Renal Failure

Question 1

What parameter do you use to define the function of the kidney?

Answer 1

GFR

Question 2

What parameter provides a clinical representation of GFR?

Answer 2

Plasma creatinine

Question 3

What is the normal range for plasma creatinine?

Answer 3

50-120uM/L

Question 4

Is ARF always symptomatic?

Answer 4

No, sometimes asymptomatic

Question 5

What level of urine output per day indicates renal failure?

Answer 5

<500 mL

Question 6

What can make urea high?

Answer 6

High protein diet

Bleeding into gut > more protein absorbed

Catabolic states (eg infection)

Question 7

What can make plasma urea low?

Answer 7

Malnutrition

Liver Disease

Question 8

Is creatinine of 110uM/L in an frail old lady ok?

Answer 8

No, should be on the lower end of the range give her low muscle mass

Question 9

Why isn’t urine urea a good marker of GFR?

Answer 9

Because it is dependent on other variables

Question 10

T/F Being obese is a risk factor for renal failure?

Answer 10

False

Question 11

What are two risk factors for acute renal failure?

Answer 11

>60 years old

Pre-existing renal disease

Question 12

What systemic perfusion pressure must be maintained for proper GFR?

Answer 12

>70mmHg

Question 13

Below what glomerular hydrostatic pressure will ARF occur?

Answer 13

<45mmHg

Question 14

T/F NSAIDs can cause pre-renal ARF

Answer 14

True, block prostaglandins required for afferent arteriole dilation

Question 15

How do ACE inhibitors effect GFR?

Answer 15

Angiotensin is required for constriction of efferent arteriole - knocking that out causes a drop in GFR

Question 16

What is the most accurate measure of daily fluid balance?

Answer 16

Daily body weight measurement

Question 17

Why do people on diets lose water weight?

Answer 17

Aldosterone drops and Na and water retention falls

Question 18

What is the most common intra-renal cause of AFR?

Answer 18

Acute tubular necrosis

Question 19

Why does diuresis (increase/excessive production of urine) sometimes occur after acute tubular necrosis?

Answer 19

Filtration and secretion returns but reabsorption doesn’t return to full function and lots of urine is excreted

Question 20

What are 4 causes of post-renal ARF?

Answer 20

Stones

Clots

Tumours

Fibrosis

Question 21

Which of these can cause anuria?

Glomerulonephritis

Renal artery occlusion

Prostatic malignancy

Interstitial nephritis

Answer 21

Renal artery occlusion

Prostatic malignancy

Glomerulonephritis

Question 22

What are some short term consequences of ARF?

Answer 22

Acidosis

Sodium and Water retention

Question 23

T/F Chronic renal failure has reversible loss of renal function

Answer 23

False, it’s irreversible loss

Question 24

What happens to the remaining nephrons as other die off during ageing?

Answer 24

They hypertrophy

Question 25

What is glomerular hyperfiltration?

Answer 25

Compensation in other nephrons due to loss of nephrons

Question 26

What are the consequences of glomerular hyperfiltration?

Answer 26

Loss of functional reverse Glomerular hypertension Further damage and glomerulosclerosis

Question 27

What is glomerulosclerosis?

Answer 27

Fibrosis and scarring of the nephrons due to hypertension and excess filtration

Question 28

What does uremia in the context of chronic renal failure mean?

Answer 28

Build of toxins (predominantly urea) due to loss of kidney function

Question 29

What are some common causes of CRF?

Answer 29

Diabetes High BP chronic glomerulonephritis Cystic disease

Question 30

What is polyuria?

Answer 30

Passing lots of dilute urine