L6-7 - Kidney Disease Flashcards by Asheton Mcinerney

What is the functional unit of the kidney?

Nephron

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What is the glomerulus?

Bundle of capillaries in Bowman’s capsule

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

Nephron function

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

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

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What are the 3 major hormones secreted by the kidneys?

Renin
Antidiuretic hormone (ADH)
Aldosterone

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

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

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Define osmolality

How is this regulated?

Concentration of solvent per unit volume of solute

Na/K pump

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What does antidiuretic hormone (ADH) do?

What does it do this in response to?

Stimulates water reabsorption

High ECF osmolality

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What does aldosterone do?

What does it do this in response to?

Stimulates Na reabsorption in exchange for K/H ions

Low ECF osmolality

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What is the major extracellular cation?

Sodium

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What is the major intracellular cation?

Potassium

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What general factors can contribute to hyper and hyponatraemia?

Water - Dehydration (hyper) or overhydration (hypo)

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

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What general factors can contribute to hyper and hypokalaemia?

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

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

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What states/diseases can cause hypernatraemia?

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

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What states/diseases can cause hyponatraemia?

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

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What states/diseases can cause hyperkalaemia?

Cell damage, acidosis, renal disease, addisons

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What states/diseases can cause hypokalaemia?

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

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

Low ADH - diabetes insipidus causes hypernatraemia

High aldosterone - Cronn’s syndrome causes both

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

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

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How does acidosis or alkalosis affect potassium levels?

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

Hyponatraemia, hyperkalaemia

Reduced urine output

Define the glomerular filtration rate (GFR)

Volume of plasma cleared of a substance per unit time

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

Endogenous - creatinine/urea

Exogenous - inulin

What is the estimated (e)GFR?

Calculated GFR based on serum creatinine levels rather than urine

What are the major biochemical indicators of renal disease?

Serum urea - increased Serum creatinine - increased Electrolytes - abnormal

What are the two types of urinalysis?

Physical examination and dipstick test

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

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

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

Proteinuria

What can cause proteinuria?

Kidney disease, infection, stresses, pre-eclampsia

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

Looking at blockages or some types of kidney damage X-ray, ultrasound, CT, isotope scan

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

Aid diagnosis of glomerular disease or kidney damage

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

Pyelonephritis - type of tubulointerstitial nephritis

What are the signs of pyelonephritis?

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

What syndromes do glomerular diseases present as?

Nephritic or nephrotic syndrome

What are the key differences between nephritic and nephrotic syndrome?

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

What does diabetic nephropathy consist of?

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

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

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

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

Acute - recovery or progression to chronic | Chronic - end stage renal disease and irreversible damage

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

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

What are the causes of pre-renal AKI? | 3

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

What are the signs of pre-renal AKI?

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

What are the causes of renal AKI? | 2

Glomerulonephritis or acute tubular necrosis

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

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

What are the causes of post-renal AKI? What are the signs of this?

Renal stones or carcinoma of bladder, ovaries or prostate Decreased urine output, blockage visualised through imaging

What are the 2 major risk factors for chronic kidney disease (CKD)? Give another 2 risk factors that are less common

Diabetes and high blood pressure Cardiovascular disease, obesity, high cholesterol, smoking, family history

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

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

What is stage 5 CKD also known as?

End stage renal disease (ESRD)

What are the consequences of CKD? | 4

Hyperkalaemia, hypocalcaemia, anaemia, metabolic acidosis

What are the three types of treatment available for CKD?

Conservative care, dialysis, renal transplants

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

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

How does dialysis work?

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

What is currently a major issue with renal transplants?

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