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Y1 Body system lecture notes year 1 > Renal > Flashcards

Renal Flashcards

1
Q

Where are the kidneys located

A

two kidneys located on either side of the spine at the lowest level of the rib cage

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2
Q

What does RRAPID stand for

A

Recognising and Responding to Acute Patient Illness and Deterioration

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3
Q

What is a nephron and how many are in the kidneys

A

A filtering unit

1 million in each kidney

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4
Q

What are the two broad functions of the kidney

A

Homeostasis: maintenance of the internal environment of the body

Hormone secretion: endocrine function

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5
Q

How does the kidney keep the balance of fluid and electrolyte

A

Volume status: regulates the fluid balance by urine
Electrolyte levels: sodium, potassium, urea, creatine
Osmolarity: concentration of particles exerting an somatic pressure

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6
Q

What are the results of small molecules being lost

A

Sugars: presence in urine indicates disease such as diabetes and tubular disorders

Amino acid: loss of amino acids occurs in disease of proximal tubule

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7
Q

What waste products and drugs are secreted by the kidneys and what can be diagnosed if levels of these are wrong

A

Nitrogenous waste from protein metabolism; level of creatine in blood is used to measure kidney function
Drugs: antibiotics, digoxin, opiates, lithium; drugs can accumulate in kidney disease

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8
Q

What are the results of chronic kidney disease

A

Decreased activation of Vitamin D
Decreased calcium level
Stimulates secretion of parathyroid hormone causing: secondary hyperthyroidism, release of calcium from the bone and development of bone disease known as renal osteodystrophy

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9
Q

What is tested in urinalysis

A 
pH
Haematuria
Proteinuria
Glucose
Nitrites
Leucocytes
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10
Q

What is the glomerular function rate and how is it measured

A

measurement of renal function
normal= 100-120 mrs/min/1.73m2

Requires the injection of a radioactive tracer of Technetium Tc99

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11
Q

What is creatinine clearance

A

Estimation of glomerular filtration rate

Creatinine is released from the muscle at a relatively constant rate

Filtered by the kidneys but some secretion into the filtrate by the proximal tubule so not as accurate and rarely used in clinical practive

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12
Q

What is serum creatinine

A

Released by muscle
Removed by kidneys
Routinely used to measure kidney function
Accumulates in kidney disease: not specific to site of injury,
delay in rise following acute kidney injury
Simple blood test:
64-104umol/L (male)
60-93 umol/L (female)

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13
Q

What is estimated glomerular filtration rate (eGFR) calculated using and what is it

A

age of patient
Sex of patient
Ethnicity
Serum creatinine

% of kidney function

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14
Q

What does the proximal convoluted tubule do

A 
Recovers 70% of glomerular filtrate:
water
electrolytes
glucose
amino acids

Reabsorption of bicarbonate:
dependent upon enzyme, carbonic anhydrase

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15
Q

What is a loop diuretic given for

A

To increase urine output

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16
Q

What does the cortical collecting duct do

A

Site of reabsorption of:
Na+ in exchange for K+
Controlled by aldosterone

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17
Q

What does the medullary collecting duct do

A 
Site of urinary concentration
Antidiuretic hormone (ADH) acts to increase water reabsorption
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18
Q

What is the mechanism responsible for concentrating urine

A

Counter current mechanism which establishes a high conc gradient in the medulla and so enables reabsorption of water from the filtrate

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19
Q

What are insensible losses of fluid

A

sweating
faeces
respiration

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20
Q

What germ layer do the kidneys develop from

A

Intermediate mesoderm

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21
Q

What are the structures of the urinary system

A

Kidneys
Ureters
Urinary bladder
Urethra

22
Q

What are the two types of genitalia of the reproductive system

A

Internal and external

23
Q

What is the first structure of the kidneys to develop and when does this happen and how

A 
Pronephros
In week 4
Non-functional 
Intermediate mesoderm in the cervical region condenses and reorganises to form a number of epithelial buds
It disappears around day 25
24
Q

What happens in development of the mesonephric duct

A

In week 4

Intermediate mesoderm in the lower cervical region is induced to epithelialise forming a solid duct- mesonephric duct

Develops caudally and fuses with the walls of the cloaca on day 26

Canalisation commences from caudal end

Induces formation of mesonephric buds

25
Q

Where does gonadal development happen

A

Medial aspect of the mesonephric ridge, forming the urogenital ridge

26
Q

What happens in development of the metanephros

A

Starts with the formation od the ureteric buds at the caudal end of the mesonephric duct

By day 32 the ureteric buds penetrate the metanephric mesenchyme (undifferentiated mesoderm), bifurcating in a specific pattern:
Renal ampulla,
renal pelvis,
Major calyces,
Minor calyces,
Collecting ducts
27
Q

What is formed by each portion of the metanephros

A 
Collecting portion:
Collecting ducts
Major and minor calyces
Renal pelvis
Ureter
Excretory portion:
Bowmans capsule
Proximal convoluted tubule
Loop of Henle
Distal convoluted tubule
28
Q

How are the adult nephrons formed

A

Newly formed collecting tubules are covered by metanephric tissue caps

Interaction between the tubule and the cap causes: specific branching of tubule
differentiation of cells in the metanephric cap to form renal vesicles which expand to form S shaped table and bowman’s capsule which form the adult nephron

29
Q

How of the kidneys relocate

A

Develop in the pelvic region but reside more cranially in the adult

Ascent of the kidneys is caused by growth and elongation od the developing vets

As it ascend it establishes new blood supply; lower vessels normally degenerate

In adult position by week 9

30
Q

How is the bladder formed

A

From the urogenital sinus which is divided into 3 distinguishable parts:
Upper: presumptive urinary bladder
Pelvic: urethra
Phallic: penile urethra (males), vestibule (females)

Bladder is initially continuous with the allantois which obliterates to form the urachus that connects the apex of the bladder with the umbilicus

31
Q

Which is the first functioning primitive kidney

A

mesonephros

32
Q

What is the anatomy of the Genito-urinary system

A

The two kidneys are associated with the posterior abdominal wall, lateral to the aorta and IVC.
Each kidney gives off a ureter which descends alongside the vertebral column to enter the pelvis and join the bladder
A single urethra leaves the bladder and passes urine to the outside world

33
Q

What are the pelvic organs and what are the characteristics

A

Bladder
Rectum
Uterus (female)

Project into the abdominal cavity
Covered by peritoneum
Form pouches where fluid collects:
Vesico-rectal pouch (male)
Vesico-uterine pouch and utero-rectal pouch (female)
34
Q

What is acute kidney injury

A

Rapid reduction in kidney function
Occurs over hours to days
Rise in creatinine and decrease in urine output

35
Q

What are the stages of AKI

A

stage 1. SCr increase >26umol/L within 48 hours or ACr increase 1.5-1.9 fold from base line
Urine output< 0.5 mL/kg/hr for 6 consecutive hours

stage 2. SCr increase 2-2.9 fold from baseline
Urine output <0.5mL/kg/hr for 12 hrs

stage 3. SCr increase >3 fold from baseline or SCr increase >354 mol/L or initiate on RRT
Urine output < 0.3 mL/kg/hr for 24 hrs or anuria for 12 hr

36
Q

How does AKI present

A 
Hypovolaemia/hypotensive
Sepsis
Nausea/vomiting
decreased urine output
Fever
Diuretics
Diarrhoea
High stoma output
Haemorrhage
Burns
37
Q

What are complications of AKI

A 
Hyperkalaemia -cardiac arrest
Acidaemia - vascular instability
Pulmonary oedema - respiratory arrest
Uraemia - pericarditis, encephalopathy 
gastritis 
malnutrition
anemia
38
Q

What investigations would you do for AKI and CKD

A 
Full blood count
U and Es and bicarbonate 
C-reactive protein
Liver function tests 
Calcium and phosphate
Immunological screen
Creatine kinase
Urinalysis
39
Q

What are causes of chronic kidney disease

A 
Diabetes meillitus
Glomerular disease
Inherited disorders such as autosomal dominant polycystic kidney disease
Renal vascular disease
Acute kidney injury
Interstitial disease
Other unknown causes
40
Q

How is CKD managed

A

BP control: ACE inhibitors
Cholesterol control: statins
Fluid balance: loop diuretics e.g. furosemide
Anaemia: erythropoietin and ferrous sulphate
Bone metabolism: vitamin D analogues, phosphate binders, calcimimetics
Acidaemia: sodium bicarbonate
Dietary advice: decrease phosphate

41
Q

What is autosomal dominant polycystic kidney disease

A 
Presents in adult life
Development of cysts on kidneys, liver, pancreas
Hypertension
Cardiac abnormalities
Berry aneurysms
42
Q

What are the treatment options of end stage kidney disease

A

Haemodialysis
Peritoneal dialysis
Transplantation
Conservative care

43
Q

What are the indications, side effects and some examples of ACEi and how does it work

A

Hypertension
Cardiac failure
CKD

Hypotension
Kyperkalaemia

Ramiprill
Lisinopril

Inhibits vasoconstrictive effect of angiotensin II

44
Q

What are the indications, side effects and some examples of Angiotensin receptor blockers and how does it work

A

Hypertension
Cardiac failure
CDK

Hypotension
Kyperkalaemia

Valsartan
Irbesartan

Inhibits vasoconstrictive effect of angiotensin II on the receptor

45
Q

What are the indications and side effects of loop diuretics and how do they work

A

CKD
Nephrotic syndrome
Hypertension
Cardiac failure

Hypovolaemia
Hypokalaemia

Inhibits uptake of sodium, potassium, chloride and water

46
Q

What are the indications, side effects of thiazides and how does it work

A

CKD
Nephrotic syndrome
Hypertension
Cardiac failure

Hypovolaemia

Inhibits sodium uptake
Remove sodium and water

47
Q

What are the indications, side effects of spironolactone and how does it work

A

Cardiac failure
Liver cirrhosis

Hyperkalaemia

Inhibits aldosterone
Prevents sodium reabsorption in exchange for potassium

48
Q

What are the indications, side effects of amiloride and how does it work

A

Prevents hypokalaemia

Hyperkalaemia

Inhibits sodium reabsorption
Removes sodium and water

49
Q

What is sepsis

A

Life threatening organ dysfunction caused by a dysregulated host response to infection

Organ dysfunction can be represented by an increase in the sequential organ failure assessment score of >2

Which is associated with an in-hospital mortality greater than 10%

50
Q

What is septic shock

A

A subset of sepsis
Profound circulatory, cellular and metabolic abnormalities
Greater risk of mortality than with sepsis alone
Hospital mortality rates > 40%

51
Q

What are crystalloids and what are the two types

A

Water to which solutes have been added

High sodium containing fluids: volume resuscitation

Low sodium fluids: disperse throughout intracellular and extracellular compartments, replacement/routine maintenance

Y1 Body system lecture notes year 1 (5 decks)

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