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Kidneys > Overview of renal diseases > Flashcards

Overview of renal diseases Flashcards

1
Q

What are the functions of the kidney?

A
  • Excretes waste substances
  • Important for acid/base balance
  • Vitamin D activation
  • Blood pressure control
  • Red blood cell production
  • Helps regulate water balance
  • Regulates minerals in extracellular fluid
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2
Q

How do we measure kidney function?

A
  • Blood tests
    • Creatinine
    • Formulae
  • Urine output
  • Elimination of radioisotopes
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3
Q

Why is the hormone that increases blood production in the kidney?

A

because there is a lot of blood flow to the kidney

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4
Q

What do people who have kidney failure therefore also suffer from?

A
  • Vitamin D deficiency

- problems with calcium and phosphate metabolism

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5
Q

Why is creatinine used to measure kidney function?

A
  • creatinine is a biomarker for the filtration of the kidney: it is a metabolic by-product of skeletal muscle (therefore muscle mass needs to be taken into consideration)
  • As GFR falls (due to kidney failure), you secrete less creatinine
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6
Q

In what situations does the GFR need to be measured and not estimated?

A
  • Kidney donor: if you take one kidney away, there needs to be enough function in the other kidney to allow the body to function properly, and to see if the kidney is a good enough donor)
  • Cancer patient using chemotherapeutic drugs: there is a very narrow therapeautic index, so need to work out the dosing (how they are cleared from the kidney)
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7
Q

How is GFR estimated using the CKD-EPI equation?

A

GFR = 141 * min (Serum_Creat/kappa, 1) alpha * max (Serum_Creat/kappa, 1) ^ -1.209 * 0.993 ^ Age * Sex * Race (White or other: 1, Black: 1.159)

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8
Q

What are the values used for females when estimating GFR using the CKD-EPI equation?

A 
Sex= 1.018 
alpha= -0.411
kappa= 0.9
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9
Q

What are the values used for males when estimating GFR using the CKD-EPI equation?

A 
Sex= 1
alpha= -0.411
kappa= 0.9
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10
Q

What limitations need to be taken into consideration when estimating GFR?

A
  • Other ethnicities
  • Extremes muscle mass
  • changing GFR
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11
Q

List some presentations of kidney disease: ‘renal syndromes’

A
  • NephrItic syndrome
  • Acute kidney injury
  • Chronic kidney disease
  • Haematuria
  • NephrOtic syndrome
  • Asymptomatic proteinuria
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12
Q

What is nephrItic syndrome?

A

Inflammatory condition in the glomerulus:

  • patient has RBC in the urine
  • they become hypertensive
  • GFR falls: leading to kidney failure
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13
Q

What is nephrOtic syndrome?

A

Glomerular filtrate becomes very leaky:

  • lots of protein in the urine: lowers serum albumin
  • so there is a lowered osmotic and oncotic pressure: fluid leaks out of the periphery: peripheral odema
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14
Q

What is Haematuria?

A

Blood in the urine due to bleeding anywhere in the urinary tract- can be due to kidney stones & infection

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15
Q

How can acute kidney injury arise?

A

Kidney was working well and suddenly something happens and it dosen’t work well

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16
Q

What is chronic kidney disease?

A

Chronic decrease in GFR and this worsens over time

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17
Q

By what means can a single disease manifest?

A

In several different syndromes

18
Q

List some syndromes that kidney disease can arise from?

A
  • Accelerated hypertension
  • Acute kidney injury
  • Vasculitis
  • Amyloidosis
  • Membranous nephropathy
  • IgA nephropathy
  • Bacterial endocarditis
  • Diabetes mellitus
  • Lupus
19
Q

What can a kidney biopsy provide?

A

A histological description which is compatible with a clinical condition and then may direct specific treatments

20
Q

How is membranous nephropathy presented and what symptoms does it involve?

A

Usually presents as nephrotic syndrome, but can also have blood in the urine

21
Q

How is IgA nephropathy presented and what symptoms does it involve?

A

Usually presented as nephritic syndrome, hypertension in the blood and kidney failure

22
Q

What is bacterial endoocarditis?

A

Chronic infection in the heart valves, results in complex disposition in the kidney
~ presented as nephritic syndrome

23
Q

Effect of diabetes on the kidney?

A

Chronic damage to the kidney due to high blood sugae

24
Q

How is Lupus categorized?

A

Nephritic

25
Q

How is Amyloidosis categorised?

A

Nephrotic

26
Q

How is Vasculitis categorised?

A

Nephritic

27
Q

How is Acute kidney injury categorised?

A

Oliguria or no urine

28
Q

How is accelerated hypertension categorised?

A

Systemic problem, e.g. vasculitis with nephritic syndrome

29
Q

What does a kidney biopsy provide?

A

A histological description which is compatible with a clinical condition and then may direct specific treatments

30
Q

Describe approaches to renal disease

A

see table in notes

31
Q

Use a graph to describe levels of serum creatinine that indicate the severity of different types of kidney disease

A

see notes

32
Q

What % of Acute Kidney Injuries is affected in emergency admissions?

A

20%

33
Q

What % of AKI may be preventable?

A

20-30%

34
Q

What is the % mortality ration AKI?

A

25-40%

-even minor increases in Cr results in increases in mortality

35
Q

Pre-renal causes of kidney disease

A

Not delivering enough blood to the kidney, intrinsic kidney disease

36
Q

Post-renal causes of kidney disease

A

Blockage in the kidney: urine not leaving

37
Q

List 3 pre-renal causes

A
  1. Hypovolaemia
  2. Decreased perfusion
  3. Drugs
38
Q

Hypovolaemia

A
  • most common pre-renal cause
  • symptoms:
  • haemorrhage
  • diarrhoea/vomiting
39
Q

Decreased perfusion

A
  • kidney is the most susceptible to ischaemic damage ~ kidney makes erythropoietin from the start
  • Parts of the tubule are borderline hypoxic, so if the kidney is under perfused, then there will be some kidney damage
  • symptoms:
  • septic shock
  • cardiac failure
40
Q

Septic shock

A

is a serious medical condition that occurs when sepsis, which is organ injury or damage in response to infection, leads to dangerously low blood pressure and abnormalities in cellular metabolism.

41
Q

Drugs as a pre-renal cause

A

Some drugs interfere with the homeostatic mechanisms that protect the kidney from being under perfused

  • Angiotensin converting inhibitors
  • Non steroidal anti-inflammatory drugs, e.g. ibroprofen

Kidneys (6 decks)

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