Overview Of Renal Diseases

Question 1

What age does GFR start to decrease and how fast does it decrease?

Answer 1

Age 40, 1 ml per year

Question 2

How can you measure kidney function?

Answer 2

Blood tests (creatinine or formula)
Urine output
Elimination of radioisotopes

Question 3

Why is creatinine a good measure of GFR?

Answer 3

Produced in the body at steady rate

Small changes at good function-> large GFR changes

Question 4

Why is urea not a great measure of GFR function?

Answer 4

Not reliable and levels may change for other reasons

Question 5

What are the pre-renal causes of AKI?

Answer 5

Hypervolaemia (haemorrhage or volume depletion)
Hypotension (cardinogenic or septic shock)
Renal hypoperfusion/ vasoconstriction (NSAIDs, ACE)

Question 6

What are the types of intrinsic renal disease?

Answer 6

glomerular, tubular, vascular, interstitial, obstruction

Question 7

What are the two types of glomerular renal disease?

Answer 7

Glomerulonephritis or systemic disease

Question 8

Give an example of a tubular renal disease

Answer 8

Acute tubular necrosis

Question 9

Give an example of an interstitial renal disease

Answer 9

Interstitial nephritis

Question 10

What proportion of AKIs are caused by a prostatic obstruction?

Answer 10

25%

Question 11

How can an obstructive uropathy be corrected?

Answer 11

Catheter or nephrostomy

Question 12

When is the ideal time to start renal replacement therapy?

Answer 12

Once AKI is established and unavoidable but before overt complications have developed

Question 13

What are the benefits of starting RRI early?

Answer 13

Avoids metabolic abnormalities and problems of volume overload

Question 14

What are the risks with starting RRI early?

Answer 14

Exposes patient to potential venous thrombosis, bacteremia or haemorrhage for anticoagulants and some will recover before the need for treatment

Question 15

What are the indications for needing acute dialysis?

Answer 15

Hyperkalaemia, severe acidosis, fluid overload and symptomatic uremia

Question 16

What does symptomatic uremia include?

Answer 16

Pericarditis and encephalopathy

Question 17

How can glomerular disease present?

Answer 17

Asymptomatic urinary abnormalities, CKD, nephrotic or nephritic syndrome

Question 18

Where can a non-visible haematuria be found?

Answer 18

Anywhere in the renal tract

Question 19

What can a non-visible haematuria be caused by?

Answer 19

UTI/ bladder carcinoma/ glomerulonephritis

Question 20

What are the thresholds for nephrotic syndrome?

Answer 20

Albumin <30g/L
Proteinuria >3g/24hr
+/- oedema

Question 21

What is the difference between nephrotic and nephritic?

Answer 21

Nephritic is nephrotic with an abrupt onset

Question 22

What is the histology of nephrotic syndrome?

Answer 22

Severe inflammation and necrosis of the glomeruli and often glomerular crescent formation

Question 23

What are the most common causes of kidney disease in the UK?

Answer 23

Diabetes, hypertension, CUD, glomerular disease, genetic

Question 24

How many stages of CKD are there?

Answer 24

6- 1, 2, 3a, 3b, 4, 5

Question 25

What are some risk factors for kidney decline?

Answer 25

Diabetes, hypertension, CVD, smoking, ethnicity, AKI, obesity, NSAIDs, untreated urinary outflow obstruction, proteinuria

Question 26

What is the building block for most kidney treatments?

Answer 26

Blocking certain parts of the RAAS system

Question 27

What changes do you see in a diabetic nephron?

Answer 27

Increased feedback from macula densa -> afferent vasodilation -> inc NaCl and glucose filtration -> increased NaCl and glucose reabsorption via SGLT2

Question 28

What is the new class of drugs to improve onset of kidney failure?

Answer 28

SGLT2 inhibitors

Question 29

What are the complications of declining GFR and ESRF?

Answer 29

Haematological, bone, CVS, immunological, malnutrition

Question 30

What is used to correct renal anaemia?

Answer 30

Iron injections

Question 31

What is the maximum conservative lane of ESRF treatment?

Answer 31

Do all other stuff apart from replacement renal therapy

Question 32

When is dialysis inappropriate?

Answer 32

May have an unacceptable impact on quality of life, patient choice, imminent death, other issues

Question 33

What are the three options for renal replacement therapy?

Answer 33

Haemodialysis, transplant, peritoneal dialysis

Question 34

What are the two mechanisms of solute movement?

Answer 34

Diffusion or convection

Question 35

When does diffusion occur?

Answer 35

Difference in solute concentration either side of the membrane

Question 36

What is convection?

Answer 36

Movement of solute in association with water pressure

Question 37

What is the basic process of haemodialysis?

Answer 37

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

Question 38

How does peritoneal dialysis happen?

Answer 38

Pop a catheter into a persons abdomen and infuse dialysate fluid into it

Question 39

What is fluid movement determined by in peritoneal dialysis?

Answer 39

Osmosis

Question 40

Where can transplants come from?

Answer 40

Live or deceased donors

Question 41

Where are transplanted kidneys placed and plumbed into?

Answer 41

Into the iliac fossa | External iliac artery and vein