Renal Failure Flashcards
What is the functional unit of the kidney?
Glomerulus
What is polyuria?
Excessive urination
What is dysuria?
Pain on urination
What is haematuria?
Blood in the urine
What is proteinuria?
Protein in the urine
What is uraemia?
Urea in the urine
How do you measure renal function?
Serum urea - urea in the blood
These level can be elevated in dehydrated patients
Serum creatinine - creatinine in the blood.
These levels are high in disease.
24 urine collection - best way to measure function.
Used to measure the clearance of creatinine.
What are the characteristics of renal failure?
Loss of excretory function
Loss of acid base balance
Loss of water and electrolyte balance
Loss of renal endocrine function:
Reduced production of erythropoietin = reduced RBCs
Reduced production of renin = unregulated BP
Reduced calcium metabolism (from reduced vitamin D conversion)
Name the 3 areas that can be affected that lead to an individual developing renal failure.
Pre-renal
renal
Post renal
Renal failure can either be..?
Acute - rapid loss of function
Chronic - gradually develops over many years
List the pre-renal causes of renal failure.
Aortic/renal artery disease
Disrupted blood flow due to illness or injury.
Shock - Sudden loss of BP means that there is a reduction in cardiac output, blood flow is prioritised to other organs before the kidneys.
List the renal causes of renal failure.
Chronic disease i.e. diabetes (common)
Trauma
Drug damage
List the post-renal causes of renal failure.
Tumours
Enlarged prostate
Kidney stones
Is kidney failure reversible?
In the acute stage it can be
Describe the stages of acute failure.
Anuric - no passage of urine
= ankle oedema
= pulmonary oedema
(weight gain from the oedema)
Polyuria - excessive urine
Hyperkalaemia - can lead to cardiac arrest.
(High concentration of K leads to excitability of the cardiac muscle tissue which makes it difficult to maintain normal cardiac rhythm)
Uraemia and acidosis:
= increased respiratory rate as the body has an increased need for CO2 to be expelled.
What is rhabdomyolysis?
When individual receives a crushing injury the damaged muscles release proteins which get carried through the blood stream to the kidney.
These proteins block the membrane in the glomerulus = failure of the kidney.
What causes primary chronic renal failure (rare failure) ?
Glomerulonephritis
Polycystic kidney disease
What is glomerulonephritis?
Inflammation of the glomerulus caused by the immune system
What do patients with glomerulonephritis present with?
Polyuria and haematuria
What can glomerulonephritis progress to?
Nephrotic syndrome
How does nephrotic syndrome cause primary chronic failure?
Excessive loss of proteins from urine.
What are the consequences of nephrotic syndrome?
Oedema
Hypercoagulation from the dehydration
How does polycystic kidney disease lead to primary chronic failure?
The cysts grow on on the kidney and reduce the amount of functional tissue.
List the causes of secondary chronic kidney failure.
Diabetes
Drug therapy
Hypertension
Renal artery/aortic disease
What drugs should be avoided in renal disease?
NSAIDS!!!!!!!!
Nephrotoxic drugs - cyclosporin
What effect do NSAIDs have on the kidneys?
The interstitial nephritis - swelling in the spaces between the kidney tubules.
Inhibit glomerular blood flow
Name 2 examples of renal vascular disease.
Reduced blood flow to the kidneys.
Caused by;
Atheroma of the renal artery/aorta
Hypertension and narrowing of the renal artery
Microangiopathy (immune reaction attacks small blood vessels and the RBCs)
= Causes thrombosis which can lead to renal vascular disease.
What can the turbulent blood flow around the junction of the renal artery lead to?
Atherosclerosis of the renal artery.
How is end stage chronic renal disease determined?
If processing < 15ml/min
If creatinine levels are between 800 - 1000 umol/l
What are the symptoms of chronic renal failure?
Insidious - no obvious symptoms initially.
Polyuria
Nocturia
Tired and weak
Nausea
What are the signs of chronic renal failure?
Anaemia
Hypertension
Renal bone disease: caused by the associated hyperparathyroidism
How do you manage chronic renal failure/end stage failure?
Reduce the rate of decline via; Eliminate nephrotoxic drugs (esp NSAIDs) Control diabetes Control hypertension Control vasculititic disease
Correct fluid balance:
Restrict fluid intake
Restrict salt, potassium and fluid intake.
Correct deficiencies:
Anaemia from the reduction in erythropoietin synthesis
Calcium from the reduction in vitamin D conversion.
Remove outflow obstructions:
Kidney stones
Prostate enlargement
Treat the infection
