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BDS2 BAMS Diseases of Human Systems > Renal systems > Flashcards

Renal systems Flashcards

ILO 8.8a: be familiar with the underlying disease processes of the common medical disorders affecting the body

1
Q

describe the location of the kidneys

A
  • retroperitoneal
  • superiorly - diaphragm
  • inferiorly - abdominal wall muscles
  • anteriorly - right liver: duodenum, ascending colon - left liver: stomach spleen, pancreas, jejunum, descending colon
  • posteriorly - diaphragm, 11th and 12th rib, abdominal wall muscles
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2
Q

what are the main anatomical aspects of the kidney?

5

A
  • renal capsule
  • renal cortex
  • renal medulla
  • renal pelvis
  • ureter
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3
Q

describe the blood suppy path of the kidneys

A
  1. renal artery from abdominal aorta which divide in the kidneys into the
  2. segmental arteries which divide into the
  3. interlobar arteries which run between the renal pyramids and divide into
  4. arcuate arteries which arch along the border of the medulla and cortex
  5. interlobular arteries which are small branches extending into the cortex
  6. afferent arterioles which lead into the glomerulus
  7. efferent arterioles where the blood leaves the glomerulus
  8. peritubular capillaries and vasa recta which surround the nephron
  9. intralobular veins - arcuate veins - interlobar veins - renal vein - inferior vena cava
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4
Q

what is a nephron? where is it? what does it do?

A
  • functional unit of the kidney consisting of the renal corpuscle (glomerulus and Bowman’s capsule) and tubules (PCT, LoH, DCT, CD)
  • located in the renal cortex and medulla
  • filters the blood, reabsorbs essential substances and excreting waste products
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5
Q

what does it mean that the renal system is autoregulated?

A

renal blood flow is independent between a mean pressure of 90-200mmHg
* both afferent and efferent arerioles can vasoconstrict to maintain constant blood flow

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6
Q

what is the function of the RAA system? what happens when blood pressure decreases?

A

maintains constant renal blood flow
1. renal blood flow and filtrate volume decrease
2. decreased soduim and chloride in the interstitial space
3. increased renin secretion from the kidney
4. angiotensin is a hormone secreted from the liver and renin stops it from being converted to angiotensin I
5. angiotensin I cannot be converted to angiotensin II by ACE from the lungs
6. angiotensin II increases blood pressure

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7
Q

how does angiotensin II increase blood pressure?

A
  1. it is a generalised vasoconstrictor: increased systemic vascular resistance (SVR) and blood pressure
  2. vasoconstriction of efferent arterioles greater than afferent arterioles: increased glomerular filtration rate (GFR)
  3. release of aldosterone from the adrenal gland: increased Na and water retention
  4. stimulates thirst by action on the hypothalamus
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8
Q

what is the role of the endothelial cells of the glomerulus?

A

have fenestrations which allow the passage of water and small molecules but retains blood

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9
Q

what is the role of the glomerulus? what does it consist of?

A
  • filters the blood to create an ultrafiltrate
  • consists of network of capillaries lined by fenestrated endothelial cells, a glomerular basement membrane and podocytes
  • this arrangement creates the glomerular basement membrane
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10
Q

what is the role of the glomerular basement membrane?

A

acts as a primary barrier to macromolecules

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11
Q

what is the role of podocytes?

A

additional filtration layer after the fenestrations in the endothelium and basement membrane

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12
Q

what is the role of mesangial cells?

A

located at the capillary loops, they provide support and help regulate blood flow within the glomerulus

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13
Q

what is the glomerular filtration rate?

A
  • a measure at how well your kidneys are filtering blood, indicating overall kidney function
  • around 125ml/min
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14
Q

what is clearance?

A

the volume of plasma that is cleared of the substance in unit time

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15
Q

what are two ways of measuring GFR?

A
  • insulin clearance as it is not reabsorbed, secreted, synthesised or metabolised by the kidney
  • creatinine clearance is an alternate measurement and gives an estimate of GFR (eGFR)
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16
Q

what is the role of the PCT?

A

reabsorbs 60% of all solute including:
* 100% glucose and amino acids
* 90% bicorbonates
* 80-90% inorganic phosphates and water
* 40-50% urea

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17
Q

what is the role of the LoH?

A

concentrating urine (water reabsorption)

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18
Q

what is the role of the DCT?

A

fine tuning and reabsorption of ions

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19
Q

what is the role of the CD?

A

has a variable permeability to water due to aquaporins - ADH dependent
achieves final urine concentration

20
Q

what are the functions of the kidney?

6

A
  1. salt and water homeostasis
  2. acid-base homeostasis
  3. excretion of waste products, water soluble toxins and drugs
  4. calcium and phosphate homeostasis
  5. retention of vital substances - protein and glucose
  6. endocrine functions - production of erythropoietin
21
Q

how do the kidneys control salt and water homeostasis?

A
  • regulation of total body fluid volume mediated by osmoreceptors that affect ADH release
  • ADH is released from the posterior pituitary gland and determines the permeability of the CD via aquaporins
22
Q

p

what is ADH released in response to?

3

A
  • increased osmolarity in the hypothalamus
  • decreased plasma volume
  • angiotensin II
23
Q

how do the kidneys control acid-base homeostasis?

A
  • bicarbonate is the most important buffer system in the body
  • it is absorbed mainly in the PCT, dependent on H+ secretion
  • when H+ secretion is increased (acidosis) by the kidney, there is increased bicarbonate reabsorption and so, increased plasma bicarbonate
  • when H+ secretion is decreased (alkalosis), there is decreased bicarbonate reabsorption and plasma bicarbonate
24
Q

how does the kidneys regulate calcium and phosphate homeostasis?

A

calcium homeostasis
* PTH is released in response to low plasma calcium
* PTH acts on the kidneys to increase calcium reabsorption in the DCT
* kidney also converts 25-hydroxyvitamin D into activated 1,25-dihydroxyvitamin D

phosphate homeostasis
* PTH decreases phosphate reabsorption in the PCT
* fibroblast growth factor 23 (FBGF23) produced by osteocytes, further enhances phosphate excretion

25
what are the endocrine functions of the kidneys?
* **erythropoietin** (EPO) is produced by renal interstitial fibroblasts and stimulates **erythopoiesis in the bone marrow** (red blood cell production) * **renin** is secreted by the juxtaglomerular cells which regulates **blood pressure, electrolyte balance and fluid homeostasis** * **calcitriol** (1,25-dihydroxyvitamin D) is the activated form of 25-hydroxyvitamin D and is crucial for **calcium and phosphate homeostasis** * **klotho** is produced in the kidneys (aKlothorotein) and is a **co-receptor for FBGF23** which is important in **phosphate metabolism and aging**
26
how would you assess renal function?
* **bloods** * **urea and electrolytes** (below) * urea and creatinine secreted by kidney to measure GFR - **renal function markers**
27
what is estimated glomerular filtration rate (eGFR)?
* number derived from patient's **creatinine** levels in conjunction with **age, sex and race** * roughly equated to a **% of kidney function ** * used to **stage chronic kidney disease**
28
what is acute kidney injury? how is it identified? what happens in pre-renal, renal and post-renal AKI?
* a **sudden decline** in renal function * identified by a **rapid increase in serum creatinine levels** and/or a **decrease in urine output** * **pre-renal** - decreased perfusion of kidneys, hypovolaemia, hypotension * **renal** - direct damage to renal parenchyma * **post-renal** - obstruction
29
what is glomerulonephritis? how does it present? how is it diagnosed? how is it treated?
* **inflammation of the glomeruli ** * **immune-mediated** disorder (**IgA** neuropathy is most common) * presents as clinical manifestations: **hematuria (blood in urine), proteinurea, hypertension, renal dysfunction** * diagnosed via **biopsy** * **immunosuppressive** and **supportive** treatment
30
what is acute tubular necrosis? what is a sign of this? how would you manage it?
* **death of tubular epithelia cells** * can be **ischaemic** or **nephrotoxic** * **muddy brown casts** in urine sediment * management: **avoid**, **supportive care** (fluid management), **renal replacement therapy**
31
what is pyelonephritis? how is it treated?
* **bacterial infection** typically ascends from the lower urinary tract - usualy ***E.coli*** * treated with **antibiotics** and **monitoring renal function **
32
what is post-renal acute kidney injury? what can it be caused by? how can it be treated?
* **obstruction of urine flow** from the renal pelvis to the ureter * obstruction from - **stones, tumours, strictures** * treatment - **relief of obstruction** - catheter, surgery
33
what are the causes of kidney stones (renal calculi)? | 5
* genetic factors * dehydration * diet * metabolic disorders (obesity, diabetes, gout) * medications (antacids, diuretics)
34
what kind of tumour is present with renal cancer? what are the risk factors? what is the treatment?
* renal cell **carcinoma** (originating from renal epithelium) * risk factors: **smoking, obesity, hypertension, certain hereditary conditions** * treatment: **surgery, nephrectomy, ablation**
35
how is chronic kidney disease discovered? what are the most common causes?
* discovered on **routine screening** * causes: **diabetes, hypertension, glomerulonephritis, polycystic kidney disease, chronic pyelonephritis**
36
what causes diabetic nephropathy? what are the signs?
* **prolonged hyperglycaemia** causes **cellular damage** and **inflammation** * **overproduction of advanced glycation end products** (AGEs) which activate **protein kinase C** which **increases oxidative stress** * signs: **glomerular hyperfiltration** and **microalbuminuria** progressing to **macroalbuminuria** and a **lower eGFR**
37
what is hypertensive nephrosclerosis? what does it cause?
* **structural changes** in the kidneys due to **sustained high blood pressure** leading to progressive renal damage and renal dysfunction causes: * **arteriosclerosis** and **arteriolohyalinosis** - thickening and stiffening of small arterioles and * **glomerular hypertension** and **hyperfiltration** - loss of autoregulation, increased glomerular capilary pressure, glomerular hypertrophy * **tubulointestinal fibrosis** - ischaemia and glomerular damage leads to tubulointerstitial inflammation and fibrosis * **podocyte damage** - reduced filtration and scarring
38
what is polycystic kidney disease? what are the difference between the two types?
* progressive **formation of and enlargement of cysts** leading to kidney enlargement, damage and chronic kidney disease **autosomal dominant polycystic kidney disease** * common * presents in adulthood * mutations in PKD1 or PKD2 gene * associated with extrarenal manifestations **autosomal recessive polycystic kidney disease** * rarer and more severe * presents in early childhood * mutation in PKD1 gene * numerous small cysts, congenital hepatic fibrosis * high morbidity and mortality
39
what are the dental presentations of chronic renal disease? | 11
* white patch * erythematous patch * ulceration * lichen planus * oral hairy leukoplakia * uremic stomatitis * macules/nodules * fibro-epithelial polyps * geographic tongue * papilloma * pyogenic granuloma
40
what are the causes of kidney failure? | 6
* diabetes * hypertension * kidney inflammation * polycystic * urine drainage tubes blocked * medicines
41
what are the symptoms of kidney failure? | 6
* energy loss * urination problems * dyspnea (SoB) * swelling * loss of appetite * lower back pain
42
how do you prevent and treat kidney failure?
prevention: * no smoking * no alcohol * healthy diet * active lifestyle treatment: * haemodialysis * peritoneal dialysis
43
what does dialysis do? what are the two different types? how does the machine work?
* **removes metabolic waste products, excess body water and rebalancing electrolytes** * **haemodialysis** and **peritoneal** dialysis * **semi-permeable membrane** that allows waste products and excess electrolytes to diffuse from the blood into the dialysate
44
how does dialysis affect dentistry?
* **increased risk of oral diseases** (PDD, caries, oral candida) * **management of bleeding risks** - anticoagulant therapy * **timing of appointments** - non-dialysis days * **infection control** - compromised immune system * **OH and systemic complications** - poor Oh linked with CVD, pneumonia
45
how do kidney transplants affect dentistry?
* **post-transplant immunosuppressant therapy** - susceptible to **infections** (PDD, oral candidiasis), immunosuppressants can cause **gingival overgrowth** and **severe oral ulceration**s * **dental caries risk increases** post-transplant * **periodontal disease** in transplant pts is associated with **systemic health conditions**
46
how is platelet function altered in patients with chronic kidney disease? what does this lead to?
* **accumulation of uremic toxins** impair platelet **aggregation** and **adhesion** * leads to **prolonged bleeding times** and **reduced platelet reactivity** to agonists such as ADP and collagen
47
what are some drugs that you should not prescribe to a patient with renal failure?
* apirin * ibuprofen * tetracyclines

BDS2 BAMS Diseases of Human Systems (20 decks)

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