Renal Medicine Flashcards
1
Q
3 tubes leaving kidney
A
artery
vein
ureter
2
Q
what does the glomerulus filtrate
A
plasma
3
Q
what does the glomerulus connect to
A
collecting duct
4
Q
what controls the pressure of glomerulus filtration
A
afferent and efferent blood vessels
5
Q
what causes changes changes in afferent and efferent blood vessels
A
muscular traps squeeze vessels open and shut so ml/hour constant
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
7
Q
act of renin
A
reduce BP
low BP means short of circulating volume so retain more fluid
8
Q
how does the glomerulus filtrate
A
it is a membrane with holes in it
9
Q
what cannot filter through the glomerulus
A
cells and proteins
10
Q
what does cells and proteins in urine indicate
A
disease
particularly of the glomerulus
11
Q
what is the role of the collecting duct system
A
secretion and reabsorption of electrolytes
- modify the electrolyte
12
Q
what is the role of the collecting tubule
A
fluid reabsorption
- modify volume
13
Q
diabetes insipidus
A
pee a lot of normal type urine
14
Q
polyuria
A
pee too much
15
Q
dysuria
A
pain when passing urine
16
Q
haematuria
A
blood in urine
- microscopic
- stained red
17
Q
proteinuria
A
protein in urine
- should not be if glomerulus is working well
- holes too small for proteins
- more leaky if inflammed
18
Q
uraemia
A
waste products that should be extracted by kidney are not so accumulate in blood
19
Q
3 measuring renal function
A
serum UREA
serum creatinine
24 hr urine collection
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
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
22
Q
24hr urine collection
A
Creatinine clearance – best measure
Faff procedure to carry out
EGFR is mainly used in clinic
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
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
25
2 types of renal failure
acute
chronic
26
acute renal failure
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
27
chronic renal failure
gradual loss of renal function
usually over many years (10-20years)
28
3 possible causes of acute renal failure
infection
trauma
medicine
29
3 sites where renal failure can occure
pre-renal
renal
post-renal
30
pre-renal causes of renal failure
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
renal causes of renal failure
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
Glomerulonephritis
- most common in renal failure of children
- Autoimmune
- Inflammation of antibodies to cells in kidney
33
rhabdomyolysis
muscle protein breakdown, block glomerulus
34
post renal causes of renal failure
renal outflow obstruction
cannot pee urine out so therefore cannot make more
- stones
- prostate blockage of urinary tract (in males)
35
what is the creatinine level in acute renal failure
above 200μmol/L
usually 80μmol/L
36
what is the process of acute renal failure
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
4 disease stages of acute renal failure
anuric (no urine) with volume overload
gradually progresses to polyuria
development of hyperkalaemia (high K+)
deverlopment of uraemia and acidosis
38
most common way to treat acute renal failure
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
primary causes of chronic renal failure
Glomerulonephritis
| Polycystic kidney disease
40
primary chronic renal failure cause site
kidney itself
41
secondary chronic renal failure causes
Diabetes (30%)
Hypertension (20%)
Drug therapy
Vasculitis
Renal artery disease/aorta disease
42
glomerulonephritis signs
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
nephrotic syndrome is
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
nephrotic syndrome signs (4)
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
2 drugs that impact renal disease
NSAIDs
Nephrotoxic drugs
46
NSAIDs effect on renal disease
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
example of nephrotoxic drug
cyclosporin
48
renal vascular disease
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
microangiopathy is
- Immune reaction causing small blood vessel damage, RBC damage and thrombosis microscopic stop of BV
- E Coli 0157
50
2 causes of renal valvular dusease
Hypertension – narrowing of renal artery
-Renal artery is first branch after neck of aorta (atherosclerosis of aorta)
microangiopathy
51
renal artery disease is
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
3 types of immune mediated renal damage
Multiple Myeloma
Goodpasture’s Syndrome
Vasculitis
- SLE and variants Lupus
53
multiple myeloma of the kidney
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
Goodpasture's syndrome
immune mediated renal damage
Anti-glomerular basement membrane antibody (anti-gbm)
- Wrong genetic makeup and - come across infection – make antibody
55
vasculitis
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
what causes polycystic kidney disease
Gene mutation (PKD1,2 or 3)
- Inherited (AD or AR) or spontaneous
- Dominate or recessive
57
what is polycystic kidney disease
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
when is end stage renal disease
when eGFR is <15ml/min
| creatinine is 800-1000μmol/L
59
eGFR
estimated glomerular filtration rate
calculated from electrolytes
60
what impacts the time taken to reach end stage renal disease
- underlying cause
| - modifying factors
61
what is a normal value for eGFR
90ml/min
62
kidney damage stage 1
eGFR 90+
normal or minimal kidney damage with normal GFR
63
kidney damage stage 2
eGFR 60-86ml/min
mild decrease in GFR
64
kidney damage stage 3
eGFR 30-59ml/min
mild decrease in GFR
65
kidney damage stage 4
eGFR 15-29ml/min
severe decrease in GFR
66
kidney damage stage 5
eGFR <15ml/min
kidney failure
protein or albumin in urine are high, cells or casts seen in urine
67
4 ways to manage chronic renal failure
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
3 signs of chronic renal failure
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
symptoms of chronic renal failure
Insidious
- May be few
- Non-specific, hard for pt to define, over long time maybe unnoticed
Polyuria
Nocturia
Tired and weak
nausea
70
what is the purpose of carrying out renal replacement therapy
replace functions of the kidney
- not a cure
always have health deficit if kidneys not woring
71
2 types of renal malignancy
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
dentistry and renal disease
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
