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Kidneys > Physiology 4 > Flashcards

Physiology 4 Flashcards

1
Q

What is acute renal failure?

A

Occurring suddenly eg one or several days.

Stop urinating for a period of 24 hours

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2
Q

Is ARF reversible?

A

ARF is often reversible The longer it lasts…less likely is recovery

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3
Q

What is consistent about chronic renal failure?

A

It always has the same specific gravity of plasma

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4
Q

What is CRF?

A

A reduction in GFR - it is considered significant it is less than 50ml/min =

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5
Q

Is the degree of tubular impairment fixed or rlative?

A

The degree of tubular impairment relative to filtration impairment is highly variable…… from “glomerular” disease to “tubular” disease

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6
Q

what happens when there is a loss of GFR?

A

Loss of GFR is invariably accompanied by impairment in tubular processes; reabsorption and secretion

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7
Q

What are the most important endocrine dysfunction which occurs in renal failure?

A

RAS
Vit D
Erythropoeitin

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8
Q

Is urea a good guide to GFR?

A

No its a poor guide

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9
Q

How much urea is absorbed?

A

50% - variable

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10
Q

Where does urea come from?

A

Protein

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11
Q

When are urea levels up?

A

Elevated in numerous situations other than CRF! Eg catabolic states, steroid Rx

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12
Q

When are urea levels down?

A

Malnutrition

Liver disease

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13
Q

How is GFR measured?

A

Creatinine Clearance = UV/P = GFR

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14
Q

Why is creatinine used as a measure of GFR?

A

1 Creatinine production is constant
2 Filtered, but 15% bound to plasma proteins (underestimates GFR)
3 Not reabsorbed
4 Small amount of secretion (overestimates GFR)
5 (2) and (4) tend to cancel out

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15
Q

What are the normal creatinine levels?

A

50-120 µM/L

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16
Q

Why is a baseline creatinine important?

A

It should stay the same, if it rises then GFR is falling

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17
Q

What happens when nephrons are destroyed?

A

The remaining nephrons tend to filter more. This tends to worsen the failure (i.e. it puts more pressure on the remaining nephrons)

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18
Q

What are the types of acute renal failure?

A
  • Pre-renal
  • Renal
  • Post-renal
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19
Q

What causes pre-renal ARF?

A

If the MAP drops far enough the GFR will drop and urine output will be insufficient.

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20
Q

What is olguria?

A

Is the low output of urine

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21
Q

What is anuria?

A

No urine output

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22
Q

What is rhabdomyolysis?

A

Leads to leakage of enough products into the urine which were not present

23
Q

What are the specific causes of pre-renal ARF?

A

Shock
Sepsis
Haemolysis Rhabdomyolysis
Nephrotoxic drugs

24
Q

What is the most common nephrotoxic drug?

A

Gentomycin

25
Q

What is acute tubular nephritis?

A

ARF not due to volume depletion

26
Q

What Intrinsic acute renal failure

A

Glomerular disease
Interstitial nephritis (Tubulo-interstitial)
Tubular damage

27
Q

What are the specific causes of tubular damage?

A

Ischemia

Toxins

28
Q

What are the specific causes of interstitial nephritis?

A

Inflammatory reaction, often drug-related

29
Q

What is the most common cause of ARF?

A

Acute tubular necrosis

30
Q

What is the major concern of someone with Acute tubular necrosis?

A

acidosis and ↑K+

31
Q

What is post-renal acute renal failure?

A

Outlet Obstruction
– Ureteric, cystic or urethral
– stones, clots, fibrosis, tumors

32
Q

What is chronic renal failure?

A

Irreversible loss of renal function • Reduction in functional renal mass • Develops over months to years (highly variable rates of decline)

33
Q

What is another name for chronic renal failure?

A

uraemia

34
Q

What happens to nephrons in CRF?

A

Remaining nephrons hypertrophy

Glomerular hyperfiltration
– loss of functional reserve
– glomerular hypertension
– further damage and glomerulosclerosis

35
Q

What happens to the fluid in CRF?

A

The leaves the nephron largely unchanged

36
Q

What can happen to people with CRF?

A

Are susceptible to both dehydration and hypertension if their water and salt intake adjusts

37
Q

What are the symptoms of uremia?

A

– Fatigue
– Loss of appetite
– Skin pigmentation (lemon)

38
Q

What causes skin pigmentation?

A

Crystallisation of urea on the skin surface

39
Q

What are the causes of CRF?

A
  • Diabetes
  • High blood pressure
  • Chronic glomerulonephritis
  • Cystic disease (poly-cystic kidney disease)
40
Q

What is uremia?

A

Accumulation of “uremic” toxins

• Mostly urea

41
Q

When is uremia symptomatic?

A

Symptomatic with less than 30% of normal renal function

42
Q

What are the salt and water imbalances observed in CRF predominantly of the glomerulus?

A

Sodium retention and hypertension

43
Q

What are the salt and water imbalances observed in CRF predominantly of the tubules?

A

– Sodium wasting and low BP

– Impaired concentrating ability & polyuria

44
Q

What happens to K in CRF?

A

Tends to rise, esp late-stage (not as fast as ARF)

– Higher in diabetes

45
Q

What happens to pH in CRF?

A

falls i.e. H+ accumulates; failure to excrete non-volatile acids • Produced at high rate in normal metabolism • Excretion requires high GFR • reduced ammonia production • low [HCO3-]

46
Q

What happens to phosphate when GFR falls?

A

Reduced phosphate excretion
Tubular capacity to reabsorb stays the same concentration secreted reduced which results in a slow rise in [PO4]
Reciprocal reduction in [Ca]

47
Q

How is phosphate excreted?

A

Sodium and Phosphate co-transporter

48
Q

What does [PO4] signal?

A

Parathyroid —

49
Q

What happens when there is low vit D?

A

Reduced renal mass and Vit D activation
– Hyperphosphatemia
– Renal “rickets”: osteomalacia with fractures and subperiosteal resorption

50
Q

What causes secondary hyperparathyriodism?

A

Excessive secretion of parathyroid hormone (PTH) by the parathyroid glands in response to hypocalcemia

51
Q

What affect does 2nd degree have on bone?

A

hyperparathyroidis (excessive osteoclastic activity)

52
Q

What is osteomalacia?

A

Osteomalacia refers to a softening of your bones, often caused by a vitamin D deficiency

53
Q

What are the symptoms of uremia?

A

Fatigue
Loss of appetite
Skin pigmentation (lemon)

54
Q

What are some common causes of CRF?

A
  • Diabetes
  • High blood pressure
  • Chronic glomerulonephritis
  • Cystic disease

Kidneys (15 decks)

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