Kidneys Flashcards
What is synthesised in the kidneys?
Vitamin D and EPO
What is the usual value for GFR?
125ml/min
What is the value for amount of filtrate per day?
180L
What 2 layers is the glomerular basement membrane between?
Endothelial cells and podocyte layer (visceral layer)
How would you describe the capillary endothelium in the kidney?
Fenestrated
What is the macula dense? where found?
wall of the distal tubule, where it touches the glomerulus
What is the bowmans space between?
The visceral layer and parietal layer of renal corpuscle
Where does the filtrate move to after passing through the fenestrations in the capillary?
Into bowmans space
How do you measure renal function?
Measure serum creatinine via blood test
What is the definition of GFR?
The sum of filtration rates in all functioning nephrons
Which 2 things are sources of creatinine?
Dietary and creatine metabolism in the skeletal muscles.
3 methods used to assess GFR?
Creatinine clearance, plasma creatinine concentration and estimation equation (Cockcroft-gault) MDRD
What is the equation for creatinine clearance?
urine creatine concxplasma creatinine conc/urine volume
Creatinine clearance value - female?
95+-20
Creatinine clearance value - male?
120+-25
Creatinine clearance value limitations?
Incomplete urine collection and increased creatinine secretion from tubule in renal impairment
What does an increase in creatinine mean?
Means dramatic DECREASE in GFR - occurs in CKI
MDRD what is it based off?
Race, age, sex, creatinine
Biggest cause of chronic renal failure?
Diabetes
When should eGFR be measured?
In cases when people at high risk of kidney disease, aka IHD, PVD, pts taking ACEI
Who makes more creatine, athlete vs non athlete and why
Athlete - muscly
eGFR value for CKD stage 3?
30-59ml/min
What are signs of stage 3 CKD?
Anaemic (due to reduced EPO), low vit D so low Ca, hypertension, however, pt is symptomatic
stage 4 CKD eGFR value?
15-29ml/min
CKD stage 4 creatinine value?
250-600umol/l
What drugs are required CKD stage 4?
Diuretics and antihypertensive drugs
What is GFR in stage 5 CKD?
below 15mls/min, if below 5 then end stage RF
Creatinine level in CKD stage 5?
over 700, if over 900 then end stage renal failure.
what is an example of a really excreted drugS?
Opiates
In CRF do basic drugs have increased binding or decreased binding?
Increased binding of basic drugs
Give 2 examples of nephrotoxic drugs?>
Gentamycin and NSAIDS
what is uraemia?
increased urea in kid disease, platelets don’t work so increased bruising.
how to improve bleeding time in uraemia?
Increased haematocrit (with EPO) or dialysis
effects of chronic renal failure?
Metabolic acidosis, hyperkalaemia, hypercalcaemia, peripheral and pul. oedema
ESRF dialysis time? and with what drug and at what site
4 hours 3 x per week, heparin tunnelled intrajugular neckline or arm arteriovenous fistula
between what artery and vein is the fistula made for the site of dialysis?
radial artery and cephalic vein
What is the dialysate made of?
Acid and bicarbonate of correct strength with water
What can happen if dialysis is missed?
Fluid overload causing pulmonary oedema
What are the signs of acidaemia?
pH below 7.2, HCO3 under 16mmol/l
When must be careful when using sodium bicarb to combat acidaemia?
Fluid overload and if the pt is hypocalcaemic already
What are three other cases of acidaemia?
lactic acidosis, poisoning, DKA
What can pericardial effusion cause?
Cardiac tamponade
What are the components of becks triad?
three signs are: low blood pressure (weak pulse or narrow pulse pressure) muffled heart sounds. raised jugular venous pressure.
Advantages of CAPD?
no anticoagulation needed, good bio chemistry control can be done at home, holidays
Disad of CAPD?
peri mem failure eventually, weight gain and peritonitis
in ESRF is prophy needed?
NO
what is oral facial digital syndrome
x linked, lethal in males
effects of oral facial digital syndrome
bifid tongue, cysts– not distinguishable from ADPKD , liver cysts, facial milia, cleft palate,,
sirolimus effect
stomatitis, hyperlipidaemia
When is the best time to treat a dialysis patient and why?
Day after dialysis - heparin will have worn off but dialysis will have peaked.
What is a quality of heparin?
Has a short half life
What is nephrotic syndrome?
Where too much protein is excreted in the urine
What is diabetic nephropathy?
Glomeruli are damaged leading to increased protein loss in the urine, due to poor diabetic control.
what is renal osteodystrophy?
wasting away of bone due to kidney disease
what’s indicative of CKI?
GFR low (persisting for over 3 months) .
Early CKD symptoms?
nocturia and poor apetite
What are the 2 key characteristics of nephrotic syndrome?
Proteinuria with hypoalbuminaemia leading to oedema
What meds may nephrotic syndrome patient be taking?
Long term steroids.
What is a diagnosing symptom of nephrotic syndrome?
Bilateral periorbital oedema
What immunosuppressive drugs are given to renal transplant patient?
Corticosteroid plus steroid sparing drug such as cyclosporin or azathioprine
What is the most common cause of ESRF?
Diabetic nephropathy
What causes renal osteodystrophy?
Increase in plasma phosphate levels, elevated PTH, suppression of plasma Ca, disruption in bit D metabolism causes calcium metabolism to be further comprimised.
What causes anaemia?
Failure of kidney to produce EPO
What does marrow fibrosis lead to?
Reduced platelet count and function. Anaemia
What are the 2 types of dialysis?
Peritoneal and extra-corporeal
The dialysis solution must be ………………… in metabolites across a semi-permeable membrane
hypotonic
Where is AV fistula formed?
At ACF or wrist
What is thromboxane?
Hormone released from platelets which causes platelet agg. and arterial constriction.
what does prostacyclin do?
inhibits platelet activation and vasodilalates
vWF function?
Promotes platelet agg and bridging molecule for normal platelet adhesion.
what does cyclosporin cause?
Gingival hypoplasia
CKD effects on oral ulceration and skin cancers?
Increased as a result of steroids and immunosuppression
Sialosis in dialysis its, specifically….
Non neoplastic/infective swelling of major salivary glands especially parotid.
CKD effects in kids?
Enamel hypoplasia, delayed tooth eruption, decreased growth
What might u see in dialysis pts mouth
Palatal and buccal keratosis
Why do you advice CKD patients not to swallow blood post XLA?
Stops renal function as heavy protein load can result in loss of renal reserve.
Name a nephrotoxic drug?
Gentamycin (used in prophy)
Which drug should be avoid in pts taking cyclosporin
Erythromycin
Which tetracycline does NOT need to be avoided in kidney disease?
Doxycycline
Which drugs should have a dose reduction?
Aciclovir, amoxicillin, ampicillin, cefalexin, erythromycin
If patient has mild kidney impairment which drug can be taken, but not if its any worse…
NSAIDs
What urine production volume is produced in hypovolaemia?
30-60ml an hour
If potassium levels rise in CKD, what 2 methods can be used to lower it?
Calcium resonium (paste given rectally) or glucose and insulin IV infusions (both take K out of the bloodstream)
Ca is taken from bones in which disease?
Renal osteodystrophy
25HCC-> 1,25HCC conversion failure leads to…
Secondary parathyroidism
What type of anaemia occurs in kidney disease>
normocytic normochromic anaemia
If potassium levels rise, what can this cause>
cardiac arrhythmias
