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Introduction to Clinical Biochemistry > L6-7 - Kidney Disease > Flashcards

L6-7 - Kidney Disease Flashcards

1
Q

What is the functional unit of the kidney?

A

Nephron

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2
Q

What is the glomerulus?

A

Bundle of capillaries in Bowman’s capsule

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3
Q

What is the glomerular filtration rate (GFR) an indicator of?

A

Nephron function

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4
Q

What could cause a high glomerular filtration rate (GFR)?

A

Hypoalbuminaemia, pre-renal arteriole dilation, post-renal arteriole constriction, alcohol

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5
Q

What are the 3 major hormones secreted by the kidneys?

A 
Renin
Antidiuretic hormone (ADH)
Aldosterone
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6
Q

What are the 2 compartments that bodily water is divided into? Where is this water located?

A 
Extracellular fluid (ECF) - plasma and interstitial fluid
Intracellular fluid (ICF) - in cells
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7
Q

Define osmolality

How is this regulated?

A

Concentration of solvent per unit volume of solute

Na/K pump

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8
Q

What does antidiuretic hormone (ADH) do?

What does it do this in response to?

A

Stimulates water reabsorption

High ECF osmolality

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9
Q

What does aldosterone do?

What does it do this in response to?

A

Stimulates Na reabsorption in exchange for K/H ions

Low ECF osmolality

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10
Q

What is the major extracellular cation?

A

Sodium

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11
Q

What is the major intracellular cation?

A

Potassium

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12
Q

What general factors can contribute to hyper and hyponatraemia?

A

Water - Dehydration (hyper) or overhydration (hypo)

Na - Excess (hyper) or reduced (hypo) Na in ECF

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13
Q

What general factors can contribute to hyper and hypokalaemia?

A

K entering the ECF - Increase (hyper) or decrease (hypo)

Rate of loss - Inefficient secretion (hyper) or increased loss (hypo)

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14
Q

What states/diseases can cause hypernatraemia?

A

Decreased water intake, increased Na intake, diabetes insipidus, cronn’s syndrome, cushings

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15
Q

What states/diseases can cause hyponatraemia?

A

Increased water intake, decreased Na intake, renal disease, addisons, SIADH (syndrome of inappropriate ADH)

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16
Q

What states/diseases can cause hyperkalaemia?

A

Cell damage, acidosis, renal disease, addisons

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17
Q

What states/diseases can cause hypokalaemia?

A

Decreased K intake, alkalosis, GI losses, Cronns, thiazide diuretics

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18
Q

What renal hormone levels generally result in high Na and/or low K? Give an example for each hormone

A

Low ADH - diabetes insipidus causes hypernatraemia

High aldosterone - Cronn’s syndrome causes both

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19
Q

What renal hormone levels generally result in low Na and/or high K? Give an example for each hormone

A

High ADH - SIADH (syndrome of inappropriate ADH) causes hyponatraemia
Low aldosterone - Addison’s causes both

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20
Q

How does acidosis or alkalosis affect potassium levels?

A

Acidosis - increased H in cells pushes K into ECF (hyperkalaemia)

Alkalosis - decreased H pulls K into ICF to maintain balance (hypokalaemia)

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21
Q

What Na/K levels are seen in renal disease? What causes this?

A

Hyponatraemia, hyperkalaemia

Reduced urine output

22
Q

Define the glomerular filtration rate (GFR)

A

Volume of plasma cleared of a substance per unit time

23
Q

What two types of substances can be used to measure GFR? Give an example of each

A

Endogenous - creatinine/urea

Exogenous - inulin

24
Q

What is the estimated (e)GFR?

A

Calculated GFR based on serum creatinine levels rather than urine

25
Q

What are the major biochemical indicators of renal disease?

A

Serum urea - increased
Serum creatinine - increased
Electrolytes - abnormal

26
Q

What are the two types of urinalysis?

A

Physical examination and dipstick test

27
Q

What does the physical examination part of a urinalysis look at?

A

Colour - can determine concentration or presence of blood
Turbidity - signs of UTIs or nephrotic syndrome
Microscopy - signs of UTI or glomerulonephritis

28
Q

What can the dipstick test in a urinalysis indicate in terms of kidney disease?

A

Proteinuria

29
Q

What can cause proteinuria?

A

Kidney disease, infection, stresses, pre-eclampsia

30
Q

What can imaging be used for in terms of kidney disease? Give two types of imaging

A

Looking at blockages or some types of kidney damage

X-ray, ultrasound, CT, isotope scan

31
Q

What can a biopsy be used for in terms of kidney disease?

A

Aid diagnosis of glomerular disease or kidney damage

32
Q

What is the most common tubulointerstitial disease? what is this a type of?

A

Pyelonephritis - type of tubulointerstitial nephritis

33
Q

What are the signs of pyelonephritis?

A

Normal urea + creatinine (normal GFR), low K, phosphate, urate and bicarbonate (acidosis)

34
Q

What syndromes do glomerular diseases present as?

A

Nephritic or nephrotic syndrome

35
Q

What are the key differences between nephritic and nephrotic syndrome?

A

Nephrotic - high proteinuria, caused by non-proliferative glomerulonephritis

Nephritic - slight proteinuria with haematuria, decreased GFR, caused by proliferative glomerulonephritis

36
Q

What does diabetic nephropathy consist of?

A

Fibrosis of the glomerulus (glomerulosclerosis) or tubules (tubulointerstitial fibrosis)

37
Q

What is the difference between acute kidney injury (AKI) and chronic kidney disease (CKD) in terms of time scale?

A

Acute have rapid onset and decline of GFR, chronic is gradual

38
Q

What is the difference between acute kidney injury (AKI) and chronic kidney disease (CKD) in terms of prognosis?

A

Acute - recovery or progression to chronic

Chronic - end stage renal disease and irreversible damage

39
Q

What are the 3 broad classifications of acute kidney injury (AKI)? What do these consist of?

A

Pre-renal - issues with blood supply
Renal - damage to kidney
Post-renal - blockage

40
Q

What are the causes of pre-renal AKI?

3

A

Decreased plasma volume, decreased cardiac output, renal artery occlusion (blockage)

41
Q

What are the signs of pre-renal AKI?

A

Increased urea and creatinine, metabolic acidosis, hyperkalaemia, increased urine osmolality

42
Q

What are the causes of renal AKI?

2

A

Glomerulonephritis or acute tubular necrosis

43
Q

What are the signs of renal AKI (in comparison to pre-renal)?

A

Lowered serum and urine urea, lowered urine osmolality and increased urine Na

44
Q

What are the causes of post-renal AKI?

What are the signs of this?

A

Renal stones or carcinoma of bladder, ovaries or prostate

Decreased urine output, blockage visualised through imaging

45
Q

What are the 2 major risk factors for chronic kidney disease (CKD)?

Give another 2 risk factors that are less common

A

Diabetes and high blood pressure

Cardiovascular disease, obesity, high cholesterol, smoking, family history

46
Q

How many stages of chronic kidney disease (CKD) are there?

How are these classified?

A

5 stages

Based on declining GFR (1 is highest, 5 is lowest)

47
Q

What is stage 5 CKD also known as?

A

End stage renal disease (ESRD)

48
Q

What are the consequences of CKD?

4

A

Hyperkalaemia, hypocalcaemia, anaemia, metabolic acidosis

49
Q

What are the three types of treatment available for CKD?

A

Conservative care, dialysis, renal transplants

50
Q

When would it be more appropriate to use conservative care over other CKD treatments?

A

In those with a poor prognosis for the other treatments e.g. elderly have poor mortality on dialysis

51
Q

How does dialysis work?

A

Blood is run through a dialyzer machine filled with wanted molecules; these diffuse into the blood

52
Q

What is currently a major issue with renal transplants?

A

There are more people on the waiting list than there are donors - many people die or become too sick to receive the transplant while waiting

Introduction to Clinical Biochemistry (11 decks)

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