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Pharmacy Stage 2 > Renal Failure > Flashcards

Renal Failure Flashcards

1
Q

what are the two layers of the interior kidney called?

A
  1. outer cortex

2. inner medulla

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2
Q

80% of the nephrons are called what?

A

cortical as they’re located in the cortex

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3
Q

20% of the nephrons are called what?

A

juxtamedulla as they’re located in the medulla

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4
Q

describe the structure of the nephron?

A
  1. bowman’s capsule surrounding a network of capillaries known as the glomerulus - site of ultrafiltration - (bowman’s capsule and glomerulus form the renal corpuscle)
  2. fluid flows into proximal tubule then into the loop of Henle.
  3. FLuid passes into distal tubue
  4. Distal tubules of up to 8 nephrons drain into a single larger tubule called the collecting duct passing from the corteex into the medulla.
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5
Q

what are the 4 processes of a nephron?

A
  1. Filtration
  2. Excretion
  3. Reabsorption
  4. Secretion
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6
Q

how do you calculate the amount of excretion via urine?

A

(amount filtered) - (amount reabsorbed + amount secreted)

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7
Q

how do you calculate clearance?

A

(urine conc X urine fow rate) / (plasma conc)

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8
Q

what is the normal creatinine clearance value?

A

89-137 mL/min

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9
Q

who has a higher GFR, larger or smaller patients?

A

Larger patients due to having a larger kidney

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10
Q

what is used to compensate for patient size when measuring patient glomerular filtration rate?

A

the body surface area is taken into consideration

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11
Q

what are the functions of the kidneys?

A
  1. Homeostatic regulation of water and ion content of the blood
  2. Excretion of metabolic waste
  3. Production of Hormones
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12
Q

what is renal failure?

A

failure of filtration

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13
Q

what are the kidney disease classifications?

A 
Mild: 60 - 89 mL/min/1.73m2
Moderate: 30 - 59 mL/min/1.73m2
Severe: 15 - 29 mL/min/1.73m2
Kidney failure: <15 mL/min/1.73m2
(The values are GFR)
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14
Q

how can we detect renal failure?

A

by the presence of urea in blood (uraemia)

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15
Q

what are the types of renal failure?

A
  1. Acute renal failure
  2. Chronic renal failure: long standing loss of renal function
    that is usually progressive
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16
Q

what is acute renal function?

A

Deterioration in renal function that is usually reversible over
a period of days or weeks

17
Q

what are symptoms of acute renal failure to help with diagnosis?

A

uraemia (urea in blood) and oligouria (uria in urine)

18
Q

what are the causes of acute renal failure grouped into?

A
  1. pre-renal
  2. renal
  3. post renal
19
Q

what is pre-renal acute injury?

A

when there is a large fall in blood pressure which can not be compensated for hence reducing glomerular filtration rate causing pre-renal injury

20
Q

what causes pre-renal acute injury?

A

impaired perfusion of the kidneys

21
Q

what conditions cause pre-renal acute injury which can lead to kidney damage and/or chronic renal failure?

A 
• Hypovolaemia
• Hypotension
• Heart failure(reduced cardiac output)
• Vascular disease that limits renal blood
flow
• Drugs that impair renal autoregulation
(NSAIDS, ACE inhibitors)
22
Q

what causes post-renal acute injury?

A

obstruction of the urinary tract by (calculus, blood clot or bladder tumour)

23
Q

what causes renal acute injury?

A 
(Cellular damge/intrinsic)
• Renal parenchymal
disease
- secondary to diseases that affect vascular system
• Glomerulonephritis
- Autoimmune (e.g. Lupus)
• Acute tubular necrosis
- caused by renal ischaemia, drugs
that cause renal toxicity
(aminoglycosides, Li+).
- All cause tubule cell injury
24
Q

what is chronic renal disease?

A

long standing and progressive decline in renal function

25
Q

what are the signs and symptoms of chronic renal failure?

A

• Fluid retention causing swelling in the ankles during day
• Fluid in lungs (pulmonary oedema)
• High blood pressure
• (hyperkalemia) – life threatening emergency since will
impair cardiac function
• Cardiovascular disease – can be secondary to renal disease and vice versa
• Weak bones and an increased risk of bone fractures
• Anemia
• Irreversible damage to your kidneys

26
Q

what are the causes of renal disease?

A
  1. associated with another pathology
  2. glomerulonephritis
  3. Interstitial nephritis
  4. prolonged obstruction of the urinary tract
  5. vesicoureteral reflux
  6. recurrent kidney infection
27
Q

what causes anaemia?

A
  • erythropoietin deficiency
  • Substances toxic to bone marrow not excreted
    -Incorrect regulation of iron, vitamin B12 and folate levels
  • Increased red cell destruction and red cell fragility
  • ACE inhibitors may cause anaemia by interfering
    with erythropoietin release
28
Q

what causes bone disease?

A

-kidneys play a role in vitamin D metabolism
-kidney disease leads to reduced production of 1α hydrolase
-this reduces the conversion of 25-(OH)2D3 to more active 1,25-
(OH)2D3
-therefore tthere’s malabsorption of Ca2+ in the gut
-Leads to demineralisation of bone and fibrosis of bone
marrow
-this affects red blood cells

29
Q

what causes endocrine dysfunction?

A
  • Decreased testosterone production in males
  • Decreased estrogen levels in females
  • Alterations in thyroid hormone levels
30
Q

what causes skin disease?

A
  • Retention of nitrogenous waste products leads to pruritis (itching)
  • In dialysis patients itching is a sign of incomplete dialysis
31
Q

what are some Gastrointestinal complications?

A
  • Increased risk of peptic ulceration
  • Increased risk of acute pancreatitis
  • Constipation and diarrhoea
32
Q

what are some Metabolic complications?

A
  1. Gout - caused by retention of urate which accumulates in joints as crystals
  2. Severe and very painful arthritis
  3. Alterations in Insulin metabolism
  4. Abnormal lipid metabolism (can cause hypercholesterolaemia)
33
Q

what are the treatment strategies for chronic renal disease?

A
  1. controlling blood pressure
  2. frequent blood tests to monitor electrolyte levels
  3. ACE inhibitor or ARB or diuretics for lowering blood pressure
  4. Statins to lower cholesterol
  5. erythopoietin stimulate RBC production
  6. Calcium and vitamin D supplements to prevent weak bones and lower risks of fracture
  7. Low protein to minimize nitrogenous waste products in your blood

Pharmacy Stage 2 (85 decks)

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