kidney in health and disease

Question 1

What is a nephron?

Answer 1

Operational kidney unit- a million

Question 2

How is urine made?

Answer 2

1. Glomerular filtration
H2O and solutes move from blood into nephron (glomerulus to Bowmans capsule)

2. Tubular reabsorption
Useful substances move from filtrate into blood (tubule into peritubular capillary network)

3. Tubular secretion
Wastes and excess substances move from blood into filtrate (peri tubular capillary network to distal tubule)

4. Water reabsorption
H2O moves from filtrate into blood (into collecting duct by osmosis)

Question 3

What are 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, vessels-renin)
4. Selectivity barrier

Question 4

What can go wrong in salt and water homeostasis?

Answer 4

1. Change in total body water
2. Change in blood pressure
3. Change in urine vol/conc

Question 5

What can go wrong in excretion of waste products?

Answer 5

1. Uraemia
2. Acidosis (eg. Lactic acid, keto acids)
3. Others: potassium, phosphate, uric acid
4. Clearance of drugs

Question 6

What can go wrong in humoral regulation?

Answer 6

1. Anaemia (erythropoietin)
2. Renal bone disease (vit D)
3. Hyper/hypotension (renin)

Question 7

What can go wrong in the selectivity barrier?

Answer 7

1. Haematuria
2. Proteinuria
3. Lipiduria

Question 8

What is GFR?

Answer 8

Glomerular filtration rate
(m) is measured
(e) is estimated

Normal is 60-120
Kidney disease is 15-60
Kidney failure is <15
Stages 1-5
K/DOQI classification

Question 9

What are complications of hypertension?

Answer 9

TIA/stroke
LVH, CHD, HF
Retinopathy
Peripheral vascular disease
Renal failure

Question 10

What are antihypertensive drugs?

Answer 10

ABC

ACE inhibitors- end in pril
Beta blockers- end in olol
Ca channel blockers- end in pine

Question 11

How is anaemia treated?

Answer 11

Erythropoietin injections weekly/monthly

Question 12

How might the kidney affects bones?

Answer 12

The kidney adds a hydroxyl group to 25-hydroxyvitamin D3

1,25-dihydroxyvitamin D3 active metabolite that maintains calcium balance in body

Can cause rickets

Question 13

What is the tx of renal disease?

Answer 13

MILD/MODERATE
Diet
Supplements- alkali, vit D, iron
Drugs- phosphate, hypertension, anaemia

SEVERE
Dialysis
Transplantation

Question 14

What are the top 5 causes of chronic kidney disease?

Answer 14

1. Glomerulonephritis
2. Pyelonephritis
3. Diabetes
4. Polycystic kidney disease
5. Hypertension/renovascular

Question 15

What are complications of dialysis?

Answer 15

Widespread CVD
-K-related arrhythmias
-hypertension
-prone to ischaemic heart disease
-sensitive to changes in electrolytes
Calcified heart valves- susceptible to bacterial endocarditis
Malnourished
Immunosuppressed
Renal osteodystrophy

Question 16

What are complications of transplantation?

Answer 16

Immunosuppressed- infection, cancer, drug side effects, etc
CVD
CAN

Question 17

What is the kidney patient?

Answer 17

Immunosuppressed
Malnourished- prone to infection, poor healing
Anaemic
Bleeding tendency
CVD- hypertensive, fluid overloaded, valvular sclerosis

Question 18

How should you manage the kidney pt?

Answer 18

Prophylactic antibiotics (CVD, immunosuppressed, malnourished)
Minimise blood loss
Transfusions ready
Maximum homeostasis
Minimise recumbent position (fluid overload)
Careful w GA and monitor serum K post op (hyperkalaemia tendency)