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Biochemistry > Kidney > Flashcards

Kidney Flashcards

1
Q

What is associated with oliguria (

A

Acute kidney injury

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2
Q

What causes pre-renal acute kidney injury?

A

Decreased renal blood flow due to haemorrhage, septic shock, dehydration or cardiac failure

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3
Q

If pre- renal AKI is not treated what can it progress to?

A

Acute tubular necrosis

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4
Q

What is pyelonephritis?

A

Infection of the kidney

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5
Q

What causes intra-renal AKI?

A

Due to acute tubular necrosis or glomerulonephritis or pyelonephritis

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6
Q

What is the outcome of intra-renal AKI?

A

It may be reversible or it may progress to chronic renal failure

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7
Q

What causes post renal AKI?

A

Obstruction to urine flow- prostate diseas, cervical carcinoma, bladder cancer

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8
Q

What is the outcome of post renal AKI?

A

Can be reversible or can progress to chronic renal failure

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9
Q

What are the signs of acute kidney injury? (3)

A

1) retention of nitrogenous waste products
2) severe water and electrolyte imbalance
3) metabolic acidosis due to retention of H

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10
Q

What is the presentation of AKI?

A

Nausea and vomiting, impaired consciousness, evidence of fluid overload

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11
Q

What are the biochemical features of acute renal failure?

A

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

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12
Q

A fall in ph is associated with what?

A

A fall in bicarbonate or a rise in pC02

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13
Q

A rise in ph (alkalosis) is associated with what?

A

A rise in bicarbonate or a fall in pc02

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14
Q

Carbon dioxide reaction

A

C02 + h20 = h2CO3

H2CO3=h+ + HCO3

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15
Q

How do you treat hyperkalaemia?

A

Insulin and glucose treatment causes potassium to move from extracellularly to intacellular compartments

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16
Q

How do you treat metabolic acidosis?

A

Bicarbonate infusions

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17
Q

True or false: regeneration of tubular epithelium after acute tubular necrosis is faster than recovery of glomerular filtration

A

False other way around

Resulting in polyurea and hypokalaemia

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18
Q

What is chronic kidney disease?

A

Chronic condition that leads to progressive loss of kidney function

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19
Q

What are risk factors for CKD?

A

Hypertension, diabetes; acute kidney disease, ACE inhibitors

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20
Q

True or false: CKD often not diagnosed until routine investigations

A

True

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21
Q

Why is fatigue often found in CKD

A

Anaemia due to lack of erythropoietin

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22
Q

When kidney damage occurs what happens albumin and creatinine levels in the urea (microalbuminuria)

A

Creatinine levels will fall and albumin levels will rise ACR ratio will rise

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23
Q

What is a normal ACR? Albumin/creatinine

A

Less than 3mg/mmol

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24
Q

What is the relationship between proteinurea protein/creatine ratio and CKD?

A

Raised proteinurea seen in CKD

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25
Q

What are the three main tests you would carry out to test for CKD?

A

1) urinary analysis for protein in urea
2) retained nitrogenous waste products (urea and creatinine)
3) low GFR

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26
Q

What is GFR? ( LOW in CKD) and what is the ref range?

A

Sum total of filtration rate from all the nephrons. Ref= 80-120 mL/minute

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27
Q

How do you calculate creatinine clearance

A

Urine creatinine /total creatinine X volume in urine

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28
Q

What equation is used to calculate eGFR?

A

Modification of diet in renal disease (MDRD) formula that takes into account 4 parameters

1) serum creatinine
2) age
3) gender
4) ethnic origin

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29
Q

What is the eGFR equation?

A

186X (creat/88.4) ^-1.154 X (age)^-0.203 X (0.742 if female) X (1.120 if black)

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30
Q

Who is eGFR not suitable for?

A

Children, pregnancy, amputees

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31
Q

What equation should be used to estimate creatinine clearance to determine optimum dose of chemo drugs ?

A

Cockcroft and gault- takes into account creatinine , sex, age, weight

32
Q

What eGFR would you see in severe impairment and established renal failure?

A

Severe impairment = 15-29ml/min/1.73m^2

Established renal failure =

33
Q

What is haematuria associated with?

A

CKD

34
Q

What is the effect of decreased excretion in CKD?

A

Volume overload, hypertension hypertension, metabolic acidosis

35
Q

What is the consequence of decreased biosynthesis in CKD?

A

Anaemia (erythropoietin ) , osteomalacia (activation of Vit d)

36
Q

What is the consequence of altered metabolism in CKD?

A

Dyslipidaemia, sex hormones- accelerated atherogenesis, abnormal reproductive function

37
Q

What is haemodialysis tubing made of?

A

Selectively permeable membrane dialysed with a solution to replenish and remove waste

38
Q

What is peritoneal dialysis?

A

Inner lining Stomach is used as a natural filter. Waste is taken out by a cleansing fluid called dialysate

39
Q

What is pro and con of peritoneal dialysis?

A

Higher technique failure rate than HD

More haemodynamic stability than HD

40
Q

What is the importance of H+ homeostasis?

A

Role in enzyme systems, neuromuscular excitability, bone mineralisation

41
Q

How do calculate body ph using H+?

A

= -log[H+]

42
Q

How is carbonic acid excreted?

A

In the lungs as CO2

43
Q

How are inorganic acids formed in the body?

A

From metabolism of phosphate and sulphur containing compounds

44
Q

How is Lactic and pyruvic acid formed?

A

From incomplete metabolism of glucose

45
Q

How are ketoacids formed?

A

Incomplete metabolism of fatty acids

46
Q

How much non volatile acids are temporarily buffered and excreted by the kidneys each day?

A

50-100 mmol a day

47
Q

How do calculate ph using the Henderson-hassle equation?

A

Ph= 6.1 + log [HCO3]/0.225xpCO2

48
Q

What is ph

A

Metabolic acidosis

49
Q

What is ph

A

Respiratory acidosis

50
Q

What ph>7.45

High bicarbonate

A

Metabolic alkalosis

51
Q

What ph>7.45
High bicarbonate
Low pCO2

A

Respiratory alkalosis

52
Q

What is respiratory compensation in primary metabolic acidosis?

A

Hyperventilation to blow off CO2

53
Q

What is respiratory compensation in primary metabolic alkalosis ?

A

Hypo ventilation

54
Q

What is metabolic compensation in primary respiratory acidosis?

A

Renal production of HCO3

55
Q

What is metabolic compensation during primary respiratory alkalosis?

A

Renal excretion of HCO3

56
Q

List some causes of metabolic acidosis?

A

Ketoacidosis due to poor diabetes control
Loss of bicarbonate from diarrhoea
Impaired clearance of acid to due renal impairment

57
Q

What are common causes of metabolic alkalosis?

A

Loss of H+ due to vomiting

Hypokalaemia - redistribution of H+ ions as they are retained in cells

58
Q

Common causes of respiratory acidosis

A

Co2 retention due to pulmonary disease

59
Q

Common cause of respiratory alkalosis

A

Hyperventilation due to anxiety, mild asthma

60
Q

In respiratory acidosis what does bicarbonate do to compensate?

A

hCO3 is high

61
Q

In respiratory alkalosis what will bicarbonate be?

A

low (compensation)

62
Q

Why might you get high potassium levels during acidosis?

A

Acidosis can force K out of cells into intracellular space

63
Q

If a patient with acidosis is treated with saline K what will happen their K results?

A

They will be hypoK due to movement of K back into cells

64
Q

Why is HCO3 low in metabolic acidosis?

A

Because it is being used up to buffer whatever acid is in excess

65
Q

What are causes of hypernatraemia?

A

Dehydration

Water and sodium deficiency

66
Q

What are causes of hyponatraemia?

A

Excess fluid intake

Or water retention due to syndrome of innapropriate anti diuretic hormone (SIADH)

67
Q

What are causes of hyperkalaemia?

A

Acute renal failure

68
Q

What can occur from hyperkalaemia ?

A

May cause cardiac arrhythmia

69
Q

What is a cause of hypokalaemia? Does it occur in acute renal failure?

A

Does not occur with renal failure!

Can occur from diuretics or aldosterone secreting tumour (conns)

70
Q

What does osmolarity test?

A

To test the body’s water balance
To test the body’s ability to produce and concentrate urine
To investigate hyponatraemia

71
Q

What are 3 reasons for increased urine output ?

A

1) a high fluid intake

2) Elevated levels of osmotic ally active agent in urine eg glucose
3) lack of inappropriate action of ADH

72
Q

What are causes of decrease in urine output?

A

1) response to dehydration
2) decreased flow to kidneys
3) damage to tubular cells in kidney

73
Q

What is osmolarity gap?

A

Difference between measured and calculated osmolality

Measured osmolality -calculated osmolality

74
Q

How do you calculate calculated osmolarity?

A

2(sodium+potassium)+glucose+urea

75
Q

What does an osmolar gap of >10 mean

A

Presence of osmotic ally active substance e.g methanol

Biochemistry (8 decks)

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