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Block 10 Ellen > L7: Kidney disease and renal failure > Flashcards

L7: Kidney disease and renal failure Flashcards

1
Q

3 categorises of kidney disease

A

pre-renal
intrinsic
post-renal

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2
Q

what does post-renal lead to in the kidney

A

hydronephrosis

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3
Q

can nephrons regenerate

A

NO

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4
Q

urinary excretion rate=

A

filtration rate - reabsorption rate + secretion rate

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5
Q

3 layers of glomerular capillaries

A

endothelium
basement membrane
podocytes

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6
Q

how does glomerular filtrate move through the podocytes

A

through slit pores between them

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7
Q

apart from the basement membrane what can also stop protein passage

A

the podocytes also have a negative charge

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8
Q

main consequence of nephrotic syndrome

A

protein loss

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9
Q

4 features of nephrotic syndrome

A

peripheral oedema
proteinuria
hypoalbuminaemia
hypercholesterolaemia

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10
Q

what biochemical markers are needed for a nephrotic syndrome diagnosis

A

proteinuria

hypoalbuminaemia

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11
Q

what is nephrotic range proteinuria almost always due to

A

glomerular disease

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12
Q

what are most nephrotic diseases associated with

A

podocyte injury and loss of anionic charge in the capillary wall

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13
Q

what 2 things does proteinuria result from

A

loss of charge and size selectivity

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14
Q

2 mechanisms for oedema in nephrotic syndrome

A

overfill and underfill mechanism

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15
Q

underfill mechanism=

A
  • reduced oncotic pressure means fluid moves into ECF

- reduced plasma volume activates sodium and water reabsorption

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16
Q

what is the overfill mechanism

A

a defect in sodium excretion increases blood volume increasing hydrostatic pressure moving fluid into ECF

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17
Q

3 primary causes of nephrotic disease

A

minimal change disease
focal segmental glomerulosclerosis
membranous GN

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18
Q

what is minimal change disease

A
  • effacement of pedicles causing protein leakage

- little chronic damage

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19
Q

treatment of minimal change disease

A

steroids

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20
Q

what is segmental glomerulosclerosis

A
  • segmental scarring lesions within glomerular tuft

- bad prognosis (hard to treat)

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21
Q

membranous nephropathy

A

electron dense immune deposits on basement membrane creating holes

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22
Q

in whom are secondary causes of nephrotic disease more common

A

adults

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23
Q

in whom are primary causes of nephrotic disease more common

A

children

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24
Q

name 4 secondary causes of nephrotic disease

A

diabetic nephropathy
amyloidosis
chronic viral infection
cancer

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25
Q

main feature of nephritic syndrome

A

haematuria

26
Q

5 features of nephritic syndrome

A 
haematuria 
small amount of proteinuria 
mild hyertension 
oliguria 
possible oedema
27
Q

in nephritic syndrome what is the oedema secondary to

A

oliguria

28
Q

3 causes of nephritic syndrome in children

A

haemolytic uraemic syndrome
Henoch-schonlein purpura
post-streptococcal GN

29
Q

3 causes of nephritic syndrome in adults

A

goodpasture’s
ANCA- associated vasculitis
primary or secondary mesangiocapillary GN

30
Q

2 pathways of membrane attack

A

classic

alternative

31
Q

what is the classic pathway characterised by

A

antigen-antibody complex

32
Q

what activates the classic pathway

A

Fc portion on the antigen-antibody complex

33
Q

what does the antigen-antibody complex trigger to cause membrane attack

A

complement

34
Q

what does the alternative pathway not depend on

A

antibody-antigen complexes

35
Q

what can activate the classic pathway (4)

A

enzymes
endotoxins
cell membrane
viruses

36
Q

what can activate the alternative pathway (4)

A

venom
aggregated Ig
yeast cell wall
bacterial endotoxins

37
Q

what is MAC

A

membrane attack complex

38
Q

what happens to MAC

A

its inserted into the lipid bilayer leading to movement of ions and water across the membrane leading to cell lysis

39
Q

in what disease can immune complex trapping happen

A

lupus

40
Q

what happens in immune complex trapping

A

immune complexes present in blood get stuck on basement membrane activating complement

41
Q

in what disease is the antigen already present in the basement membrane

A

goodpastures disease

42
Q

what damage occurs in the basement membrane in goodpastures disease

A

alpha 3 chain collagen is damaged

43
Q

in what disease can the antigen be implanted

A

post infectious GN

44
Q

what happens in post infectious GN

A

bacterial antigen implanted in basement membrane causing circulating antibody to bind

45
Q

what happens in diarrhoea + HUS ( haemolytic uraemic syndrome)

A

certain endotoxins activate complement (can be through classical or alternative pathway)

46
Q

who is vasculitis seen in and when

A

adults in winter season

47
Q

what causes damage to the kidney in vasculitis

A

anti-neutrophil cytoplasmic antibodies

48
Q

what is acute kidney failure

A

sudden decline in renal function over hrs or days

49
Q

to cause acute renal failure what does the insult need to be

A

bilateral

50
Q

what is acute on chronic renal failure

A

sudden decline in renal function with CKD background

51
Q

presentation of acute renal injury

A

oliguria/ anuria

azotaemia

52
Q

azotaemia=

A

high levels of nitrogen containing compounds

53
Q

3 causes of acute renal injury

A

glomerular injury
interstitial injury
acute tubular necrosis

54
Q

what part of the kidney does diabetes type 1 damage

A

glomerular injury

55
Q

3 pre-renal causes of kidney damage

A

sepsis
heart failure
dehydration

56
Q

2 post renal causes of kidney damage

A

tumour

stones

57
Q

3 intrarenal causes of kidney damage

A

glomerular injury
tubulo-interstitial injury
vascular injury

58
Q

in CKD what stage do symptoms develop

A

after stage 4 (GFR <15-29ml/min)

59
Q

normal kidney function (A wet bed)

A

-acid base balance
-water balance
-electrolyte balance
-toxin removal
-Blood pressure
-EPO
vit D

60
Q

3 symptoms of Na/sodium retention

A

hypertension
oedema
raised JVP

61
Q

why are patients with CKD prone to gout

A

high uric acid

Block 10 Ellen (9 decks)

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