Renal Failure Flashcards

1
Q

What is the functional unit of the kidney?

A

Glomerulus

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2
Q

What is polyuria?

A

Excessive urination

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3
Q

What is dysuria?

A

Pain on urination

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4
Q

What is haematuria?

A

Blood in the urine

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5
Q

What is proteinuria?

A

Protein in the urine

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6
Q

What is uraemia?

A

Urea in the urine

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7
Q

How do you measure renal function?

A

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.

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8
Q

What are the characteristics of renal failure?

A

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)

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9
Q

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

A

Pre-renal

renal

Post renal

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10
Q

Renal failure can either be..?

A

Acute - rapid loss of function

Chronic - gradually develops over many years

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11
Q

List the pre-renal causes of renal failure.

A

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.

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12
Q

List the renal causes of renal failure.

A

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

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13
Q

List the post-renal causes of renal failure.

A

Tumours
Enlarged prostate
Kidney stones

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14
Q

Is kidney failure reversible?

A

In the acute stage it can be

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15
Q

Describe the stages of acute failure.

A

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.

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16
Q

What is rhabdomyolysis?

A

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.

17
Q

What causes primary chronic renal failure (rare failure) ?

A

Glomerulonephritis

Polycystic kidney disease

18
Q

What is glomerulonephritis?

A

Inflammation of the glomerulus caused by the immune system

19
Q

What do patients with glomerulonephritis present with?

A

Polyuria and haematuria

20
Q

What can glomerulonephritis progress to?

A

Nephrotic syndrome

21
Q

How does nephrotic syndrome cause primary chronic failure?

A

Excessive loss of proteins from urine.

22
Q

What are the consequences of nephrotic syndrome?

A

Oedema

Hypercoagulation from the dehydration

23
Q

How does polycystic kidney disease lead to primary chronic failure?

A

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

24
Q

List the causes of secondary chronic kidney failure.

A

Diabetes
Drug therapy
Hypertension
Renal artery/aortic disease

25
What drugs should be avoided in renal disease?
NSAIDS!!!!!!!! Nephrotoxic drugs - cyclosporin
26
What effect do NSAIDs have on the kidneys?
The interstitial nephritis - swelling in the spaces between the kidney tubules. Inhibit glomerular blood flow
27
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.
28
What can the turbulent blood flow around the junction of the renal artery lead to?
Atherosclerosis of the renal artery.
29
How is end stage chronic renal disease determined?
If processing < 15ml/min If creatinine levels are between 800 - 1000 umol/l
30
What are the symptoms of chronic renal failure?
Insidious - no obvious symptoms initially. Polyuria Nocturia Tired and weak Nausea
31
What are the signs of chronic renal failure?
Anaemia Hypertension Renal bone disease: caused by the associated hyperparathyroidism
32
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