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
