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GI/GU Illness > Renal Failure and Cystic Renal Disease > Flashcards

Renal Failure and Cystic Renal Disease Flashcards

1
Q

What ways can glomerulus fail? (2)

A
  1. barrier failure

2. filtration failure

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2
Q

What ways can tubules fail? (2)

A
  1. blockage

2. leakage

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3
Q

What are the manifestations of renal disease? (8)

A
  1. hypertension
  2. ansarca - extreme oedema
  3. azotaemia
  4. uraemia
  5. acute kidney injury
  6. anuria
  7. polyuria
  8. chronic kidney disease
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4
Q

What is anasarca?

A

extreme oedema due to extracellular fluid accumulation related to fluid overload and decreased oncotic pressure

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5
Q

What is azotaemia?

A

kidneys are no longer able to get rid of nitrogen waste

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6
Q

What blood changes are seen in azotaemia?

A
  1. increased serum urea
  2. increased creatine
  3. decreased GFR
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7
Q

What is uraemia?

A

sufficient azotaemia to cause clinical signs and symptoms

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8
Q

What is acute kidney injury?

A

a rapid decrease in GFR in hours to days

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9
Q

What is anuria?

A

less than 50mL of urine passed a day

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10
Q

What is oliguria?

A

less than 300mL of urine passed a day

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11
Q

What is polyuria?

A

more than 300mL or urine passed a day

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12
Q

What is chronic kidney disease?

A

abnormality of the kidney structure or function for more than 3 months

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13
Q

What are the clinical symptoms of uraemia? (7)

A
  1. malaise
  2. aches and pains
  3. fatigue
  4. cognitive slowing
  5. anorexia
  6. nausea
  7. weight loss
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14
Q

How can uraemia lead to cardiovascular disease? (2)

A
  1. endothelial dysfunction

2. dyslipidaemia

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15
Q

What serositis manifestations of uraemia are there? (3)

A
  1. pericarditis
  2. peritonitis
  3. pleuritis
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16
Q

What are the skin manifestations of uraemia? (5)

A
  1. itch
  2. discolouration
  3. dryness
  4. pallor
  5. bruising
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17
Q

What are the neurological manifestations of uraemia?

A
  1. peripheral neuropathy
  2. hiccups
  3. muscle cramps
  4. seizures
  5. drowsiness
  6. coma
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18
Q

In healthy individuals when does urea and creatine rise in response to GFR falling?

A

urea and creatine only start to rise when the GFR falls to 40-50% of previous levels

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19
Q

What are bloods like during a decrease in renal reserve?

A

bloods are normal

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20
Q

What is detectable during renal insufficiency? (3)

A
  1. abnormal bloods
  2. no symptoms or signs
  3. GFR 20-50% of normal
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21
Q

What is detectable during renal failure? (3)

A
  1. abnormal bloods
  2. symptoms and signs or uraemia
  3. GFR less than 20% of normal
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22
Q

What is detectable during end stage renal disease? (4)

A
  1. abnormal bloods
  2. symptoms and signs of uraemia
  3. death predicted imminently
  4. GFR less than 5% of normal
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23
Q

How is renal disease assessed? (11)

A
  1. history
  2. physical examination
  3. urine dipstick
  4. urine microscopy
  5. 24 hour urine collection
  6. urea
  7. creatinine
  8. full blood count
  9. serology
  10. imagine
  11. renal biopsy
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24
Q

What can you see using urine microscopy?

A
  1. RBCs and morphology
  2. WBCs
  3. tubular cells
  4. Casts
  5. crystals
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25
Q

How is a renal biopsy done?

A

ultrasound guided

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26
Q

What is done with the three parts of the kidney biopsy? (3)

A
  1. formalin fixation and paraffin embedding for routine light microscopy
  2. frozen for direct immunofluorescence
  3. glutaraldehyde for electron microscopy
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27
Q

What type of damage is seen when looking at the glomeruli biopsy (2)

A
  1. immunologic

2. microvaqscular and endothelial processes

28
Q

What type of damage is seen when looking at the tubules biopsy? (3)

A
  1. toxic
  2. ischaemic
  3. infectious
29
Q

What type of damage is seen when looking at the interstitium in a renal biopsy? (3)

A
  1. toxic
  2. allergic
  3. infectious
30
Q

What type of damage is seen when looking at the vessels in a renal biopsy? (2)

A
  1. haemodynamic

2. pressure

31
Q

What does atrophy and fibrosis/sclerosis look like on a renal biopsy?

A

loss of specialist cells

32
Q

How does lots of inflammation and little fibrosis impact treatment of kidney disease?

A

treating the cause of inflammation has potential for significant return of function

33
Q

How does little inflammation and lots of fibrosis impact treatment of kidney disease?

A

treating the cause may help but it won’t reverse the chronic scarring

34
Q

What is acute kidney injury?

A

Sudden loss of renal function over days or weeks often reversible over 7-21 days

35
Q

What is acute kidney injury associated with in terms of urine volume and creatinine?

A

reduction in urine volume or rising serum creatinine

36
Q

What is acute kidney injury commonly associated with? (4)

A
  1. hyperkalaemia
  2. oedema
  3. acidosis
  4. hyponatraemia
37
Q

What is acute kidney injury less associated?

A

uraemia

38
Q

What is the prognosis if acute kidney injury is uncomplicated?

A

good prognosis

39
Q

What is the prognosis if there is a serious infection or multiorgan failure associated with acute kidney injury?

A

50-70% mortality

40
Q

What is recovery of acute kidney injury associated with?

A

a period of diuresis/polyuria due to recovering tubules not yet concentrating the returning filtrate and may require electrolyte management

41
Q

What are the mechanisms of acute kidney injury? (5)

A
  1. pre-renal
  2. post-renal
  3. renal
  4. tubular
  5. glomerular
42
Q

What is a pre-renal impairment?

A

a perfusion impairment

43
Q

What are the causes of pre-renal impairment? (5)

A
  1. shock
  2. dehydration
  3. cardiac failure
  4. vascular occlusion
  5. microcirculatory dysfunction
44
Q

What are the characteristics of pre-renal impairment? (3)

A
  1. urinary Na+ is low
  2. urea:creatine ratio is more than 20
  3. improves with fluid restoration
45
Q

What is a renal impairment?

A

a functional impairment

46
Q

What are the causes of renal impairment? (4)

A
  1. small vessel vasculitis
  2. glomerulonephritis
  3. tubular injury
  4. interstitial nephritis
47
Q

What are the characteristic features of renal impairment? (2)

A
  1. kidneys often swollen

2. fluid supplementation exacerbates fluid overload

48
Q

What is a post-renal impairment?

A

an obstruction

49
Q

What are the causes of a post-renal impairment? (4)

A
  1. stones
  2. retroperitoneal fibrosis
  3. prostatic and cervical disease
  4. urethral and meatal problems
50
Q

What are the main categories of the intrinsic renal causes of acute kidney injury?

A
  1. ischaemic and nephrotoxic acute tubular injury/necrosis
  2. diseases of large vessels
  3. diseases of renal microcirculation and glomeruli
  4. tubulointerstitial inflammation
51
Q

What are the causes of chronic renal disease? (7)

A
  1. congenital and inherited
  2. renovascular disease
  3. hypertension
  4. primary glomerular disease
  5. interstitial diseases
  6. systemic inflammatory disease
  7. diabetes
52
Q

What is autosomal dominant polycystic kidney disease?

A

adult form of polycystic kidney disease

53
Q

What happens during autosomal dominant PCKD?

A

as cysts expand the renal parenchyma is progressively displaced and destroyed

54
Q

What are the mutations associated with autosomal dominant PCKD?

A
  1. PKD1 - polycystin 1 chromosome 16

2. PKD1 - polycystin 2 chromosome 4

55
Q

What are the complications of autosomal dominant PCKD? (2)

A
  1. hepatic cysts

2. berry aneurysms

56
Q

What is the clinical presentation of ad PCKD? (6)

A
  1. haematuria
  2. flank pain
  3. infection
  4. stones
  5. hypertension
  6. renal failure
57
Q

Which ADPCKD mutation presents earlier and progresses more quickly?

A

PKD1

58
Q

What inheritance pattern does childhood PCKD have?

A

autosomal recessive

59
Q

What mutation is associated with childhood PCKD?

A

PKHD1

60
Q

What are the complications of childhood PCKD? (4)

A
  1. hepatic fibrosis
  2. bile duct extasia
  3. death in infancy/childhood
  4. end stage renal disease
61
Q

What are the kidneys like in childhood PCKD?

A
  1. kidneys are enlarged at birth
  2. smooth external contour
  3. sponge like
  4. small and perpendicular slits
62
Q

What are the medullary cystic kidney diseases? (3)

A
  1. adult onset medullary cystic disease
  2. familial juvenile nephronophthisis
  3. medullary sponge kidney
63
Q

What genes are responsible to adult onset medullary cystic disease? (2)

A
  1. MCKD1

2. MCKD2

64
Q

What is the clinical presentation of adult onset medullary cystic disease? (6)

A
  1. corticomedullary cysts
  2. shrunken kidneys
  3. tubular dysfunction
  4. salt wasting
  5. polyuria
  6. adulthood renal failure
65
Q

What is the clinical presentation of familial juvenile nephronophthisis? (6)

A
  1. corticomedullary cysts
  2. shrunken kidneys
  3. tubular dysfunction
  4. salt wasting
  5. polyuria
  6. childhood renal failure
66
Q

What is seen in medullary sponge kidney?

A

cysts in papillary medulla on excretory urography

GI/GU Illness (15 decks)

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