Overview of Renal Diseases Flashcards
What are the functions of the kidneys?
Excretes waste substances Important for acid base balance Vitamin D activation BP control RBC production Helps regulate water balance Regulates mineral in ECF
How much fluid is filtered through the glomerulus in a day?
~2000 L of blood through glomeruli per day
How can we measure the efficiency of kidney function?
Blood tests - Creatinine - Formulae Urine output Elimination of radioisotypes
Name renal syndromes leading to kidney disease
Asymptomatic pneumonia Nephritic syndrome Acute kidney injury Chronic kidney disease Haematuria Nephrotic syndrome
Why is renal disease so significant?
A single disease can manifest in several different syndromes Accelerated hypertension Acute kidney injury Vasculitis Amyloidosis Lupus Diabetes mellitus Bacterial endocarditis IgA nephropathy Membranous nephropathy
Why are biopsy’s used to determine disease?
Kidney biopsy provides a histological description which is compatible with a clinical condition and then may direct specific treatments
What are the pre-renal causes of disease?
Hypovolemia
↓Perfusion
Drugs
What causes hypovolemia?
Haemorrhage
Diarrhoea/vomiting
What causes decreased perfusion to the kidneys?
Septic shock
Cardiac failure
Which drugs contribute to renal disease?
Angiotensin converting inhibitors (ACEi)
Non steroidal anti-inflammatory drugs
What are the intrinsic renal diseases?
Interstitial nephritis
Acute tubular necrosis
Glomerulonephritis
Systemic disease (glomerulus)
How are glomerular diseases identified?
urine analysis (blood & proteins)
Red cell casts
Glomerulus / dysmorphic erythrocytes
How is proteinuria measured?
Proteinuria quantified by:
Urine albumin : creatinine ratio
Urine protein : creatinine ratio
What post renal causes for kidney disease?
Acute Kidney Injury (AKI
Fluid retention
Hyperkalaemia
Explain the occurence of AKI
18% hospital admissions
20-30% of cases may be preventable
What is the consequence of hyperkalemia systemically?
High potassium can lead to cardiac arrhythmias
What are the consequences of AKI?
Patient morbidity:
acute complications
dysfunction of other organs
risk of CKD
How can we treat renal failure?
RRT - renal replacement therapy
What is the occurrence of Kidney disease in the UK?
4.9% of UK population likely to have chronic kidney disease stage 3 or worse
What is the major consequence of Chronic Kidney disease (CKD?)
Chronic Kidney Disease (CKD) has become recognised as a potent marker of cardiovascular risk - leads to atherosclerosis
What is uremia?
complication of CKD - aka. acute renal failure
What are the uremia related CVS risk factors?
Increased ECF volume Calcification Parathyroid hormone Anemia Oxidant stress Malnutrition Pulse pressure Sleep disorders Inflammation (c-reactive protein)
What are the coronary risk factors of cardiovascular disease?
Hypertension High LDL / HDL cholesterol Smoking Diabetes Older age Physical inactivity Menopause
How can we treat uremia?
Supportive care
- General measures
- Dialysis
- Transplantation
Treatment of underlying condition
How can we tackle chronic renal failure?
Conservative
- slow progression
- minimise symptoms/complications
Control Na+, water, BP
Diet (K+, phosphate, {protein})
Vitamin D (1-alpha)
ErythropoetinWhat are the functions of dialysis?
Removes nitrogenous wastes
Corrects electrolytes
Removes water
Correct acid base abnormalities
What is the survival rate of a kidney transplant?
50% survival rate
What are the criteria for a living kidney donor?
Pre-emptive (may rarely be deceased donor) Related (biological, emotional, social) Kidney sharing scheme Altruistic ABO/HLA incompatible
