Overview of renal disease

Question 1

What are the 7 functions of the kidney?

Answer 1

→ Excrete waste substances
→ Regulates minerals in extracellular fluid 
→ Regulates water balance 
→ RBC production
→ Blood pressure control 
→ Vitamin D activation
→ acid base balance

Question 2

How much blood passes through the glomeruli per day?

Answer 2

→ 2000

Question 3

How much blood is filtered per day?

Answer 3

→ 200 L

Question 4

What tests are used to measure kidney function?

Answer 4

→ Blood tests
→ Creatinine 
→ formulae
→ Urine output
→ Elimination of radioisotopes

Question 5

What is creatinine and where is it produced?

Answer 5

→ biomarker for filtration of the glomerulus

→ skeletal muslce

Question 6

What is asymptomatic proteinuria?

Answer 6

→ glomerular filter has become leaky

Question 7

What is nephritic syndrome?

Answer 7

→ Inflammatory condition in the glomerulus
→ RBC in urine
→ hypertensive
→ GFR falls

Question 8

What is haematuria?

Answer 8

→ blood in urine due to bleeding anywhere along the urinary tract

Question 9

What is chronic kidney disease?

Answer 9

→ Reduction in GFR that gets worse over time

Question 10

What does diabetes mellitus do to the kidney?

Answer 10

→ Chronic damage to kidney through high BP

Question 11

What are pre renal causes of kidney disease?

Answer 11

→ hypovolaemia
→ Perfusion decreases
→ Drugs

Question 12

How can hypovolaemia be caused?

Answer 12

→ Haemorrhage

→ Diarrhoea

Question 13

Why does perfusion decrease?

Answer 13

→ Septic shock

→ Cardiac failure

Question 14

How can drugs cause kidney disease?

Answer 14

→ Angiotensin converting inhibitors

→ NSAIDs

Question 15

How are glomerular diseases diagnosed?

Answer 15

→ Urine analysis

→ measures blood and protein

Question 16

How is proteinuria quantified?

Answer 16

→ Urine albumin : creatinine ratio

→ Urine protein : creatinine ratio

Question 17

What does glomerular bleeding lead to?

Answer 17

→ Red cell casts in the urine

→ Red cells get stuck together and form the shape of the tubule

Question 18

How do dysmorphic erythrocytes form?

Answer 18

→ Red blood cells squeeze along the glomerular filter and become deformed

Question 19

What do you need to distinguish between in glomerular disease?

Answer 19

→ primary and secondary

Question 20

What is a post renal disease?

Answer 20

→ Acute kidney injury

Question 21

What happens in acute kidney injury?

Answer 21

→ Fluid retention - lymphoedema leads to pulmonary oedema

→ Hyperkalaemia - high K+ leads to cardiac arrhythmias

Question 22

What are the consequences of acute kidney injury?

Answer 22

→ Impact on outcome 
    - hospital mortality 
→ Resources
    - length of stay in hospital 
    - referrals, tests and treatments 
→ Patient morbidity 
    - Acute complications 
    - dysfunction of other organs 
    - risk of CKD

Question 23

What are the long term sequelae of acute kidney disease?

Answer 23

→ CKD
→ ESRF (end stage renal failure)
→ death

Question 24

How is AKI measured?

Answer 24

→ changes in creatinine

Question 25

If there is a problem with blood going into the kidney what is this called?

Answer 25

→ pre renal

Question 26

if there is a problem with the kidney what is this called?

Answer 26

→ renal

Question 27

If there is a problem with urine getting out what is this called?

Answer 27

→ post renal

Question 28

What are intrinsic renal causes?

Answer 28

→ Glomerular - glomerulonephritis - systemic disease → Tubular - acute tubular necrosis → Vascular and interstitial

Question 29

What are the 3 kidney compartments?

Answer 29

→ vascular → tubulointerstitial → glomerular

Question 30

What are 3 tubulointerstitial diseases?

Answer 30

→ acute tubular injury → acute tubulointerstitial nephritis → chronic tubulointerstitial nephritis

Question 31

What does it mean if the bleeding is in the urinary tract?

Answer 31

→ a symptom of cancer

Question 32

What are the two ways that the glomerulus can fail?

Answer 32

→ Filter things it shouldn't | →Not filter things it needs to filter (reduced GFR)

Question 33

What is nephrotic syndrome?

Answer 33

→ Heavy proteinuria → hypoalbuminaemia → Oedema (result of hypoalbuminaemia) → frothy urine

Question 34

What is nephritic syndrome?

Answer 34

→ Both filter failures → Abrupt onset → reduced GFR →blood and protein in urine

Question 35

What are asymptomatic urine abnormalities and what is important in it?

Answer 35

→ blood or protein in urine | → IgA nephropathy is important

Question 36

What is rapidly progressive glomerular nephritis?

Answer 36

→ both modes of filter failure | → Weeks or months

Question 37

What is a cause of nephritic syndrome?

Answer 37

→ Post-streptococcal GN

Question 38

What are three causes of rapidly progressive GN?

Answer 38

→ Goodpasture disease | → ANCA (small vessel anti neutrophil cytoplasm antibody)

Question 39

What is the first stage in AKI management?

Answer 39

→ Correct pre-renal factors | → Relieve obstruction

Question 40

What is the second stage in AKI management?

Answer 40

→ Maintain fluid and electrolyte balance → Nutrition → Gastric protection

Question 41

What are three effects that indicate dialysis may be needed?

Answer 41

→ Oedema (pulmonary) | → Hyperkalaemia

Question 42

By what amount is your risk of cardiovascular mortality increased by when on dialysis?

Answer 42

→ 300 -400 x

Question 43

What is CKD a marker of?

Answer 43

→ cardiovascular risk

Question 44

How is CKD treated?

Answer 44

→ Treating endocrine issues → Ca2+, PO4, Vitamin D, PO4 binders, alfacalcidol → IV Fe and erythropoeitin

Question 45

What are the three options for end stage renal failure?

Answer 45

→ Dialysis → Transplantation → Conservative management

Question 46

What are the two forms of dialysis?

Answer 46

→ Haemodialysis | → Peritoneal fluid

Question 47

What are 2 types of donors?

Answer 47

→ brain death | → cardiac death