Renal Failure

Question 1

What is the functional unit of the kidney?

Answer 1

Glomerulus

Question 2

What is polyuria?

Answer 2

Excessive urination

Question 3

What is dysuria?

Answer 3

Pain on urination

Question 4

What is haematuria?

Answer 4

Blood in the urine

Question 5

What is proteinuria?

Answer 5

Protein in the urine

Question 6

What is uraemia?

Answer 6

Urea in the urine

Question 7

How do you measure renal function?

Answer 7

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.

Question 8

What are the characteristics of renal failure?

Answer 8

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)

Question 9

Name the 3 areas that can be affected that lead to an individual developing renal failure.

Answer 9

Pre-renal

renal

Post renal

Question 10

Renal failure can either be..?

Answer 10

Acute - rapid loss of function

Chronic - gradually develops over many years

Question 11

List the pre-renal causes of renal failure.

Answer 11

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.

Question 12

List the renal causes of renal failure.

Answer 12

Chronic disease i.e. diabetes (common)
Trauma
Drug damage

Question 13

List the post-renal causes of renal failure.

Answer 13

Tumours
Enlarged prostate
Kidney stones

Question 14

Is kidney failure reversible?

Answer 14

In the acute stage it can be

Question 15

Describe the stages of acute failure.

Answer 15

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.

Question 16

What is rhabdomyolysis?

Answer 16

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.

Question 17

What causes primary chronic renal failure (rare failure) ?

Answer 17

Glomerulonephritis

Polycystic kidney disease

Question 18

What is glomerulonephritis?

Answer 18

Inflammation of the glomerulus caused by the immune system

Question 19

What do patients with glomerulonephritis present with?

Answer 19

Polyuria and haematuria

Question 20

What can glomerulonephritis progress to?

Answer 20

Nephrotic syndrome

Question 21

How does nephrotic syndrome cause primary chronic failure?

Answer 21

Excessive loss of proteins from urine.

Question 22

What are the consequences of nephrotic syndrome?

Answer 22

Oedema

Hypercoagulation from the dehydration

Question 23

How does polycystic kidney disease lead to primary chronic failure?

Answer 23

The cysts grow on on the kidney and reduce the amount of functional tissue.

Question 24

List the causes of secondary chronic kidney failure.

Answer 24

Diabetes
Drug therapy
Hypertension
Renal artery/aortic disease

Question 25

What drugs should be avoided in renal disease?

Answer 25

NSAIDS!!!!!!!!

Nephrotoxic drugs - cyclosporin

Question 26

What effect do NSAIDs have on the kidneys?

Answer 26

The interstitial nephritis - swelling in the spaces between the kidney tubules.

Inhibit glomerular blood flow

Question 27

Name 2 examples of renal vascular disease.

Answer 27

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.

Question 28

What can the turbulent blood flow around the junction of the renal artery lead to?

Answer 28

Atherosclerosis of the renal artery.

Question 29

How is end stage chronic renal disease determined?

Answer 29

If processing < 15ml/min

If creatinine levels are between 800 - 1000 umol/l

Question 30

What are the symptoms of chronic renal failure?

Answer 30

Insidious - no obvious symptoms initially.

Polyuria
Nocturia
Tired and weak
Nausea

Question 31

What are the signs of chronic renal failure?

Answer 31

Anaemia
Hypertension
Renal bone disease: caused by the associated hyperparathyroidism

Question 32

How do you manage chronic renal failure/end stage failure?

Answer 32

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