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Applied Clinical Physiology > Renal > Flashcards

Renal Flashcards

1
Q

How much blood do your kidneys hold at any time?

A

22%

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2
Q

How often does blood pass through your kidneys?

A

Every 5 mins

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3
Q

What aspects of homeostasis does the kidney maintain?

A 
To maintain homeostasis:
pH - H+ ions
Blood pressure - Na+ and Cl- ions
Osmolarity
Waste - urea
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4
Q

What are main functions of the renal system?

A 
1. Filtrate Blood
Absorb ions and water into renal veins
2. Collection
3. Activates Vitamin D
4. Keeps blood in neutral non-acid state
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5
Q

Label diagram of kidney

A 
Renal hilum (whole entrance part - artery and vein)
Renal pelvis (of collecting system)
Renal calyx (renal collecting parts - touch medulla)
Renal medulla (inner portion)
Renal cortex - outer portion
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6
Q

What is smallest functional unit of kidney?

A

Nephron

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7
Q

Where do nephrons sit?

A

Between cortex and medulla

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8
Q

What is purpose of renal calyx?

A

First point that collects urine

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9
Q

Describe the pathway of urine

A 
Renal calyx
Calyces
Renal pelvis
Ureter
Bladder
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10
Q

What is bladder lined with?

A

Transitional epithelium.

Inbetween columnar and squamous - allows bladder to expand

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11
Q

How much can the bladder hold?

A

300-500ml

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12
Q

What is at the neck of the bladder?

A

Internal urethral sphincter

Smooth muscle (involuntary) controlling bladder. Not under our control

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13
Q

Describe urethra in females

A

Internal urethral sphincter
Membranous urethra:
Has external urethral sphincter/passes through membrane
Outside world

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14
Q

What is difference between internal and external urethral sphincter

A

Internal = smooth muscle = involuntary

External = skeletal muscle = voluntary

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15
Q

Describe urethra in males

A 
internal urethral sphincter
Prostatic urethra
Membranous urethra (has external urethral sphincter)
Spongy urethra (in penis)
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16
Q

Why are men less likely to have UTIs?

A

Because women have less urethra to outside space

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17
Q

How many nephrons in kidney

A

1 million

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18
Q

What is different between afferent and efferent arterioles?

A

afferent = towArds

efferent = lEft kidney

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19
Q

What is glomerulus?

A

Tight circling of blood vessel

Has afferent arteriole leading into it and efferent arteriole coming away

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20
Q

What is Bowmans capsule?

A

Sits underneath glomerulus and collects the filtrate. Bowmans space is top part of the capsule

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21
Q

What is cellular structure of glomerulus?

A

Fenestrated endothelial cells ‘holy’

Also basement membrane which ions, amino acids and glucose can leak through but larger molecules like proteins can’t.

Then have tubule cells underneath (epithelial cels) with podocytes - some have legs that hug around the arteriole

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22
Q

Describe a nephron

A

Starts with glomerulus and bowman capsule

Proximal tubule - convoluted (cortex)

Descending loop of henle - drops into medulla

Ascending loop of henle

Distal tubule - convoluted

Goes to collecting ducts

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23
Q

Describe action of loop of Henle

A

ascending - pumps out Na, Cl and K to make the medulla hypertonic. No water leaves this part

Descending - permeable to water, which leaves because the medulla is hypertonic.

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24
Q

How does glomerular filtration rate change with age?

A

Low at birth
Rapidly increases in first 6 months
Then gradually increases to reach adult levels by 1-2 years old

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25
Q

What is adult body surface area?

A

1.73m2

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26
Q

How do you calculate eGFR over 1y.o?

A

40 x height (cm) divided by serum creatinine

27
Q

How do you calculate eGFR for a neonate?

A

30 x height (cm) divided by serum creatinine

28
Q

What are eGFR values for normal and then renal impairment stages?

A 
Stage 1 (normal) > 90
Stage 2 Mild 60-89
Stage 3 Moderate 30-59
Stage 4 Severe 15-29
Stage 4 Renal failure <15
29
Q

Which stage of renal impairment is the average dehydrated child? Will they recover?

A

Stage 2 - yes

30
Q

Which renal impairment stages may have lasting damage?

31
Q

What is RAAS?

A

Renin-Angiotensin-Aldersterone System

32
Q

Describe how RAAS works

A

Juxta glomerular cells (JG) in blood vessels in kidney (smooth muscle)

Release renin if:

  1. BP low
  2. Neighbouring cell sympathetic nerves trigger
  3. Macula densa cells in distal tubule of nephron can sense not enough Na+ ions. They send prostaglandin message to JG cells.

Renin meets angiotensinogen from liver (which is not active)

Renin cuts some protein away (it is enzyme) and it angiotenisongen becomes angiotensin 1.

Endothelial cells in blood vessels in lungs produce ACE (angiotensin converting enzyme). Converts angiotensin 1 to angiotensin 2.

Angiotensin 2 raises BP through 4 actions

33
Q

What does angiotensin 2 act on?

A
  1. Smooth muscle cells in blood vessels all over contract - therefore increase resistance
  2. Pituitary gland - sends antidiuretic hormone to also vasoconstrict and acts on renal cells to hold more water
  3. Adrenal gland - makes aldosterone to make renal cells hold more water
  4. Renal cells - absorb more water (increases stroke volume)
34
Q

What is ACE inhibitor? What is side effect?

A

Angiotensin converting enzyme inhibitor - used to control blood pressure - but as ACE in lungs can get cough as side effect

35
Q

What are different causes of renal disease?

A
  1. Birth defect - e.g. renal dysplasia
  2. Hereditary - e.g. Fanconi/Allport syndrome, polycystic kidneys
  3. Infection - haemolytic uremic infection, glomerular nephritis
  4. Nephrotic Syndrome
  5. Systemic Disease (e.g. cardiac disease affects kidneys, sepsis, medications)
  6. Trauma
  7. Urine blockage or reflux
36
Q

What are most common renal cause present birth - 4 years old?

A

Birth Defect

Hereditary

37
Q

What is most common renal cause to present 5 to 14 years?

A

Hereditary

Infection

Nephrotic syndrome

Systemic disease

38
Q

What is nephrotic syndrome?

A

Present as very swollen - kidneys leak proteins lead to shits in internal fluids.

39
Q

What are 2 types of renal disease?

A

Acute

Chronic

40
Q

How common is acute kidney disease?

A

3.9 in 1000 admissions in USA

41
Q

What is consequence of AKI in hospital?

A

If get AKI type 3 then mortality increases 50-60%

42
Q

What are 3 categories of AKI?

A
  1. Pre-renal - decreased blood volume, renal artery stenosis
  2. Renal - nephritis, tubular necrosis
  3. Post-renal - obstruction of collecting system.
43
Q

For an inpatient, how might a patient get AKI?

A
  • medication
  • dehydration and not correcting
  • fluid overlaod
  • ITU admission
  • ECMO/ventilation
44
Q

What is occurrence of chronic kidney disease in children?

A

About 1000 children in UK

Often present in early teens as it is gradual change

45
Q

What is presentation of chronic kidney disease?

A

Difficult to directly assess.

Nausea/vomiting - due to toxicity
Altered mental state (build up of urea)
Fatigue
Abdo pain
No urine/lots of urine
Loss of appetite
Blood in urine
Swelling
Hypertension (but can be changeable)
46
Q

What is important blood test for possible kidney disease?

A

U+Es

Checks urea and creatinine

47
Q

Where does urea come from?

A

Protein in cells broken down to ammonia.

Liver breaks toxic ammonia into urea - urea excreted by kidney.

48
Q

What would low urea/creatinine indicate in U+E blood test?

A

Low protein diet
Liver disease
Pregnancy
Decrease in muscle mass (creatinine)

49
Q

What would increased urea/creatinine indicate in U+E blood test?

A

from a Renal point offie w- rate of filtration
blockage in filter
opposing pressure on other side of filter

Other: 
protein rich diet
chronic starvation
GI bleed (blood = extra protein in diet)
dehydrtion (amount of urea reabsorbed in blood by tubules is higher in those who are dehydrated)
50
Q

What is haemolytic uremic syndrome?

A

Small blood vessels in the kidney become damaged and inflammed.

Risks are that clots in the vessels can clog the filtering system

51
Q

What are causes of haemolytic uremic syndrome?

A

a strain of E coli
HIV
Influenza

52
Q

What age group is affected by haemolytic uremic syndrome?

53
Q

What are symptoms of haemolytic uremic syndrome?

A 
Bloody loose stools
Abdo pain
Cramping/bloating
Fever
Vomiting

This will all depend on cause.

patient may also present with fatigue, SOB, easy bruising, increased BP, decreased urination, seizures/stroke

54
Q

What is glomerulonephritis?

A

Inflammation of the glomeruli (filters) in the kidneys.

Therefore the kidneys can lose filtering ability

Therefore can lead to acute/chronic kidney disease, increased BP and nephrotic syndrome

55
Q

What are treatments for glomerulonephritis?

A

Low salt diet
ACE inhibitors
steroids
immunesuppresants

56
Q

How would someone present with glomerulonephritis?

A

haematuria
increase BP
proteinuria
oedeam

57
Q

What causes glomerulonephritis?

A

Can occur on it’s own or as part of another disease like lupus or diabetes?

Can be cause by infection/autoimmune/vasculaitis

58
Q

What is nephrotic syndrome?

A

The kidneys excrete too much protein in the urine.

59
Q

What are complications of nephrotic syndrome?

A 
blood clots
increase cholesterol 
poor nutrition
AKI 
increased BP
60
Q

What causes nephrotic syndrome?

A

Damage to blood vessels
Kidney disease
Lupus
Blood clots

61
Q

What are symptoms of nephrotic syndrome?

A 
Sweling
Foamy urine
Increased weight due to fluid retention
Decreased albumin <25g/L
Fatigue
62
Q

What are causes of nephrotic syndrome?

A

Primary - congenital/infantile

Secondary risks - medical conditions/medications/infections

63
Q

Where does creatinine come from?

A

Muscle metabolism biproduct.

Applied Clinical Physiology (14 decks)

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