renal 1 + 2

Question 1

how are renal diseases classified?

Answer 1

pre-renal, renal and post-renal

Question 2

what are the two classifications of renal dysfunction?

Answer 2

• Acute :–Rapidly Progressive (within hours)–Process is reversible
• Chronic:–Irreversible loss of renal function; affects all organ system–Progressing to end-stage renal failure(over months or years)

Question 3

define renal insufficiency

Answer 3

Decline in renal function to about 25% of normal or GFR of 25 to 30 ml/min
•Levels of serum creatinine and urea mildly elevated

Question 4

define renal failure

Answer 4

• Significant loss of renal function

* When less than 10% remains End stage renal failure (ESRF)

Question 5

define uremia

Answer 5

• Syndrome of renal failure
• Elevated blood urea & creatinine levelaccompanied by fatigue, anorexia, nausea,vomiting , pruritus & neurological changes
• Due to–Retention of toxic waste–Deficiency state / Electrolyte disorders

Question 6

define Azotemia

Answer 6

• Increased serum levels; Frequently increased creatinine

* Renal insufficiency / failure cause azotemia

Question 7

what do Azotemia and Uremia have in common

Answer 7

Accumulation of nitrogenous waste products in blood

Question 8

what is acute kidney injury (AKI)?

Answer 8

Abrupt (within hours) reduction in renal function

Question 9

AKI is associated with Oliguria, what is this?

Answer 9

passing small volume of urine - less than 30ml/hr or less than 400ml/day

Question 10

how is the diagnosis of AKI confirmed?

Answer 10

confirmed when blood test reveal–High conc. of Urea(BUN- blood Urea Nitrogen)and Creatinine- not being excreted

Question 11

what does biochemical testing of AKI reveal?

Answer 11

Metabolic acidosis due to inability to excrete hydrogen ion

–Hyperkalaemia due to impaired excretion of K+ ion

Question 12

what does BUN stand for and what is it?

Answer 12

Blood Urea Nitrogen-Urea produced by breakdown of amino acids

Question 13

what is the normal range of BUN?

Answer 13

2.5-6.6mmol/L (15-40 mg/ dL)

Question 14

what happens if the GFR decreases to renal disease or blockage/ decreased blood flow to kidney?

Answer 14

BUN increases

Question 15

what is Creatinine?

Answer 15

is an end product of muscle metabolism

Muscle mass is constant; creatinine is constant

Question 16

what is the normal levels of creatine in the blood?

Answer 16

–Male : 64 -111μmol/L(0.72 –1.26 mg/ dL)

–Female: 50 -98 μmol/L (0.57-1.11 mg/dL)

Question 17

is creatine reabsorbed?

Answer 17

Creatinine is neither reabsorbed norsecreted, just freely filtered
.•Amount Excreted = Amount Filtered

Question 18

what does AKI result in?

Answer 18

Results in failure to maintain electrolyte and acid –base homeostasis

Question 19

what’s a common etiology of PRE-RENAL AKI?

Answer 19

decrease in renal perfusion through a decrease in effective extracellular volume.

Question 20

what is a common aetiology of intra-renal AKI?

Answer 20

Renal parenchymal injury

Question 21

what is a common aetiology of post-renal AKI?

Answer 21

Urinary tract obstruction

Question 22

what are the causes of pre-renal failure?

Answer 22

decrease in extracellular volume

Altered renal vascular regulation

Question 23

what causes a decrease in extracellular volume?

Answer 23

hypovolaemia
decrease in cardiac output
Systemic dilatation

Question 24

what causes altered renal vascular regulation?

Answer 24

Afferent arteriolar vasodilation (Prostaglandins)(preglomerular following cause inhibition
Efferent arteriolar constriction (Angiotensin II)(postglomerular following cause inhibition)

Question 25

what are examples of intra-renal failure?

Answer 25

• Acute tubular necrosis
• Glomerulopathies
• Malignant Hypertension
• Coagulation defects
• Bilateral acute pyelonephritis
• Renal artery/vein occlusion
• Allograft rejection
• Drug allergy
• Infection
• Tumour growth

Question 26

what are some causes of post-renal failure?

Answer 26

Results from obstruction of the urinary tract
•Urinary stones
•Prostatic hypertrophy
•Blood clots
•Neoplasms
•Unusual for drugs