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T year lectures > Renal > Flashcards

Renal Flashcards

1
Q

At what vertebral level do the kidneys sit?

A

T12-L3

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2
Q

what size are the kidneys?

A

10-12cm

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3
Q

What is the mesangial of the kidney?

A

In the glomerular capillary loop with contractile properties

- nucleated

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4
Q

What is a secondary glomerular disease?

A

A systemic disease that involves the glomerulus such as diabetes, lupus or myeloma

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5
Q

What are examples of primary glomerular diseases?

A

Nephrotic syndrome
Nephritic syndrome
CKD

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6
Q

what is the triad seen in nephrotic syndrome?

A

Heavy proteinurea (>3,5gm/day)
Hypoalbuminaemia (<30g/L)
Oedema

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7
Q

Other than the main three (Proteinuria, hypoalbumininaemia and oedema) what are other signs of nephrotic syndrome?

A

frothy urine, hypercoagubility, hypercholesterolaemia

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8
Q

what are the main three illnesses that cause nephrotic syndrome?

A

Minimal change disease

Membranous nephropathy

focal segmental glomerulosclerosis

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9
Q

What Is seen in minimal change disease inside the kidneys?

A

podocyte foot process effacement

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10
Q

what is seen inside the kidney in membranous nephropathy?

A

Inflammation and thickening of the glomerular basement membrane and immune deposits.

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11
Q

what is the onset for nephritic syndrome?

A

An abrupt onset of days

onset for nephrotic syndrome is longer

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12
Q

what is a classic cause of nephritic syndrome?

A

Post streptococcal GN

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13
Q

what is seen in nephritic syndrome?

A

Haematuria, proteinuria, oedema, hypertension

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14
Q

what is rapidly progressive glomerulonephritis?

A

Similar to nephritis but over weeks and months

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15
Q

what are the three main groups of rapidly progressive glomerulonephritis?

A
  1. antiglomerular basement membrane (goodpasture disease) often get pulmonary haemorrhage and poor prognosis
  2. small vessel ANCA positive vasculitis
  3. miscellaneous conditions; damage; fibrin in bowmans space
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16
Q

what is the primary site for reabsorption of filtered nutrients?

A

PCT

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17
Q

in brief what is fanconis syndrome?

A

inadequate reabsorption in the PCT

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18
Q

what substances can cause acute tubular injury?

A

gentamicin, heavy metals, mercury, CCL4.

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19
Q

what are non infectious causes of tubulointerstitual nephritis?

A

Gentamicin, penicillin, allopurinol and sarcoidosis

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20
Q

what are infectious causes of tubulointerstitual nephritis?

A

pyelonephritis, TB, legionella, CMV

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21
Q

what is the pathology behind acute interstitial nephritis?

A
  • interstitial oedema- infiltration by inflammatory cells (eosinophils and granulomas), tubular injury but a normal glomeruli.
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22
Q

what is the cause of anaemia in CKD?

A

Low EPO

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23
Q

what happens to calcium levels in CKD?

A

Fall

24
Q

Why do PTH Levels rise in CKD?

A

Low calcium levels

25
Q

what form of vit D therapy is appropriate in advanced CKD?

A

1,25 (OH) vit D

26
Q

what is the most common cause of death in kidney failure patients?

A

CVS

27
Q

what happens to acid base balance in patients with CKD?

A

acidosis due to low bicarbonate levels. normally carbonic anhydrase is used in the PCT to supply bicarbonate

28
Q

List some complications of CKD?

A
  • anaemia
  • mineral bone disease
  • CVS issues
  • malnutrition
29
Q

what is the definition of CKD?

A

A slow process over more than 3 months of inexorable attrition of nephron number and function due to multiple aetiologies frequently leading to end stage renal failure.

30
Q

what is the process occurring to the nephrons in CKD?

A

Fibrosis–> nephron sclerosis –> nephron loss –> hyperfunction of remaining nephrons due to TGF B

31
Q

what complications occurs occur at each stage of CKD?

A

Stage 2- increased CVS issues
stage 3- increased CVS, bone disease (high PTH)
Stage 4- increased CVS, anaemia, bone disease (low calcium and high phosphate)
stage 5- increased CVS, anaemia, bone disease, pruritus, bleeding, malnutrition

32
Q

what is the process of red blood cell formation?

A

pluripotent stem cell –> myeloid progenitor –> normoblast –> reticulocyte –> erythrocyte

33
Q

Other than being deficient in EPO what are other causes of anaemia in patients with CKD?

A
  • iron deficiency
  • hypothyroidism
  • active blood loss
  • hemoglobinopathies
  • haemolysis
  • hyperparathyroid
  • folic acid deficiency
  • vit B12 deficiency
34
Q

What is the management flow of anaemia in patients with CKD?

A
  1. Exclude other causes such as iron deficiency, vit B12 deficiency and blood loss
  2. EPO 30ug/week
  3. monitor Hb every 2 weeks
  4. adjust EPO 25% increase
  5. if Ferritin below 200 give IV iron
35
Q

what is the target haemoglobin and ferritin in patients with CKD?

A

Hb; 10.5-12 (slightly lower than normal target as getting it back to normal has no extra benefits and increased stroke risk)
Ferritin 200-500

36
Q

In anaemic CKD patients why can you not give oral iron?

A

hepcadin will prevent it being absorbed

37
Q

in patients with CKD what leads to increased calcium mobilisation from the bone?

A
  1. Low Vit D from the kidneys
  2. less calcium absorption
  3. PTH stimulated
  4. mobilisation of calcium from the bone
38
Q

In patients with CKD how does PTH affect phosphate levels?

A

PTH increases phosphate excretion

39
Q

what is the effect in CKD of phosphate retention?

A

Causes FGF23 release which is cardio toxic.

40
Q

what Vitamin D hydroxylation occurs in the kidney?

A

1 hydroxylation

41
Q

what are the types of bone disease seen in patients with CKD?

A 
osteitis fibrosa (increased PTH)
osteomalacia (defective mineralisation)
adynamic bone disease (low bone turnover)
osteoporosis (defective bone formation)
42
Q

what is the cause of adynamic bone disease in patients with CKD?

A

Over suppression of PTH causing low bone turnover

43
Q

what are the bone changes seen in children with CKD?

A

growth retardation

deformities

44
Q

how do you manage bone disease in patients with CKD?

A
  • if they have low vitamin D start them on Vit D
  • give calcium based phosphate binders for high phosphate
  • high PTH give 1alpha calcidol
45
Q

what are the three diagnostic categories for kidney disease?

A

Pre renal
renal
post renal

46
Q

for kidney investigations what is the hierarchy of investigation?

A
  1. history and exam
  2. urine tests
  3. blood tests
  4. radiology
  5. renal biopsy
47
Q

would does cloudy urine indicate?

A

infection

48
Q

what drug can be responsible for red/brown urine?

A

Rifampicin

49
Q

what do white blood cells and bacteria in the urine suggest?

A

UTI

50
Q

what are post renal causes of haematuria?

A

cancer, trauma and renal stones

51
Q

what do dysmorphic red blood cells indicate when in the urine?

A

glomerular nephritis

52
Q

what does pyelonephritis present with?

A
  • white cell casts in urine

- fever

53
Q

what do epithelial cell casts suggest?

A

acute tubular necrosis

54
Q

when are oxylate crystals seen in the urine?

A

Anti freeze poisoning

Oxalate nephropathy

55
Q

when are urate crystals seen In the urine?

A

Joint aspirations

Gout

56
Q

what is the normal range for 24 hour urinary protein and what is nephrotic?

A

normal; <300mg

Nephrotic; >3g

57
Q

what do bence jones proteins suggest?

A

myeloma

T year lectures (1 decks)

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