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1005 > Renal disease > Flashcards

Renal disease Flashcards

1
Q

State the functions of the kidney? 3 marks

A

filters the blood., excretes unwanted waste products, regulated fluid and electrolytes

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2
Q

Provide examples of alterations/diseases that can

occur in the kidney and/or urinary tract. 4 marks

A
  • Cystitis
  • renal calculi
  • acute kidney injury
  • Glomerulonephritis
  • Urinary tract Infection
  • renal colic
  • nephrotic syndrome
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3
Q

Define the term urinary tract obstruction.

A
  • blockage of the passage of urine

- can occur at any site along the urinary tract

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4
Q

Outline how the severity of obstructive uropathy is classified.. 3 marks

A
  • refers to the anatomical changes which occur as a result of the blockage
  • severity of the obstruction is determined by: location of the obstruction, if it affects both or one kidney, the completeness of the kidney, how long the blockage has existed, nature of the obstruction
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5
Q

Describe common causes of upper urinary tract obstruction. 4 marks

A
  • narrowing of a ureter or urethra
  • compression due to either a congenital defect or physical compression from a blood vessel, scarring, tumour, abdominal inflammation, renal calculi, malignancy
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6
Q

What short term effects would upper urinary obstruction have on the kidney? 4 marks

A
  • The effects would depend on the size of the obstruction.
    – Initially the urine backs up, which leads to the dilation of the ureter,
    renal pelvis and calyces. Dilation occurs close to the site of the urinary blockage.

-Within 14 days the obstruction will have affected both the proximal
and distal part of the nephron.
– Within 28 days this backflow of urine will lead to the glomeruli
becoming damaged and consequently the renal cortex and medulla
will decrease in size.
– Total obstruction = leads to damage to the renal tubule in 4 hours and is irreversible if not corrected within 4 weeks

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7
Q

What effect would a total obstruction in the

ureter have on fluid and electrolyte balance? 3 marks

A
  • backflow of urine into tubules changes pressure gradient and reduces GFR
  • retention of sodium and fluid= increases BP and oedema
  • retention of potassium= hyperkalaemia
  • retention of H+= metabolic acidosis
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8
Q

What are kidney stones (renal calculi)? 2 marks

A
  • Kidney stones (renal calculi)
    are formed in the kidney.
    – They may be caused by a
    collection of crystals (70-80% are either calcium oxalate or calcium phosphate), struvite (15%) or uric acid (7%).
    -Drinking adequate amounts of water and
    being physically active can reduce the risk of the development of a kidney stone
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9
Q

What symptoms will a patient with kidney stones exhibit? 3 marks

A
  • Patients with calculi tend to experience renal colic, which is a moderate to severe pain originating in the flank region and radiating to the groin.
    – The patient may also experience nausea and vomiting.
    – Microscopic examination of urine may show the presence of haematuria
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10
Q

Describe two common causes of lower urinary obstruction. 2 marks

A
  • Lower urinary obstruction is associated mainly with either problems of urinary storage in the bladder or problems of urine emptying out of the bladder.
    – This is either the result of neurogenic and/or anatomical alterations.
    – Incontinence is the most common symptom observed in these patients
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11
Q

State what causes urinary tract infections? 1 mark

A

A UTI can be described as inflammation of the urinary epithelium that has resulted from infection of the urinary tract with bacteria (usually from gut
flora).

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12
Q

Briefly describe the types of urinary tract infections. 3 marks

A

Acute cystitis – inflection of the urinary bladder (most common site of a UTI)
– Generally caused by Escherichia coli (E.coli) although other organisms
can also cause infection.
– Individuals may be asymptomatic or they may have urinary frequency,
urgency, dysuria and lower back pain.
– Acute Pyelonephritis – infection of the renal pelvis and interstitium.
– Chronic Pyelonephritis – persistent or recurrent infection that leads to
scarring of the kidney.

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13
Q

Why are urinary tract infections more common in

children and the elderly? 2 marks

A

A UTI can be defined as inflammation of the urinary tract and is predominantly caused by bacteria that come from gut flora.
– Many people are at risk of a UTI including children and the elderly,
sexually active and pregnant women, diabetics and those with UT obstruction.
– Children and the elderly are at risk for several reasons. In children,
especially girls, hygiene practices may not be well developed and the child
may wipe incorrectly which may introduce gut bacteria into the UT leading
to infection.

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14
Q

Why are urinary tract infections more common in children and

the elderly?

A

In the elderly decreased dexterity may also lead to translocation of
bacteria to the UT.
– Decreased oestrogen in elderly women or antibiotic use can also increase
the risk of infection.
– Men are less likely to have a UTI as they have a long urethra and the
prostatic secretions also decrease the risk.
– Please note that the elderly will often not experience symptoms or have minimal symptoms.
– UTIs should be investigated in an elderly person who has an elevated temperature or is confused.

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15
Q

Compare and contrast acute and chronic glomerulonephritis. 2 marks

A

Acute glomerulonephritis is
inflammation within the glomerulus. This inflammation is often the result of immune reactions following a streptococcal infection.
– Chronic glomerulonephritis is also
inflammation of the glomerulus. However, it is usually due to alterations/diseases, which cause progressive deterioration of glomerular function leading to a loss
of total renal function

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16
Q

What is acute kidney injury and what is the RIFLE staging system? 2 marks

A

AKI is a sudden decline in kidney function (hours to days) and leads to
disorders of acid/base, electrolyte and fluid balance. Due to disparity in
the literature as to the precise definition of AKI a staging system was
required and the RIFLE system was developed. It stands for:
– R – risk
– I – injury
– F – failure
– L – loss
– E – end stage renal failure
– It may be caused by many things including but not limited to hypovolaemiav(a prerenal cause), acute tubular necrosis (intrarenal cause), obstructive
uropathies (postrenal cause).
AKI has three phases: oliguria, diuresis, recovery.

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17
Q

Describe the classification system used to describe the causes of AKI (ARF). 1 mark

A

– Acute kidney injury was formerly known as acute renal failure
– AKI is commonly defined as an abrupt decline in renal function, clinically
manifesting as a reversible acute increase in nitrogen waste products—
measured by blood urea nitrogen (BUN) and serum creatinine levels—over
the course of hours to weeks.
– ARF (AKI) is observed in 5% of hospital admissions & approx 30% of ICU
admissions.
– ARF (AKI) can be divided into three categories:
1. Prerenal – problems with blood supply.
2. Intrinsic or intrarenal – damage to kidney.
3. Postrenal – obstruction in the urinary tract

18
Q

What are the major causes of prerenal AKI (ARF)? 5 marks

A
    1. Hypovolaemia (volume depletion) e.g. Haemorrhage, vomiting, renal
      fluid loss via diuretic drugs.
      – 2. Low cardiac output e.g. diseases of the myocardium, pulmonary
      hypertension, massive pulmonary embolus.
      – 3. Alterations in renal system vascular resistance ratio e.g. anaphylaxis,
      renal vasoconstriction, cirrhosis with ascites (hepatorenal syndrome).
      – 4. Renal hypoperfusion e.g. ACE inhibitors, atherosclerotic plaque,
      thrombosis
      – 5. Hyperviscosity syndrome e.g. polycythaemia
19
Q

What are the major causes of intrinsic AKI (ARF) ? 4 marks

A
  1. Diseases of the glomeruli or renal microvasculature e.g. SLE,
    glomerulonephritis.
    – 2. Acute tubular necrosis e.g. ischaemia, toxins.
    – 3. Interstitial nephritis e.g. NSAIDs, lymphoma, cytomegalovirus.
20
Q

Describe the pathophysiology of acute tubular necrosis. 2 marks

A
  • Acute tubular necrosis (ATN) is the death of tubular cells.
    May result from:
    – Lack of O2 (ischaemic ATN)
    – Exposure to a toxic drug or molecule (nephrotoxic ATN).
    – New tubular cells usually replace those that have died.
    – May be mistaken for Prerenal ARF (AKI).
21
Q

Why is dialysis often required in acute tubular necrosis? 2 marks

A

-Dialysis may be required as waste products can no longer be excreted effectively and electrolyte and fluid reabsorption/excretion is affected.
– Unlike pre-renal acute kidney failure, ATN does not rapidly improve
following the administration of large-volume intravenous fluid because the kidneys have lost their ability to handle fluids and therefore administration
of fluids can lead to the patient experiencing fluid overload.

22
Q

What are the major causes of post renal ARF (AKI)? 2 marks

A 
Obstruction e.g.
– calculi
– cancer causing an obstruction
– prostatic hypertrophy
– stricture of the urethra
23
Q

Describe the clinical signs of prerenal ARF (AKI) 3 marks

A 
Symptoms observed are associated with the underlying cause i.e. lack of
blood supply:
– Thirst.
– Tachycardia
– Orthostatic dizziness.
– Reduced JVP (jugular venous pressure).
– Reduced axillary sweating.
– Dry mucous membranes.
– In addition they may have oliguria and flank pain but it may not always be present.
24
Q

What are the clinical signs of intrinsic or intrarenal ARF (AKI)? 3 marks

A

Ischaemic and nephritic causes constitute 90% of causes.
– Signs are related to the complications associated with renal failure.
– Fever, joint pain, flank pain, headache, dizziness, confusion, seizure,
oliguria (reduced urination), oedema, hypertension, heart failure.

25
Q

Describe the clinical signs of postrenal ARF (AKI). 2 marks

A
  • Suprapubic and flank pain.

– Colicky pain

26
Q

How would you diagnose ARF (AKI)? 2 marks

A 
- History
– Drug charts
– Physical examination
– Urinalysis
– Routine blood tests → biochemical status & general health
27
Q

Define the term Chronic Renal Failure (CRF)

[or Chronic Kidney Disease (CKD)] 3 marks

A

Chronic Renal Failure = progressive loss of kidney function.
– The destruction of renal mass with irreversible sclerosis and loss of
nephrons leads to a progressive decline in GFR.
– CRF is clinically indicated by kidney damage or a decreased kidney
glomerular filtration rate (GFR) of <90 mL/min/1.73 m2 for 3 or more
months.

28
Q

Describe the five stages and treatment of chronic kidney

disease. 5 marks

A

Stage 1: The kidney has an amazing ability to compensate for reductions in
nephron function. Therefore the patient with stage one chronic kidney failure
may not be identified initially. They will have a relatively normal or relatively high GFR (>90mL/min). At this point the patient’s BP should be measured, level of proteinuria determined and urinalysis conducted.

– Stage 2: The patient will exhibit mild kidney damage and will have a mild reduction in GFR (60-89mL/min). Urinalysis should be conducted and
cardiovascular risk reduction implemented.

Stage 3: Moderate kidney damage with a GFR (30-59mL/min). At
this stage the patient’s GFR should be monitored every 3 months, nephrotoxins should be avoided, ACE inhibitors may be required, drug dosages need to be adjusted due to changes in excretion.

– Stage 4: Severe kidney damage has occurred and the GFR will be low (15-29mL/min). Patient will need to be treated by a renal specialist and start treatment both physical and psychological to prepare for dialysis and transplant.

– Stage 5: This is referred to as end stage kidney disease and the kidney has a GFR of <15mL/min. The patient will need a transplant
and dialysis at this stage. Potassium and protein in the diet will need to be carefully monitored.

29
Q

What are the clinical manifestations of CKD? 6 marks

A

The manifestations of CKD are described as uraemia, which is the
accumulation of nitrogenous wastes from protein metabolism as well as systemic effects caused by the accumulation of toxins in the blood stream.
Specific problems include:
– A rise in serum creatinine and decreased creatinine clearance rates.
– Sodium and fluid retention = oedema and hypertension
– If the body cannot get rid of excess fluid this can lead to hyponatraemia (sodium is diluted)
– Hyperkalaemia (think electrolyte balance between hydrogen, potassium and sodium). This is the main cause of death in people who miss dialysis sessions.
– Alterations in calcium and phosphate metabolism leading to hypocalcaemia. Renal phosphate excretion decreases which leads to
phosphate binding to calcium thus further perpetuating hypocalcaemia.

30
Q

Describe the pathophysiology of CRF (CKD) 3 marks

A

In CRF, the kidneys attempt to compensate for renal damage by hyperfiltration.
– Hyperfiltration, through the nephrons, causes further loss of function.
– Chronic loss of function causes generalised wasting and progressive
scarring within all parts of the kidneys.
– CRF may not be identified until over 70% of the normal combined function of both kidneys is lost

31
Q

Name the causes of CRF (CKD) 1 marks

A

Determining the cause of CRF (CKD) can be difficult.

– Most common causes are hypertension and diabetes.

32
Q

State the cause of Pre, Intra, & Post Renal CRF

A

Pre : Sudden reduction in blood flow in the kidney
– poor cardiac function
– chronic liver failure
– atherosclerosis of the renal arteries
– Intra: changes within the kidneys.
– Examples include: Diabetic nephropathy – most common
cause of CRF, Chronic glomerular nephritis, vasculitis, polycystic kidney disease

33
Q 
What clinical indicators may be used to determine if a patient
has CRF (CKD)? 5 marks
A

Rise in serum creatinine concentration
– Azotaemia (a rise in blood urea nitrogen [BUN] concentration)
– Disturbances in ECF, electrolyte and acid/base homeostasis.
– Oliguria is a common finding but is not always present.
– May be asymptomatic.

34
Q

What risk factors increase the likelihood of the
development of renal carcinoma in a patient? 3
marks

A

– It is twice as common in men than women, with approximately 850 people dying from it each year.
– Although the aetiology is unknown,
a moderate association has been identified between smoking tobacco, hypertension and obesity
and the incidence of renal
carcinoma.

35
Q

What is dialysis and how does it compensate for

decreased kidney function? 4 marks

A

There are two types of dialysis - peritoneal dialysis and haemodialysis.
– In peritoneal dialysis, a catheter is inserted into the abdomen filling the
peritoneal cavity with dialysis solution. The peritoneal membrane is very thin and acts like a filter allowing waste products to pass from the blood vessels
in the peritoneum into the dialysate solution.
– The dialysis fluid is then drained and the used solution containing waste
products is thrown away. The process of draining and filling is called the
exchange and this takes approximately 30 minutes to complete.
– Most patients are required to have four exchanges a day with the solution
remaining in the abdomen for 4 to 6 hours. This form of peritoneal dialysis is
called continuous ambulatory peritoneal dialysis (CAPD). Peritoneal dialysis can also be conducted at night using a machine and is called cycler assisted peritoneal dialysis (CCPD).

36
Q

What is peritoneal dialysis?

A 
Peritoneal dialysis is always done in your home but there are two different types.
Haemodialysis can be done either by you in your home, or by travelling regularly to a
dialysis unit (centre-based haemodialysis).
37
Q

What is haemodialysis?

A

Haemodialysis is a procedure that cleans and filters a patient’s blood. It
removes nitrogen wastes, extra salt and fluid. It also helps the body to
maintain blood pressure and keep the right balance of potassium, sodium
and chloride.
– It removes the blood from an artery usually located in the arm to a machine
and then returns to the body via a vein. Haemodialysis uses a dialyser or special filter to clean the patient’s blood.
– Access to the bloodstream is provided via a fistula, this access can be
internal or external to the body. Haemodialysis can be done at home or at
the centre.
– Home dialysis requires special training. Side effects can be caused by rapid changes in fluid and salt concentrations within the body. Muscle cramps and hypotension are two common side effect

38
Q

What electrolyte imbalances may occur as a result of kidney

disease? 4 marks

A

Hyperkalaemia (kidney cannot excrete potassium) – leads to abdominal
cramping, muscle weakness, paralysis and cardiac arrest.
– *Hypernatraemia (kidney cannot excrete excess sodium) – leads to high
blood pressure, muscle twitching, weakness and disorientation.
– Hypermagnesaemia – leads to a decrease in blood pressure, decreased
heart rate, coma and cardiac arrest.
– Hypocalcaemia – leads to muscle spasms, abnormal heart rhythm and
seizures.
– *Note hyponatraemia is also common in kidney disease indicating that the
kidney’s ability to concentrate urine is affected.

39
Q

What is urinalysis? 1 mark

A

Screening / diagnostic tool.
– Detects substances in urine
associated with renal dysfunction,
UTIs and metabolic disorders

40
Q

Discuss the biochemical changes (changes in electrolytes) that you would expect to see in someone with acute renal failure and chronic renal failure.

A

In renal failure, acute or chronic, one most commonly sees patients who have a tendency to develop hypervolemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and bicarbonate deficiency (metabolic acidosis), increased uric acid, anuria, fluid overload lead to pulmonary oedema, hyperfiltration and back flow (in chronic),
Hypervolemia: When kidneys retain salt, they increase the body’s total sodium content, which increases your fluid content.
Hyperkalemia: excessive potassium

41
Q

Explain why anaemia may occur as a result of chronic kidney disease.

A

Healthy kidneys produce a hormone called erythropoietin (EPO).EPO prompts the bone marrow to make red blood cells, which then carry oxygen throughout the body. When kidneys are diseased or damaged, they do not make enough EPO. As a result, the bone marrow makes fewer red blood cells, causing anemia. When blood has fewer red blood cells, it deprives the body of the oxygen it needs.
Blood loss from haemodialysis can also cause anaemia.

42
Q

Discuss the causes or pre-renal, intrarenal and post-renal acute and chronic kidney injury

A

Pre Renal CFR: poor cardiac function, chronic liver failure, atherosclerosis.

Intrinsic renal failure: caused by changes within the kidneys.

Post renal CFR: obstructions can cause urinary back flow and put pressure on the kidneys.

1005 (6 decks)

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