urine
55
Q

What is a normal protein/creatinine ratio?

A

Normal < 13.0

56
Q

What is a normal albumin/creatinine ratio?

A

Normal < 3.0

57
Q

What is midstream urine and when is it used?

A

It is a clean catch of urine

It is sent off if a urinary tract infection is suspected

58
Q

What radiological investigations may be performed?

What are you looking for?

A

Ultrasound is performed

You want to look at the size of the kidneys and whether there is an obstruction

59
Q

What will the ultrasound look like for a patient with chronic kidney disease?

A

The kidneys will be small and shrunken due to fibrosis

Normal kidneys are around 10-12 cm

60
Q

What is a MRA?

A

Magnetic resonance angiography

61
Q

Why is a kidney biopsy performed?

How is it performed?

A

It is required to diagnose some rarer forms of kidney disease

It is performed with ultrasound guidance

62
Q

What are the complications associated with kidney biopsy?

A

It is not performed in every patient due to the risks:

Risk of bleeding - 1 in 100

Risk of losing a kidney - 1 in 1000

BS - Renal System (8 decks)

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