Overview Of Renal Diseases Flashcards
What age does GFR start to decrease and how fast does it decrease?
Age 40, 1 ml per year
How can you measure kidney function?
Blood tests (creatinine or formula)
Urine output
Elimination of radioisotopes
Why is creatinine a good measure of GFR?
Produced in the body at steady rate
Small changes at good function-> large GFR changes
Why is urea not a great measure of GFR function?
Not reliable and levels may change for other reasons
What are the pre-renal causes of AKI?
Hypervolaemia (haemorrhage or volume depletion)
Hypotension (cardinogenic or septic shock)
Renal hypoperfusion/ vasoconstriction (NSAIDs, ACE)
What are the types of intrinsic renal disease?
glomerular, tubular, vascular, interstitial, obstruction
What are the two types of glomerular renal disease?
Glomerulonephritis or systemic disease
Give an example of a tubular renal disease
Acute tubular necrosis
Give an example of an interstitial renal disease
Interstitial nephritis
What proportion of AKIs are caused by a prostatic obstruction?
25%
How can an obstructive uropathy be corrected?
Catheter or nephrostomy
When is the ideal time to start renal replacement therapy?
Once AKI is established and unavoidable but before overt complications have developed
What are the benefits of starting RRI early?
Avoids metabolic abnormalities and problems of volume overload
What are the risks with starting RRI early?
Exposes patient to potential venous thrombosis, bacteremia or haemorrhage for anticoagulants and some will recover before the need for treatment
What are the indications for needing acute dialysis?
Hyperkalaemia, severe acidosis, fluid overload and symptomatic uremia
What does symptomatic uremia include?
Pericarditis and encephalopathy
How can glomerular disease present?
Asymptomatic urinary abnormalities, CKD, nephrotic or nephritic syndrome
Where can a non-visible haematuria be found?
Anywhere in the renal tract
What can a non-visible haematuria be caused by?
UTI/ bladder carcinoma/ glomerulonephritis
What are the thresholds for nephrotic syndrome?
Albumin <30g/L
Proteinuria >3g/24hr
+/- oedema
What is the difference between nephrotic and nephritic?
Nephritic is nephrotic with an abrupt onset
What is the histology of nephrotic syndrome?
Severe inflammation and necrosis of the glomeruli and often glomerular crescent formation
What are the most common causes of kidney disease in the UK?
Diabetes, hypertension, CUD, glomerular disease, genetic
How many stages of CKD are there?
6- 1, 2, 3a, 3b, 4, 5
What are some risk factors for kidney decline?
Diabetes, hypertension, CVD, smoking, ethnicity, AKI, obesity, NSAIDs, untreated urinary outflow obstruction, proteinuria
What is the building block for most kidney treatments?
Blocking certain parts of the RAAS system
What changes do you see in a diabetic nephron?
Increased feedback from macula densa -> afferent vasodilation -> inc NaCl and glucose filtration -> increased NaCl and glucose reabsorption via SGLT2
What is the new class of drugs to improve onset of kidney failure?
SGLT2 inhibitors
What are the complications of declining GFR and ESRF?
Haematological, bone, CVS, immunological, malnutrition
What is used to correct renal anaemia?
Iron injections
What is the maximum conservative lane of ESRF treatment?
Do all other stuff apart from replacement renal therapy
When is dialysis inappropriate?
May have an unacceptable impact on quality of life, patient choice, imminent death, other issues
What are the three options for renal replacement therapy?
Haemodialysis, transplant, peritoneal dialysis
What are the two mechanisms of solute movement?
Diffusion or convection
When does diffusion occur?
Difference in solute concentration either side of the membrane
What is convection?
Movement of solute in association with water pressure
What is the basic process of haemodialysis?
Blood passes down one side of a highly permeable membrane
Water and solutes pass across the membrane
Infuse replacement solution with physiologic concentrations of electrolytes
How does peritoneal dialysis happen?
Pop a catheter into a persons abdomen and infuse dialysate fluid into it
What is fluid movement determined by in peritoneal dialysis?
Osmosis
Where can transplants come from?
Live or deceased donors
Where are transplanted kidneys placed and plumbed into?
Into the iliac fossa
External iliac artery and vein
