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P1: Ren > Overview of Renal Diseases > Flashcards

Overview of Renal Diseases Flashcards

1
Q

What are the 7 functions of the kidney?

A 
→ Excrete waste substances
→ Regulates minerals in extracellular fluid
→ Regulates water balance
→ RBC production
→ Blood pressure control
→ Vitamin D activation
→ acid base balance
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2
Q

How much blood passes through the glomeruli per day?

A

→ 2000

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3
Q

How much blood is filtered per day?

A

→ 200 L

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4
Q

What tests are used to measure kidney function?

A 
→ Blood tests
→ Creatinine
→ formulae
→ Urine output
→ Elimination of radioisotopes
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5
Q

What is creatinine and where is it produced?

A

→ biomarker for filtration of the glomerulus

→ skeletal muslce

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6
Q

What is asymptomatic proteinuria?

A

→ glomerular filter has become leaky

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7
Q

What is nephritic syndrome?

A

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

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8
Q

What is haematuria?

A

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

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9
Q

What is chronic kidney disease?

A

→ Reduction in GFR that gets worse over time

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10
Q

What does diabetes mellitus do to the kidney?

A

→ Chronic damage to kidney through high BP

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11
Q

What are pre renal causes of kidney disease?

A

→ hypovolaemia
→ Perfusion decreases
→ Drugs

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12
Q

How can hypovolaemia be caused?

A

→ Haemorrhage

→ Diarrhoea

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13
Q

Why does perfusion decrease?

A

→ Septic shock

→ Cardiac failure

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14
Q

How can drugs cause kidney disease?

A

→ Angiotensin converting inhibitors
→ NSAIDs
NSAIDs disrupt the compensatory vasodilation response of renal prostaglandins to vasoconstrictor hormones released by the body

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15
Q

How are glomerular diseases diagnosed?

A

→ Urine analysis

→ measures blood and protein

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16
Q

How is proteinuria quantified?

A

→ Urine albumin : creatinine ratio

→ Urine protein : creatinine ratio

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17
Q

What does glomerular bleeding lead to?

A

→ Red cell casts in the urine

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

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18
Q

How do dysmorphic erythrocytes form?

A

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

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19
Q

What do you need to distinguish between in glomerular disease?

A

→ primary and secondary

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20
Q

What is a post renal disease?

A

→ Acute kidney injury

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21
Q

What happens in acute kidney injury?

A

→ Fluid retention - lymphoedema leads to pulmonary oedema

→ Hyperkalaemia - high K+ leads to cardiac arrhythmias

22
Q

What are the consequences of acute kidney injury?

A 
→ 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
23
Q

What are the long term sequelae of acute kidney disease?

A

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

24
Q

How is AKI measured?

A

changes in creatinine

25
Q

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

A

→ pre renal

26
Q

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

A

→ renal

27
Q

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

A

→ post renal

28
Q

What are intrinsic renal causes?

A

→ Glomerular

  • glomerulonephritis
  • systemic disease

→ Tubular
- acute tubular necrosis

→ Vascular and interstitial

→Interstitial
Interstitial nephritis

29
Q

What are the 3 kidney compartments?

A

→ vascular
→ tubulointerstitial
→ glomerular

30
Q

What are 3 tubulointerstitial diseases?

A

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

31
Q

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

A

→ a symptom of cancer

32
Q

What are the two ways that the glomerulus can fail?

A

→ Filter things it shouldn’t

→Not filter things it needs to filter (reduced GFR)

33
Q

What is nephrotic syndrome?

A

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

34
Q

What are signs of nephritic syndrome?

A

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

35
Q

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

A

→ blood or protein in urine

→ IgA nephropathy is important

36
Q

What is rapidly progressive glomerular nephritis?

A

→ both modes of filter failure

→ Weeks or months

37
Q

What is a cause of nephritic syndrome?

A

→ Post-streptococcal GN

38
Q

What are three causes of rapidly progressive GN?

A

→ Goodpasture disease

→ ANCA (small vessel anti neutrophil cytoplasm antibody)

39
Q

What is the first stage in AKI management?

A

→ Correct pre-renal factors

→ Relieve obstruction

40
Q

What is the second stage in AKI management?

A

→ Maintain fluid and electrolyte balance
→ Nutrition
→ Gastric protection

41
Q

What are the effects that indicate dialysis may be needed?

A

→ Oedema (pulmonary)

→ Hyperkalaemia

42
Q

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

A

→ 300 -400 x

43
Q

What is CKD a marker of?

A

→ cardiovascular risk

44
Q

How is CKD treated?

A

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

45
Q

What are the three options for end stage renal failure?

A

→ Dialysis
→ Transplantation
→ Conservative management

46
Q

What are the two forms of dialysis?

A

→ Haemodialysis

→ Peritoneal fluid

47
Q

What are 2 types of donors?

A

→ brain death

→ cardiac death

48
Q

What should be considered when deciding what time to start RRT?

A

Avoids: metabolic abnormalities
and problems of volume overload

Exposes patient to potential of: Venous thrombosis →Bacteraemia
→Haemorrhage from anticoagulants

49
Q

What is obstructive uropathy?

A

→Prostatic obstruction causes 25% of AKI
→Single remaining kidneys at high risk
→Can still produce significant amounts of urine
→Delay in correction (catheter or nephrostomy) compromises renal function permanently

50
Q

Indications for acute dialysis…

A 
→Hyperkalaemia refractory to medical therapy
K+	> 6.5 with ECG changes
→Severe Acidosis	pH < 7.25, HCO3 <15
→Fluid overload
despite high-dose furosemide	appropriate
→Symptomatic uraemia: urea > 35
Pericarditis, encephalopathy
51
Q

Describe peritoneal dialysis

A

→Peritoneum used as the membrane
Solute and water exchange between peritoneal capillary blood and dialysate fluid
→Membrane= vascular wall, interstitium, mesothelium and adjacent fluid films
→Small molecules transfer by diffusion
Fluid movement determined by osmosis
→Dialysate dextrose concentration
Solvent drag for middle sized molecule

52
Q

Describe haemodialysis

A

Blood passes down one side of a highly permeable membrane
→Water and solutes pass across the
membrane
→Solutes up to 20,000 daltons
Drugs & electrolytes
→Infuse replacement solution with physiologic concentrations of electrolytes

P1: Ren (13 decks)

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