Renal System

Question 1

Discuss the biochemical changes (changes in electrolytes) that you would expect to see in someone with acute renal failure and chronic renal failure

Answer 1

• hypervolemia,
• hyperkalemia,
• hyperphosphatemia,
• hypocalcemia, and
• bicarbonate deficiency (metabolic acidosis)

Question 2

Discuss the progression of chronic kidney disease

Answer 2

Stage 1: normal kidney function
- normal/relatively high GFR (>90 ml/min)

Stage 2: mild kidney damage
- mild reduction in GFR (60-89 ml/min)

Stage 3: moderate kidney damage
- moderate reduction in GFR (30-59 ml/min)

Stage 4: severe kidney damage
- severe reduction in GFR (15-29ml/min)

Stage 5: end-stage kidney diseae
- established kidney failure (>15ml/min)

Question 3

Factors that contribute to CKD development

Answer 3

• diabetes
• hypertension
• cardiovascular disease
• smoking
• obesity

Question 4

Why may anaemia occur as a result of CKD

Answer 4

Erythropoietin (EPO) is a hormone produced by the kidneys - key role in the production of RBC’s

• impaired kidney function = decrease in EPO = decrease in RBC’s

Question 5

Discuss the causes of pre-renal chronic kidney injury

Answer 5

problems with blood supply

• poor cardiac function
• chronic liver failure
• atherosclerosis of renal arteries

Question 6

Discuss the causes of infrarenal chronic kidney injury

Answer 6

Damage to the kidney

• diabetic nephropathy
• chronic glomerular nephritis
• vasculitis
• polycystic kidney disease

Question 7

Discuss the causes of post-renal kidney disease

Answer 7

Obstruction in urinary tract

• kidney stones
• bladder outlet obstruction
• retroperitoneal fibrosis

Question 8

Outline the causes of upper urinary obstruction

Answer 8

• narrowing of a ureter or the urethra
• compression due to congenital defect or physical compression from a blood vessel, scarring, tumour or abdominal inflammation
• renal calculi (kidney stones)
• malignancy in either renal pelvis, ureter, prostate or bladder

Question 9

Effects of upper urinary obstruction

Answer 9

urine backs up, leading to dilation of ureter, renal pelvis and calyces.

• obstruction eventually affects both proximal and distal part of the nephron
• later, back flow or urine leads to glomeruli becoming damaged and consequently the renal cortex and medulla decrease in size

total obstruction = leads to damage to the renal tubule in 4 hours and is irreversible if not corrected within 4 weeks

Question 10

Effects of upper urinary obstruction

Answer 10

urine backs up, leading to dilation or ureter, renal pelvis and calyces.

• obstruction eventually affects both proximal and distal part of the nephron
• later, back flow or urine leads to glomeruli becoming damaged and consequently the renal cortex and medulla decrease in size

total obstruction = leads to damage to the renal tubule in 4 hours and is irreversible if not corrected within 4 weeks