RENAL Flashcards
EXPLAIN THE RAAS SYSTEM.
renin-angiotensin-aldosterone system
what is the function of erythropoietin (EPO)?
when 02 levels are low, the kidneys produce and secrete erythropoietin, erythropoietin stimulates the bone marrow to begin the production of erythrocytes (RBC)
what do these cells produce... ALPHA CELLS BETA CELLS DELTA CELLS EPSILON CELLS
alpha: glucagon-promotes movement of glucose from storage and into the blood
beta: insulin- movement of glucose out of the blood and into the cells
delta: somatostatin-regulates secretion of other pancreatic hormones
epsilon: ghrelin- boosts appetite, affects energy balance
pathophysiology of type 2 diabetes?
insulin deficiency and insulin resistance
therefore glucose cant effectively be moved from the bloodstream into the cells to be used, glucose levels in the blood increase, BETA CELLS- progressively decrease in numbers, they are sensitive to high levels of glucose
what is HbA1c? normal range?
glycated haemoglobin- form of haemoglobin that is linked to sugar. normal range is 4-5.6%
embolic vs thrombotic stroke?
embolic= when a clot forms elsewhere in the body and then breaks loose and travels to the brain via the bloodstream. when the clot goes into an artery and blocks the blood flow then this is a stroke.
thrombotic= formation of a blood clot inside a blood vessel, the clot obstructs the flow of blood to the brain therefore the symptoms occur
hormones that cardiovascular system produces to regulate the production of renin?
ANP- released by atria
BNP-released by ventricles
both inhibit renin secretion, cause vasodilation and therefore decrease BP
what is metabolic syndrome? symptoms?
cluster on conditions that occur together, increase risk of heart disease, stroke and t2 diabetes
symptoms: hypertension, high blood sugar levels, high triglyceride levels, large waist circumference, decreased levels of HDL (good cholesterol)
what is metformin prescribed for? what group does it belong to?
t2 diabetes
targets the liver, slows the release of glucose from the liver into the bloodstream and also helps the cells to use the glucose that is available in the blood
group= biguanides
what are thiazolidinediones?
anti-diabetic medication.
end with “zone” eg. pioglitazone
reduce BGL by improving insulin secretion in adipose tissue and skeletal muscle, and by decreasing release of glucose by liver
what are sulfonylureas?
anti-diabetic medication, eg. glipizide
act by increasing insulin secretion therefore require some pancreatic beta cell activity for effect
what are alpha-glucosidase inhibitors?
anti diabetic med. eg, acarbose & miglitol
block breakdown of starchy foods and slow down absorption of some sugars.
what is a UTI? complicated vs uncomplicated?
Urinary tract infection.
complicated: pregnancy, men, over 65
uncomplicated: under 65, healthy, woman
syx: frequency and urgency, dysuria/ stinging, fever
women get more UTIs than men because they have a shorter urethra therefore the bacteria has a shorter way to travel
what is incontinence? stress incontinence? urgency incontinence? overactive bladder syndrome? functional incontinence?
lack of control over urination or defecation.
stress= associated w/ physical activity or coughing, sneezing. associated w/ childbirth and menopause
urgency= sudden urge to urinate
overactive bladder= urgency, frequency, nocturia
functional= cognitive/physical impairment eg. cant get to bathroom/dont know that need to pee (children)
impact of incontinence:
- depression
- embarrassment
- shame
- loss of confidence
how do we investigate and treat incontinence?
INVESTIGATIONS:
cough test, pelvic examination, urinalysis, bladder diary, post void US scan
TREATMENT: bladder training pelvic floor exercises botox injections into bladder muscle medications- anticholinesterase, tricyclic antidepressants surgery mgt w/ incontinence pads
what is GFR? normal rate?
glomerular filtration rate- the amount of blood that has passed through the glomeruli each minute.
normal rate: 125ml/min
how do we test kidney function?
eGFR- the amount of blood that has passed through the glomeruli over a minute, normal rate= 125ml/min
SERUM CREATININE - is a waste product that is produced during normal muscle breakdown, measures how well the kidneys are clearing creatinine from the body.
BUN (blood urea nitrogen)- measures the amount of nitrogen in blood that comes from the waste product urea, urea is made when protein is broken down in your body
what is benign prostatic hyperplasia? S+S?
enlarged prostate, common condition as males get older.
S+S: difficulty to start voiding, poor urine flow, frequency, urgency, nocturia, stopping + starting, UTI.
what are the investigations done for benign prostatic hyperplasia? treatment?
> INTERNATIONAL PROSTATE SYMPTOM SCORE (IPSS)- questionnaire score 1-5, severity of symptoms over the past month.
> urine dip test
digital rectal examination
voiding diary
TREATMENT:
LIFESTYLE- avoid liquids 1-2 hrs before bed, avoid smoking, alcohol and caffeine, moderate activity 30-60 mins per day.
BLADDER TRAINING PROGRAMME
MEDICATIONS- Finasteride or dutasteride - block dihydrotestosterone (DHT) -can reduce the size of the prostate and improve associated symptoms. Effect – up to six months. Teratogenic effects, impotence & low sperm count
alpha blockers- relax bladder muscles
SURGERY
what is acute kidney injury?
rapid decline in renal filtration function - reversible
causes fall into 3 categories:
- pre-renal - hypovolaemia, hypoperfusion, cardiogenic shock, heart failure, myocardial infarction, fluid volume shifts, medications
- intrinsic renal- direct damage to the nephrons,
- post renal- caused by a blockage to the flow of urine resulting in back pressure the kidney causing damage to the nephrons
what are the 4 phases of AKI?
- ONSET- triggering event, renal blood flow 25% of normal, urine output less than 0.5ml/kg/hr
- OLIGURIC- urine output below 400ml/day, increased BUN& creatinine levels, electrolyte disturbances, acidosis and fluid overload
- DIURETIC- when cause of AKI is corrected, incresed GFR, increased urine output, renal tubule scarring and oedema
- RECOVERY- decreased oedema, normal fluid and electrolyte balance, GFR returns to 80% of normal
what is the normal urine output?
1.5-2ml/kg/hour
management of AKI?
- restore renal blood flow- fluid replacement and treat cause of the volume loss
- treat urinary obstructions
what is chronic kidney disease?
when kidneys are damaged and can’t filter blood properly.
diagnosed by blood test.
risk factors: diabetes hypertension cardiovascular disease family hx long term use of potentiallty nephrotoxic medications- NSAIDS, ACE inhibitors, diuretics, lithium
