Overview Of Renal Diseases Flashcards
What are the functions of the kidney?
excreted waste substances
important for acid-base balance
Vit D activation
blood pressure control
red blood cell production
helps regulate water balance
regulates minerals in extracellular fluid
How do we measure kidney function?
blood tests (such as creatinine)
urine output
elimination of radioisotopes
List some renal syndromes.
asymptomatic proteinuria
nephrotic syndrome
nephritic syndrome
haematuria
acute kidney injury
chronic kidney disease
Why is a kidney biopsy helpful?
A single disease can manifest in several different syndromes.
A kidney biopsy provides a histological description which is compatible with a clinical condition and then may direct specific treatments.
What are some prerenal causes of kidney disease?
HYPOVOLAEMIA:
haemorrhage
diarrhoea/ vomiting
DECREASED PERFUSION:
septic shock
cardiac failure
DRUGS:
ACE inhibitors
non-steroidal anti-inflammatory drugs
List some intrinsic renal diseases based on where they manifest.
GLOMERULAR:
glomerulonephritis
systemic disease
TUBULAR:
- acute tubular necrosis
INTERSTITIAL:
- interstitial nephritis
What are some principles of glomerular disease?
you have to distinguish between the primary and secondary disease
whether it is primary or secondary, or if there’s a limited response to injury to the kidney
we consider the primary under headings of a clinical syndrome, histopathology, and pathogenesis
it is a difficult subject since there is often no good clinicopathological correlation, the terminology is hard, and there is the ignorance of pathogenesis in many cases
What are the consequences of AKI?
there’s a significant impact on the outcome (hospital mortality/ post-discharge mortality)
it’s a drain on resources (length of stay in the ICU/ hospital, referrals, tests, treatment, etc.)
it affects patient morbidity (with acute complications, disfunction of other organs, risk of CKD)
How would you treat renal disease?
With supportive care, you would take general measures, such as dialysis, transplantation, etc.
You would also have to treat the underlying condition.
Describe chronic renal management.
it’s conservative, with slow progression, to minimise symptoms and complication
we control Na+, water, BP
regulate the diet (K+, phosphate, [protein])
Vitamin D (1-α)
erythropoietin
What does dialysis achieve?
it removes nitrogenous wastes
it corrects electrolytes
it removes water
it corrects acid-base abnormalities
List the different types of donors for transplantations.
deceased donor (brain death - DBD)
deceased donor (cardiac death - DCD)
living donor:
pre-emptive (may rarely be a deceased owner)
related (biological, emotional, social)
kidney sharing scheme
altruistic
ABO/HLA incompatible
List the order of events that would occur if it was found that a patient had low eGFR?
measure GFR
is there blood/protein in the urine?
is this intrinsic renal disease?
what is the tempo of the disease?
what is the kidney size?
perform biopsy
provide general and specific treatments
manage consequences of poor eGFR (such as Vit D deficiency, lack of erythropoietin, dialysis, transplantation, conservative, etc.)
List the different ways in which we can measure kidney function, from the most accurate to the least accurate.
Inulin (continuous infusion technique)
Inulin (single bolus method), EDTA, iohexol
125l-iothalamate, DTPA
3-hour creatinine clearance with cimetidine
estimated glomerular filtration rate (MDRD)
estimates glomerular filtration rate (Cockcroft and Gault)
serum cystatin C
serum creatinine
24-hour creatinine clearance
List some uremia-related cardiovascular risk factors.
-increased ECF volume
-calcification and calcium/phosphorus
-parathyroid hormone
-anaemia
-oxidant stress
-malnutrition
-pulse pressure
-triglycerides
-lipoprotein remnants
-lp (a)
-homocysteine
-thrombogenic factors
-inflammation (C-reactive protein)
-sleep disorders
List some traditional coronary risk factors (Framingham).
hypertension
high LDL cholesterol
low HDL cholesterol
smoking
diabetes
older age
male
white
physical inactivity
menopauses
LVH (left ventricular hypertrophy)
