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Year 2 > Kidney disease and Renal Failure > Flashcards

Kidney disease and Renal Failure Flashcards

1
Q

What is a measure of kidney clearance?

A

Serum creatinine- there is a non-linear relationship to kidney function and it is freely filtered by the kidneys. High levels in the blood indicates kidney disease.

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2
Q

What are the important factors to consider when using serum creatinine as a measure?

A

Serum creatinine is influenced based on individuals such as age, body weight, ethnicity and sex.

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3
Q

What is eGFR?

A

Estimated glomerular filtration rate. Mathematical number based on patient factors such as age, ethnicity and the serum creatinine level. It is the best measure of stable kidney function.

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4
Q

What is hyper-reninanemia?

A

High levels of renin secretion which results in hypernatremia and hypokalemia due to increased action of the RAAS system to increase BP. This causes salt and water retention, causing oedema.

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5
Q

What are causes of salt and water retention?

A

Inability to concentrate urine- linked to dehydration
Inability to excrete water load -linked to overhydration
Hypertension
Hyper-reninanemia

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6
Q

What causes an inability to concentrate urine?

A

Issue with vasopressin release or response to vasopressin in kidneys when dehydrated. This results in loss of renal diurnal rhythm of urine excretion where retention occurs in sleep and production + voiding occurs in active phase. As a result, there is Na+ and H20 retention.

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7
Q

Why are the kidneys unable to excrete water load?

A

Due to chronic kidney disease, where there is a failure to remove excess water via urine production. Instead, water is mainly reabsorbed into the blood and results in dilutational hyponatremia and oedema.

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8
Q

What is dilutional hyponatremia?

A

Low levels of sodium in the blood due to overhydration as a result of excess water retention. This is linked to kidney disease where filtration of electrolytes is impaired.

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9
Q

What is renal anaemia?

A

Normocytic anaemia which is a complication of chronic kidney disease. Caused by reduction in haemoglobin production due to insufficient EPO production

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10
Q

What is the impact of renal anaemia?

A

Impaired quality of life due to reduced exercise capacity and cognition
Increased risk of cardiovascular disease and left ventricular hypertrophy.

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11
Q

Why does renal anaemia cause cardiovascular disease?

A

Insufficient oxygen supply due to low RBC count so heart rate increases to compensate which results in left ventricle hypertrophy of overworked muscles and hypertension.

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12
Q

What is the role of the kidneys in bone density?

A

Kidney is responsible for the final stage in hydroxylation of 25, OH, D3 -> 1 hydroxylate 25-D3.

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13
Q

How does kidney disease affect bones?

A

Reduced formation of 1, 25 OH, D3 so there is lower calcium absorption and phosphate excretion. This induces release of PTH which causes bone resorption.

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14
Q

How are the ion levels affected in kidney mineral disease?

A

Low calcium; high phosphate due to lower excretion

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15
Q

How is renal kidney mineral disease treated?

A

Phosphate excretion and 1-hydroxylated Vitamin D.

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16
Q

What is a urine cast?

A

Clusters of particles wrapped in a protein matrix found in the urine which forms in the DCT and collecting duct.

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17
Q

What is the most common type of urinary cast?

A

Hyaline cast found in healthy and non healthy patients. It can be an indication of strenuous exercise, slow urine flow, use of diuretics, vomiting or fever.

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18
Q

What are red blood cell casts?

A

Indication of bleeding in the kidney which may be due to glomerulus damage and occurs in nephritic kidney disease.
-> Lower urinary tract bleeding will not form casts.

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19
Q

What accelerates the decline of the kidney function?

A

Hypertension which damages the renal arteries, affecting flow and GFR

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20
Q

Why does hyperkalemia affect muscles?

A

Causes weakness and when in excess, paralysis of muscles due to depolarisation of skeletal muscle.

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21
Q

What is the effect of kidney disease on K+ levels?

A

Lower excretion of K+ into urine, resulting in hyperkalemia. This results in peaked T waves, and flattened P waves, muscle dysfunction and cardiac arrythmia

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22
Q

Why does hyperkalemia affect the heart?

A

Peaked T waves and flattened P waves as a result of cardiac arrythmia. High levels of K+ increases membrane depolarisation of cardiac muscles closer to threshold for action potential initiation.

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23
Q

Effect of sodium imbalance?

A

Neurological dysfunction such as confusion, nausea and vomiting as a result of cerebral oedema which impairs brain function.

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24
Q

What are the features of metabolic acidosis?

A

Caused by diabetes due to high levels of ketone bodies or
Renal tubular acidosis: low blood pH because of inability to reabsorb bicarbonate.

Results in Chest pain, increased respiratory drive, confusion, bone pain, demineralisation of bone

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25
Q

How does acidosis affect bone?

A

Acidity causes increase in calcium excretion/loss, inducing osteoclast-mediated bone resorption

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26
Q

How does acidosis affect the heart and lungs?

A

Decreases cardiac output and causes bradycardia so lungs compensate with increased respiratory drive.

27
Q

What is chronic kidney disease?

A

Progressive loss of kidney function which is irreversible when eGFR is below 60ml/min for 3 months. Markers of kidney damage may be present.

28
Q

How are the stages of Chronic Kidney disease characterised?

A

Severity is based on proteinuria and eGFR.

29
Q

What is the prevalence of chronic kidney disease in the UK?

A

Increasing age
Associated with increased risk of cardiovascular disease

30
Q

What is the cause of chronic kidney disease?

A

Atherosclerosis
Systemic diseases: Diabetes and hypertension
Immune mediated diseases
Obstructions
Drugs
Infections
Genetic diseases

31
Q

Which drugs cause kidney disease?

A

NSAIDs
Antiviral medication
ACE inhibitors
Diuretics
Gentamicin
Vancomycin

32
Q

Which antibiotics cause kidney disease?

A

Gentamycin and vancomycin

33
Q

What is the effect of gentamycin on the kidneys?

A

Tubular nephrotoxicity. It is an aminoglycoside so it also causes hearing damage.

34
Q

Which immune mediated diseases cause CKD?

A

Membranous nephropathy: IgG-mediated damage of glomeruli
IgA nephropathy: IgA mediated damage of glomeruli
Systemic lupus erythematous: type 3 hypersensitivity with immune complex deposition causing nephritis.

35
Q

How do NSAIDs cause CKD?

A

NSAIDS prevent action of prostaglandins for vasodilation, reducing renal blood flow and GFR

36
Q

Which infectious agents cause CKD?

A

Hepatitis B, Hepatitis C, HIV, TB- infections induce immune mediated damage of the kidney such as membranous nephropathy

37
Q

Which genetic diseases cause CKD?

A

Polycystic kidney disease: cysts impair function
Cystinosis

38
Q

What is cystinosis?

A

Genetic condition with the accumulation of the amino acid cystine in the body, formed from the hydrolysis of cysteine in the lysosomal compartment of cells. In renal cells, it induces apoptosis

39
Q

Diabetic nephropathy

A

Nephrotic syndrome caused by high blood glucose levels damaging the kidney capillaries and resulting in high blood pressure due to impaired kidney function meaning more salt and water are retained and RAAS system can’t function. This is typically treated with ACE inhibitors and treating the underlying diabetes.

Proteinuria, hypertension and podocyte fusion are key characteristics.

40
Q

What is renal artery stenosis?

A

Atheroma disease of the renal arteries impairing renal blood flow that causes chronic kidney disease which can cause fibromuscular dysplasia

41
Q

What is fibromuscular dysplasia?

A

Abnormal growth in the wall of the arteries where cells are replaced with fibrous cells, narrowing arteries and leads to high blood pressure

42
Q

What are the consequences of kidney obstruction?

A

Hydronephrosis: Urine backflow into kidneys that results in swelling

43
Q

What are the complications of chronic kidney disease?

A

Cardiovascular disease
Infection
Loss of homeostatic function

44
Q

What is the main cause of death in CKD?

A

Cardiovascular disease due to heart working harder to increase renal blood flow when GFR is low as a result of renal dysfunction.

45
Q

Why is there increased infection risk with CKD?

A

Kidneys are involved in immune homeostasis for removal of cytokines and bacterial toxins in the blood
Use of dialysis which requires frequent bloodstream access
CKD due to autoimmune condition will increase infection susceptibility

46
Q

What is a feature of end stage kidney disease?

A

Loss of homeostatic functions
Kidney is involved in immune homeostasis so in kidney disease, there is increased inflammation and tissue damage which increases cardiovascular risk.

47
Q

What is AKI?

A

A rapid decline in kidney function where creatinine levels increase above 26 or urine output below 0.5kg.

48
Q

What is the risk factors for AKI?

A

Hypertension
Diabetes mellitus
Heart/Liver disease
Chronic Kidney Disease
Antibiotics such as Gentamycin and Vancomycin
NSAID
Chemotherapy
ACE inhibitors

49
Q

How do antibiotics affect the kidney?

A

Gentamycin and Vanocmycin due to high intracellular drug accumulation in the renal tubules or interstitial space.

50
Q

What is the effect of perfusion failure?

A

Anuria due to low blood volume and low blood pressure

51
Q

What causes obstruction of the ureter?

A

Kidney stones
Benign prostate
Tumours
Fibrosis

52
Q

What is the main cause of death in AKI?

A

Death by infection-induced sepsis. This is due to accumulation of inflammatory cytokines in AKI with loss of immune homeostasis combined with the risk of frequent dialysis

53
Q

What is the measure of function in chronic kidney disease?

A

eGFR

54
Q

What is Nephritic syndrome?

A

Condition where glomerulus is inflamed that leads to impaired kidney function associated with both AKI and CKD. oedema. Characterised by haematuria, hypertension and a lesser proteinuria.

55
Q

What is the cause of nephritic syndrome?

A

Glomerulus inflammation due to:
Infection such as Post streptococcal glomerulonephritis and Bacterial endocarditis
Autoimmune disease such as IgA Nephropathy

56
Q

Which infections cause nephritic syndrome?

A

Postinfectious glomerulonephritis such as post-streptococcal
Bacterial endocarditis
HCV (hepatitis C virus)

57
Q

What is bacterial endocarditis?

A

Bacterial infection where accumulation occurs in the heart valves

58
Q

What is nephrotic syndrome?

A

Injury to the glomerular filtration barrier of the podocytes, glomerular basement membrane or endothelium. This leads to proteinuria, hypoalbuminemia, oedema and peripheral oedema.

59
Q

What are the primary causes of nephrotic syndrome?

A

Minimal change disease
Focal segmental disease
Membranous nephropathy

60
Q

What are the secondary causes of nephrotic syndrome?

A

Amyloid
Cancer
Diabetes mellitus
Infection with HIV, HepB or Hep C
Systemic lupus erythematous

61
Q

What are the complications of nephrotic syndrome?

A

DVT and renal vein thrombosis due to hypoalbuminemia and loss of the protein anti-thrombin.
Infection due to loss of immune homeostasis with immune dysfunction and loss of IgG

62
Q

How is nephrotic syndrome treated?

A

Diuretics and ACE inhibitors
Salt restriction to prevent oedema worsening
Thrombo-prophylaxis

63
Q
A
64
Q

What is chronic kidney disease?

A

GFR is below 60ml/min due to prolonged kidney damage which disrupts kidney function. It results in hypertension, oedema, anaemia of chronic disease, metabolic acidosis and hyperkalemia.

Year 2 (247 decks)

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