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BDS2 BAMS > Renal Medicine > Flashcards

Renal Medicine Flashcards

1
Q

3 tubes leaving kidney

A

artery

vein

ureter

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2
Q

what does the glomerulus filtrate

A

plasma

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3
Q

what does the glomerulus connect to

A

collecting duct

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4
Q

what controls the pressure of glomerulus filtration

A

afferent and efferent blood vessels

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5
Q

what causes changes changes in afferent and efferent blood vessels

A

muscular traps squeeze vessels open and shut so ml/hour constant

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6
Q

what is the effect of the renal artery having a high BP

A

the renal artery will shut off to reduce the pressure going into the glomerulus

maintain same pressure difference despite high BP to maintain filtration

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7
Q

act of renin

A

reduce BP

low BP means short of circulating volume so retain more fluid

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8
Q

how does the glomerulus filtrate

A

it is a membrane with holes in it

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9
Q

what cannot filter through the glomerulus

A

cells and proteins

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10
Q

what does cells and proteins in urine indicate

A

disease

particularly of the glomerulus

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11
Q

what is the role of the collecting duct system

A

secretion and reabsorption of electrolytes

  • modify the electrolyte
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12
Q

what is the role of the collecting tubule

A

fluid reabsorption

  • modify volume
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13
Q

diabetes insipidus

A

pee a lot of normal type urine

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14
Q

polyuria

A

pee too much

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15
Q

dysuria

A

pain when passing urine

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16
Q

haematuria

A

blood in urine

  • microscopic
  • stained red
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17
Q

proteinuria

A

protein in urine

  • should not be if glomerulus is working well
  • holes too small for proteins
  • more leaky if inflammed
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18
Q

uraemia

A

waste products that should be extracted by kidney are not so accumulate in blood

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19
Q

3 measuring renal function

A

serum UREA

serum creatinine

24 hr urine collection

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20
Q

urea level in urine

A

waste product from body
constant level

increase in urea also increase water excretion

  • dehydration
  • poor renal function

not a good marker to use

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21
Q

serum creatinine in urine

A

good general guide to renal function

should be generally low

if kidney not working well then will rise

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22
Q

24hr urine collection

A

Creatinine clearance – best measure

Faff procedure to carry out

EGFR is mainly used in clinic

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23
Q

4 consequences of renal failure

A

loss of renal excretory function

loss of water and electrolyte balance
- cannot modify or concentrate amount in system

loss of acid base balance

  • loss H ions or base
  • compensate by ventilation partially
  • CO2 removal from body is same as removing H ions from Kidney

loss of renal endocrine function

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24
Q

3 endocrine functions of the kidney

A

Erythropoietin
- Become anaemic (lack of RBC)

calcium metabolism

  • less production of vitamin D dependent factors
  • not normal Ca metabolism

renin secretion

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25
Q

2 types of renal failure

A

acute

chronic

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26
Q

acute renal failure

A

rapid loss of renal function

usually over hours or days
- infection
- trauma e.g. accident
muscle injury causes muscle proteins to be broken down and circulate in blood stream to kidneys
swamp glomerulus as too many proteins
block holes so not able to filter plasma effectively
- medicines – can be toxic

sudden and quick

pt notice as become unwell
need tx till kidney can recover

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27
Q

chronic renal failure

A

gradual loss of renal function

usually over many years (10-20years)

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28
Q

3 possible causes of acute renal failure

A

infection

trauma

medicine

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29
Q

3 sites where renal failure can occure

A

pre-renal

renal

post-renal

30
Q

pre-renal causes of renal failure

A

hypoperfusion of the kidney

  • not get enough oxygen
  • not able to metabolise properly
  • significant drop in BP

shock

  • resuscitate but BP low for several hours
  • BP and normal cardiac output is too low

renal artery or Aorta disease
- aneurisms can cause burst
- blood flow to kidney lowers
renal

31
Q

renal causes of renal failure

A

disease of kidney itself
- chronic disease – uncommon

  • drug damage – certain combinations
  • trauma – usually defended due to where they sit anatomically
  • rhabdomyolysis – muscle protein breakdown, block glomerulus

Glomerulonephritis

  • most common in children
  • Autoimmune
  • Inflammation of antibodies to cells in kidney

Renal diabetic disease
- Large cause of renal failure in adults

32
Q

Glomerulonephritis

A
  • most common in renal failure of children
  • Autoimmune
  • Inflammation of antibodies to cells in kidney
33
Q

rhabdomyolysis

A

muscle protein breakdown, block glomerulus

34
Q

post renal causes of renal failure

A

renal outflow obstruction

cannot pee urine out so therefore cannot make more

  • stones
  • prostate blockage of urinary tract (in males)
35
Q

what is the creatinine level in acute renal failure

A

above 200μmol/L

usually 80μmol/L

36
Q

what is the process of acute renal failure

A

Anuric initially (no urine) with volume overload

  • Accumulate fluid
  • —–Ankle oedema (if ambulatory), sacral oedema (if bed bound)
  • Pulmonary oedema & breathlessness
  • Raised Jugular Venous Pressure (JVP)
  • Weight gain

Gradually progresses to polyuria (none to a lot of urine production)

  • Healing restores filtration before concentration ability
  • —–Become dehydrated before concentration ability returns

development of Hyperkalaemia (high K+)

  • Can lead to cardiac arrest
  • —-K makes nerves excitable or unexcitable
  • —–Needed to make muscles contract

development of Uraemia and Acidosis (slower process)

  • High urea
  • low bicarbonate
  • increased respiratory excretion of CO2
37
Q

4 disease stages of acute renal failure

A

anuric (no urine) with volume overload

gradually progresses to polyuria

development of hyperkalaemia (high K+)

deverlopment of uraemia and acidosis

38
Q

most common way to treat acute renal failure

A

Usually pre-renal cause
- Catastrophic drop in BP

Give support till kidney function comes back and then recover

Usually reversible with time 
Renal support until recover 
- Dialysis 
-------Artificial replacement of some aspects of renal function
- Nutrition
39
Q

primary causes of chronic renal failure

A

Glomerulonephritis

Polycystic kidney disease

40
Q

primary chronic renal failure cause site

A

kidney itself

41
Q

secondary chronic renal failure causes

A

Diabetes (30%)

Hypertension (20%)

Drug therapy

Vasculitis

Renal artery disease/aorta disease

42
Q

glomerulonephritis signs

A

Haematuria/proteinuria
- glomerulus inflamed, spaced between holes become decreased, so increased leaking of blood cells and protein

Gradual progression to

  • Hypertension
  • —–Overactive system angiotensin system
  • Chronic renal failure
  • ——gradually destroying glomerulus
43
Q

nephrotic syndrome is

A

complication of Glomerulonephritis

  • excessive loss of protein in urine (>3g in 24hrs)
  • —-hypoalbuminaemia
  • loss of plasma oncotic pressure
  • —-suck of fluid into BV is reduced so not get fluid moving into BV from tissue
  • tissue swelling (oedema)

Hypercoagulable state

  • Loss of clotting factor proteins – AT3 deficiency
  • dehydration raises other coagulation factors concentrations
44
Q

nephrotic syndrome signs (4)

A

excessive loss of protein in urine (>3g in 24hrs)
—–hypoalbuminaemia

loss of plasma oncotic pressure
—–suck of fluid into BV is reduced so not get fluid moving into BV from tissue

tissue swelling (oedema)

Hypercoagulable state

  • Loss of clotting factor proteins – AT3 deficiency
  • dehydration raises other coagulation factors concentrations
45
Q

2 drugs that impact renal disease

A

NSAIDs

Nephrotoxic drugs

46
Q

NSAIDs effect on renal disease

A

Inhibit glomerular blood flow
- Opening of BV into glomerulus and closing to keep pressure constant controlled by prostaglandins
Inhibited by NSAID

Cause interstitial nephritis

Avoid in renal disease if possible

47
Q

example of nephrotoxic drug

A

cyclosporin

48
Q

renal vascular disease

A

Reduced blood flow to the kidney

  • Atheroma of renal artery/aorta
  • —-Atherosclerosis of aorta is common cause
  • ——-Worse in narrowing branches

causes:
Hypertension – narrowing of renal artery
-Renal artery is first branch after neck of aorta (atherosclerosis of aorta)

Microangiopathy

49
Q

microangiopathy is

A
  • Immune reaction causing small blood vessel damage, RBC damage and thrombosis microscopic stop of BV
  • E Coli 0157
50
Q

2 causes of renal valvular dusease

A

Hypertension – narrowing of renal artery
-Renal artery is first branch after neck of aorta (atherosclerosis of aorta)

microangiopathy

51
Q

renal artery disease is

A

Junction of renal artery Comes off at 90 degrees
- Flow hard
so Damage to surrounding mucosa

Prone to atherosclerosis

  • lead to problems with renal blood flow
  • hypertension
52
Q

3 types of immune mediated renal damage

A

Multiple Myeloma

Goodpasture’s Syndrome

Vasculitis
- SLE and variants Lupus

53
Q

multiple myeloma of the kidney

A

immune mediated renal damage

Plasma cell tumour

  • B cells committed to making antibodies
  • Excess light chain production ‘clogs’ kidney Tubular nephritis results
  • Start to proliferate outwith control
  • —-Make more and more and more
  • Crush and clog up kidney
  • Largely effects bones (more) and kidneys
54
Q

Goodpasture’s syndrome

A

immune mediated renal damage

Anti-glomerular basement membrane antibody (anti-gbm)
- Wrong genetic makeup and - come across infection – make antibody

55
Q

vasculitis

A

immune mediated renal damage
- SLE, lupus

Inflammation of blood vessels – smaller ones tend to clog and shut down if in kidney, causes function issue

56
Q

what causes polycystic kidney disease

A

Gene mutation (PKD1,2 or 3)

  • Inherited (AD or AR) or spontaneous
  • Dominate or recessive
57
Q

what is polycystic kidney disease

A

Multiple cysts in the renal parenchyma

Enlarged kidney (cysts make size increase)

Progressive destruction of normal kidney (squash away remaining functioning kidney tissue)

Gradual renal failure

58
Q

when is end stage renal disease

A

when eGFR is <15ml/min

creatinine is 800-1000μmol/L

59
Q

eGFR

A

estimated glomerular filtration rate

calculated from electrolytes

60
Q

what impacts the time taken to reach end stage renal disease

A
  • underlying cause

- modifying factors

61
Q

what is a normal value for eGFR

A

90ml/min

62
Q

kidney damage stage 1

A

eGFR 90+

normal or minimal kidney damage with normal GFR

63
Q

kidney damage stage 2

A

eGFR 60-86ml/min

mild decrease in GFR

64
Q

kidney damage stage 3

A

eGFR 30-59ml/min

mild decrease in GFR

65
Q

kidney damage stage 4

A

eGFR 15-29ml/min

severe decrease in GFR

66
Q

kidney damage stage 5

A

eGFR <15ml/min

kidney failure

protein or albumin in urine are high, cells or casts seen in urine

67
Q

4 ways to manage chronic renal failure

A

reduced the rate of decline

  • Eliminate nephrotoxic drugs
  • —–Non-steroidals taken regularly for rheumatoid - reduce
  • Control hypertension
  • Control diabetes
  • Control vasculitic disease
  • ——Steroids/other immune suppressant drugs

Correct Fluid Balance

  • Restrict fluid intake
  • restrict salt, potassium, protein

Correct deficiencies

  • Anaemia (erythropoietin)
  • Calcium (vitamin D)

REMOVE outflow obstruction

  • Renal stones (calculi)
  • prostate enlargement

TREAT infection

  • Chronic renal system infection
  • —Make progressively worse
  • — Speed up rate to complete failure
68
Q

3 signs of chronic renal failure

A

anaemia

hypertension
- caused by renal failure but also causes renal failure

renal bone disease

  • low Ca, high PO4
  • hyperparathyroidism
  • osteomalacia
  • —-caused by low Ca level  resorption of bone
69
Q

symptoms of chronic renal failure

A

Insidious

  • May be few
  • Non-specific, hard for pt to define, over long time maybe unnoticed

Polyuria

Nocturia

Tired and weak

nausea

70
Q

what is the purpose of carrying out renal replacement therapy

A

replace functions of the kidney
- not a cure

always have health deficit if kidneys not woring

71
Q

2 types of renal malignancy

A

Renal Cell Carcinoma

  • Renal tubular cell tumour
  • Abdominal mass & haematuria
  • Commoner in men, smokers
  • Hypertension (renin) polycythaemia (EPO)

Transitional Cell carcinoma

  • Usually bladder – ureter/kidney possible
  • Haematuria – often asymptomatic
72
Q

dentistry and renal disease

A

Few direct oral problems

General health may dictate treatment timing

CARE with prescribing

  • CHECK all drugs with renal physician
  • avoid NSAIDs, some tetracyclines
  • reduce dose of most others

growth may be slow in children
- tooth eruption may be delayed

secondary effects of anaemia

  • Oral ulceration
  • ‘dysaesthesias’ – painful mucosa and tongue

white patches
- uraemic stomatitis

oral opportunistic infections

  • Fungal and viral infections/reactivations
  • Prone to post-op infections

dry mouth & taste disturbance
- fluid restriction and electrolyte disturbance

bleeding tendencies
- Platelet dysfunction

renal osteodystrophy - lamina dura lost

  • bony radiolucency
  • Secondary hyperparathyroidism increases osteoclast activity

BDS2 BAMS (54 decks)

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