kidney and renal disease medicine

Question 1

what is the kidney formed from and how do they work/flow

Answer 1

nephrons
starts from glomerulus (filtration), filtrate produced and pass through tubular segmetns
modified and collects in collecting ducts
drain into pelvis of kidney
then into ureter

Question 2

making urine steps

Answer 2

1) Glomerular filtration
- H20 and solutes move from blood into nephron
2) Tubular reabsorption
- useful substances move from filtrate into blood
- modified
3) tubular secretion
- wastes and excess substances move from blood into filtrate
4) water reabsorption
- h20 moves from filtrate into blood
dependant on dehydration

Question 3

normal kidney functions

Answer 3

1) salt and water homeostasis
2) excretion of waste
3) humoral regulation of other organs
- bone (vit D)
- RBC (erythropoietin)
- blood vessels (renin)
4) selectivity barrier
- for the 1st two functions especially

Question 4

how can salt and water homeostasis going wrong appear

Answer 4

changes in total body water
change in blood pressure
changes in urine vol/concentration

Question 5

issues with excretion of waste products (salt and water homeostasis)

Answer 5

• uraemia
• acidosis eg lactic acid, ketoacids (if not controlled pH of blood can be altered)
• Others: potassium, phosphate, Uric acid
• clearance of drugs (dose of drugs should be adjusted if there are issues with renal excretion)

Question 6

humoral disturbance (salt and water homeostasis)

Answer 6

• anaemia (issue in production of EPO)
• renal bone disease (problems with activation of Vit D)
• Hypertension/hypo (excessive renin or insufficient)

Question 7

if there is a barrier failure (salt and water homeostasis) what can this lead to

Answer 7

• haematuria
• proteinuria
• lipiduria

Question 8

what blood test is used for the kidney

Answer 8

GFR

Question 9

GFR

Answer 9

glomerular filtration rate
measured by the concentration of urea in the blood

usually between 60-120
kidney disease 60-15
less than 15 is failure

Question 10

why can GFR be estimated

Answer 10

it is steady state concentration

Question 11

consequnces of kidney disease

Answer 11

hypertension
stroke
HF
retinopathy (due to the untreated hypertension)

Question 12

medications used for hypertentson

Answer 12

ace inhibitors
beta blockers
calcium antagonists

Question 13

anaemia

Answer 13

liner relationship between anaemia and GFR

treated with erythropoietin

Question 14

treatment of chronic renal fialure

Answer 14

1) mild/moderate
- diet
- supplements – alkali (keeps pH in normal range), vit D, iron (usually IV)
- drugs, phosphate, hypertension, anaemia
2) severe (when GFR is below 15)
- dialysis
- transplantation

Question 15

dialysis

Answer 15

• fluid and electrolytes pass through dialysis membrane (semi permeable)
• RBCs and proteins are retained within circulation

Mimics the function of the kidney – but quicker

Question 16

what membrane is used in dialysis

Answer 16

peritoneal membrane

Question 17

causes of chronic kidney disease

Answer 17

1) glomerulonephritis
2) pyelonephritis
3) diabetes
4) polycystic kidney disease
- autosomal dominant genetic cause
5) hypertension/renovascular

Question 18

complications of haemodialysis

Answer 18

1) CVD
- hypertension
- K related arrhythmias
- cardiac valvular calcifications
2) infections
- due to immunosuppression
3) malnutrition
4) renal osteodystrophy

Question 19

transplantation of kidney complications

Answer 19

1) immunosuppression
- infection
- cancer
- others
- the drugs may have specific side effects also
2) CAN
3) CVD