Kidney Flashcards
What is associated with oliguria (
Acute kidney injury
What causes pre-renal acute kidney injury?
Decreased renal blood flow due to haemorrhage, septic shock, dehydration or cardiac failure
If pre- renal AKI is not treated what can it progress to?
Acute tubular necrosis
What is pyelonephritis?
Infection of the kidney
What causes intra-renal AKI?
Due to acute tubular necrosis or glomerulonephritis or pyelonephritis
What is the outcome of intra-renal AKI?
It may be reversible or it may progress to chronic renal failure
What causes post renal AKI?
Obstruction to urine flow- prostate diseas, cervical carcinoma, bladder cancer
What is the outcome of post renal AKI?
Can be reversible or can progress to chronic renal failure
What are the signs of acute kidney injury? (3)
1) retention of nitrogenous waste products
2) severe water and electrolyte imbalance
3) metabolic acidosis due to retention of H
What is the presentation of AKI?
Nausea and vomiting, impaired consciousness, evidence of fluid overload
What are the biochemical features of acute renal failure?
1) retention of nirtrogenous waste products - high urea and high creatinine
2) retention of potassium
3) retention of hydrogen ion= metabolic acidosis- low ph and low p c02 (hyperventilation)and low bicarbonate
A fall in ph is associated with what?
A fall in bicarbonate or a rise in pC02
A rise in ph (alkalosis) is associated with what?
A rise in bicarbonate or a fall in pc02
Carbon dioxide reaction
C02 + h20 = h2CO3
H2CO3=h+ + HCO3
How do you treat hyperkalaemia?
Insulin and glucose treatment causes potassium to move from extracellularly to intacellular compartments
How do you treat metabolic acidosis?
Bicarbonate infusions
True or false: regeneration of tubular epithelium after acute tubular necrosis is faster than recovery of glomerular filtration
False other way around
Resulting in polyurea and hypokalaemia
What is chronic kidney disease?
Chronic condition that leads to progressive loss of kidney function
What are risk factors for CKD?
Hypertension, diabetes; acute kidney disease, ACE inhibitors
True or false: CKD often not diagnosed until routine investigations
True
Why is fatigue often found in CKD
Anaemia due to lack of erythropoietin
When kidney damage occurs what happens albumin and creatinine levels in the urea (microalbuminuria)
Creatinine levels will fall and albumin levels will rise ACR ratio will rise
What is a normal ACR? Albumin/creatinine
Less than 3mg/mmol
What is the relationship between proteinurea protein/creatine ratio and CKD?
Raised proteinurea seen in CKD
What are the three main tests you would carry out to test for CKD?
1) urinary analysis for protein in urea
2) retained nitrogenous waste products (urea and creatinine)
3) low GFR
What is GFR? ( LOW in CKD) and what is the ref range?
Sum total of filtration rate from all the nephrons. Ref= 80-120 mL/minute
How do you calculate creatinine clearance
Urine creatinine /total creatinine X volume in urine
What equation is used to calculate eGFR?
Modification of diet in renal disease (MDRD) formula that takes into account 4 parameters
1) serum creatinine
2) age
3) gender
4) ethnic origin
What is the eGFR equation?
186X (creat/88.4) ^-1.154 X (age)^-0.203 X (0.742 if female) X (1.120 if black)
Who is eGFR not suitable for?
Children, pregnancy, amputees