L26 - kidney injury

Question 1

functiond of kidneys

Answer 1

homeostasis - water, lectrolyte, BP, acid-base balance

metabolic and endocrine - synthesis of hormones like vitaminsD, excreting drug and its metabolities

Question 2

types of kidney diseases

Answer 2

chronic and acute

Question 3

differences of chronic (CKI) vs acite kidney injury (AKI)?

Answer 3

chronic - gradual progressive and irreversible, at least for 3 months, commonly caused by diabetes or High BP

acute - rapid and sudden, caused by combo of illness and medication from hours and days. it’s reversible with treatment

Question 4

people who develop AKI

Answer 4

• old people
• have diabetes mellitus
• high BO
• heart and liver diseases
• CKI

Question 5

people who develop CKI and risk factors

Answer 5

• quite common in UK
• most are unrecognised
• better to check people who are at risk for AKI for CKI
• more common in people with increases social deprivation
• age, diabetes, smoking, hypertension, poor education

Question 6

what hormones or systems control the electrolyte and water homeostasis

Answer 6

anti diuretic hormone and renin-angiotensin system

Question 7

what happens when salt and water homeostasis fails

Answer 7

• lose control of Na and K+ conc which then affects the neurological functions so hypertension and CNS dysfunction
• cant excrete water so builds up in tissues (odema) and lungs too
• cant have concentrated urine

Question 8

what happens when potassium homeostasis fails

Answer 8

-K is needed to regulate contraction of the heart
- so it leads to membrane excitability and leads to cardiac arrhythmias
and severe hyperkalemia

Question 9

what happens when acid base homeostasis fails

Answer 9

• this is when excess H is failed to be excreted
• leads to acidosis and breathlessness
• hyperkalaemia

Question 10

what happens if Vit d not activated

Answer 10

• vit d needed to regulate Ca and Phosphate as well as keeping the bones and muscles healthy
• leads to hypocalcemia, muscles spasm, cardiac rhythm problems, bone fragility

Question 11

pathway acting on the kidneys and bone when there is lowe [Ca]

Answer 11

stimulates parathyroid to produce a hormone that acts on kidneys and bone.

• kidney produced activated form of vit D (1.25- vit D) to increases the absorption of Ca from the gut
• bone is stimulated to reabsorb Ca ions

Question 12

pathway acting on the kidneys and bone when there is lowe [Ca] and there’s a kidney failure

Answer 12

-kidney cant make activated form of vit D
-so bone is stimulated to reabsorb Ca to maintain the conc
but its still lower since the kidneys isn’t working so this increases bone fragility

Question 13

what happens when erythropoietin is not made

Answer 13

• its a hormone secreted by the kidneys to increase the rate of RBC production in response to a fall on O2 levels
• leads to anaemia which has an effect on stuff like the quality of life, impaired cognition, blood-borne infection

Question 14

how does the kidneys measure the O2 level

Answer 14

specialised cells in the kidney are capable of detecting and responding to low levels of oxygen through increased production of erythropoietin.

Question 15

what happens if the waste products cant be excreted

Answer 15

• becomes toxic

- egs like creatinine, nitrogenous waste. urate, phosphate

Question 16

role of kidneys in drug metabolism

Answer 16

• they get excreted

- can cause an increased risk of toxicitiy

Question 17

complication due to loss in kidneys

Answer 17

anaemia 
hypertension
cvs disease
bone disease
immune suppression 
bleeding

Question 18

therapy for kidney failure

Answer 18

dialysis and transplatation

Question 19

what is dialysis

Answer 19

where the fluid and the solutes are removed or added depending on the patients blood.

• uses a semipermeable membrane with dialysis fluid
• has a GFR of less than 15ml/min

Question 20

types of the semi-permeable membrane in dialysis

Answer 20

-haemodialysis and peritoneal membrane

Question 21

what happens in peritoneal dialysis

Answer 21

• dialysate solution inserted through carether into the abdominal cavity lined with the peritoneum
• the waste will be drained out in another bag attached to the carather

Question 22

how are the substances regulated in the peritoneal dialysis

Answer 22

-diffuse down the conc gradient so if there’s excess stuff in the blood, it can diffuse to the peritoneal cavity which will be drained

Question 23

what happens during haemodialysis

Answer 23

• blood taken out and goes through the filter where the waste will diffuse out the blood across the filter into the waste diaylstae
• blood put back in

Question 24

what happens during kidney transplantation

Answer 24

• needs immunosuppressants

- better treatment because longer life, better quality of life and replaces ALL function of renal functions