Renal Disease

Question 1

Understand how we measure renal function

Answer 1

Glomerular Filtration Rate (GFR)

• the volume of water filtered from the plasma per unit of time, this gives a rough measure of the number of functioning nephrons
• normal GFR MEN : 130mL/min.1.73m2 WOMEN: 120mL/min.1.73m2
• ( how much the liver can pump in a given time)
• cannot be directly measured directly, so we use creatinine and creatininev clearance to estimate

Measuring GFR formula on page 8

Question 2

Understand the main cause of kidney failure

Answer 2

PRERENAL DISEASE

• reduced renal perfusion due to volume depletion and/or decreased perfusion
• caused by dehydration, volume loss (bleeding), heart failure, shock, liver disease

VASCULAR DISEASE

GLOMERULAR DISEASE
• Nephritis
- Inflammation seen on histologic exam
- Active sediment (things that shouldn’t be there): Red cells, white cells, granular casts, red cell casts
- variable degree of protein Uris (<3G/day)
• Nephrotic
- bland sediment (dead cells, not doing anything (difference from nephritis) : no cells, fatty casts
- Nephrotic range proteinuria (>3.5 g/ a day)
- Nephrotic syndrome = proteinuria + hyperlipidemia + edema

INTESTITIAL TUBULAR DISEASE
• Chronic
- Polycystic kidney disease
- Hypercalcemia
- Autoimmune disorders
   - Sarcoidosis 
   - Sjögren’s syndrome

OBSTRUCTIVE UROPATHY

• obstruction of the urinary flow anywhere from the renal pelvis to the urethra
• can be acute or chronic
• most commonly caused by tumour or prostatic enlargement (hyperplasia or malignancy)
• need to have bilateral obstruction in order to have renal insufficiency

Question 3

Understand the causes and symptoms of acute and chronic renal failure

Answer 3

ACUTE RENAL FAILURE - sudden often temporary loss of kidney function, develops rapidly, several hours or days
• An abrupt decrease in renal function sufficient to cause retention of metabolic water such as urea and creatinine
• Frequently have: metabolic acidosis, hyperkalemia, disturbance in the body fluid homeostasis, secondary effects on the other organ a systems

RISK FACTORS: advanced age, predicting renal parenchymal disease, diabetes mellitus, underlying cardiac or liver disease

CAUSES :

• prerenal - sudden and severe drop in blood pressure (shock) or interruption of blood flow to the kidneys from severe injury or illness
• intrarenal - direct damage to the kidneys by inflammation, toxins, drugs, infection, or reduced blood supply
• postrenal - sudden obstruction of urine flow due to enlarged prostate, kidney stones, bladder tumour, injury
• prerenal
• acute tubular necrosis (ATN)
• acute in chronic renal failure (usually due to ATN or prerenal)
• obstructive uropathy
• Glomerulonephritis/vasculitis
• acute interstitial Nephritis
• atheroemboli

SYMPTOMS

• waste products accumulate (blood)
• setting of cascade of symptoms
• decreased urination
• nausea
• fatigue
• shortness of breath
• oedema
• changes in the heart

TREATMENT

• treat underlying cause
• hydration
• diuresis (lasix)
• dialysis
• renal transplant

Question 4

Understand the causes and symptoms of kidney stones

Answer 4

Renal disease 3

Question 5

Understand the causes and symptoms of renal hypertension

Answer 5

WK5

Question 6

Understand the causes and symptoms of renal cell carcinoma

Answer 6

a

Question 7

Understand the cause and symptoms of UTIs

Answer 7

a

Question 8

Understand the treatments for renal disease

Answer 8

a

Question 9

Examination of the urine

Answer 9

• Proteinura (when proteins are in the urine not really supposed to be) is the most common sign of renal disease
• measured via ALBUMIN
• up to 30mg/day
• affected by pyrexia, posture and exercise