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PM2A Spring Amy L > Renal Therapeutics II > Flashcards

Renal Therapeutics II Flashcards

1
Q

Define: Acute renal failure (ARF)

A

Rapid, potentially irreversible decline in renal function (GFR) occurring over hours or days

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2
Q

Define: Chronic renal failure (CRF)

A

Slowly worsening loss of the ability of the kidneys to:
Remove wastes
Concentrate urine
Conserve elctrolytes

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3
Q

List the stages of renal failure

A
  1. Normal GFR with other evidence of chronic kidney damage
  2. Mild impairment, decreased GFR
  3. Moderate impairment, decreased GFR
  4. Sever impairment, decreased GFR
  5. Established renal failure (ERF) =
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4
Q

What classes as ‘other evidence of chronic kidney damage’ which diagnoses an individual with the 1st stage of renal failure?

A 
Persistent microalbuminuria = albumin in urine
Persistent proteinuria = abnormal quantities of protein in the urine
Persistent haematuria (after exclusion of other causes) = presence of blood in urine
Structural abnormalities revealed by ultrasound
Biopsy-proven glomerulonephritis = damage to the glomeruli
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5
Q

List 3 types of causes of renal failure

A

Pre-renal cause/failure = consequence of decreased renal perfusion –> reduction in GFR
Intrinsic renal cause/failure = e.g. damage to nephrons
Post-renal cause/failure = beyond the kidney e.g. obstruction to urine flow

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6
Q

What causes glomerular dysfunction?

A

Pre-renal perfusion
Intrinsic glomerular inflammation = problems with liquid being able to pass through
Post-renal obstruction

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7
Q

What are the consequences of glomerular dysfunction?

A

Fall of GFR with retention of substances that should be cleared by filtration
So:
Reduced volume of tubular fluid and urine
Slower tubular flow
Increased tubular reabsorption
This can cause proteinuria and increased protein loss

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8
Q

What is the function of the tubules?

A

Selective reabsorption of water, electrolytes etc.

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9
Q

What are the consequences of tubular dysfunction?

A

Polyuria and loss of electrolytes

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10
Q

Which 3 areas of the nephron can suffer from tubular dysfunction?

A

Loop of Henle
Proximal convoluted tubule
Distal convoluted tubule

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11
Q

What is the result of a failure of the Loop of Henle?

A

Urine cannot be concentrated (missing medulla gradient)

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12
Q

What is the result of proximal tubular failure?

A

Potassium loss

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13
Q

What is the result of distal convoluted failure?

A

Impaired Na-K acid exchange pump,

So failed acid secretion (body cant get rid of acid through the urine) = acidosis = decreased pH in bloodstream

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14
Q

Define: Nephrotoxic effect

A

Poisonous effects of some substances on the kidneys

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15
Q

Name 2 drugs that can cause glomerulonephritis (damage to glomeruli)

A

Penicillamine

Gold

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16
Q

Name 2 drugs that can cause an alteration in renal blood flow

A

RAAS inhibitors

NSAIDs

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17
Q

What can cause obstruction in the kidneys?

A

Crystallisation of drugs = crystalluria

Prevents liquid flowing through

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18
Q

Describe the typical time course of acute renal failure if it has a pre-renal cause

A

Pre-renal cause
GFR decreased, oliguria (small amounts of urine)
Acute tubular necrosis
Oliguric phase = glomerular and tubular dysfunction
Polyuric phase = persistent tubular dysfunction
Recovery period

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19
Q

What causes the oliguric phase in ARF?

A 
Low GFR 
= Acute tubular necrosis 
= Glomerular dysfunction 
= Oliguric phase 
= Reduced clearance, fluid and electrolyte retention
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20
Q

What occurs during the polyuric phase of ARF?

A

The glomeruli have recovered but tubular dysfunction still exists
Filtration is increasing but concentration mechanisms do not work so still causing issues
= large volume of urine produced

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21
Q

What occurs during the recovery phase of ARF?

A

The tubule cells slowly regenerate

Kidneys recover their own function and regenerate

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22
Q

What are the clinical features of the oliguric phase of ARF?

A 
Fluid and electrolyte overload
Accumulation of metabolites
= Infections, bleedings
and
= Problems related to volume overload = hypertension, oedema
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23
Q

What are the clinical features of the polyuric phase of ARF?

A

Dehydration
Electrolyte depletion
= Volume depletion = nausea, vomiting, muscle cramps

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24
Q

Describe the management of ARF

A

No specific management for ARF
Remove cause
Keep patient alive until kidney functions have recovered (maintain fluid and electrolytes)
Dialysis helpful

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25
Q

How is restoration of function achieved after pre-renal failure?

A

Fluid or blood replenishment
Restoration of CV function
Prevent acute tubular necrosis
This may require aggressive dialysis therapy

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26
Q

Which 2 groups of drug are commonly used in order to restore function after pre-renal failure?

A

Calcium-channel blockers = dilate glomerular arterioles (=more blood to kidney), induce natriuresis (excretion of sodium in urine)
Diuretics = block normal solute reabsorption

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27
Q

Describe how thiazides (diuretics) work to restore function after pre-renal failure

A

Block Na & Cl reabsorption in the distal tubule
However K excretion increases = hypokalaemia
Reduced calcium excretion
Increases urine volume

28
Q

Describe how Loop diuretics work to restore function after pre-renal failure

A

Block Cl, Na & K reabsorption in the LoH (mainly ascending)
Side effect = potassium loss

29
Q

Give an example of a loop diuretic

A

Furosemide

30
Q

Describe how potassium sparing diuretics work to restore function after pre-renal failure

A

Block Na/K exchange pump (DCT/CD)
= Natriuresis (excretion of Na in urine)
= Increased water excretion and decreased K excretion

31
Q

Describe how osmotic diuretics work to restore function after pre-renal failure

A

Act on PCT
Filtered by the glomerulus and blocks water reabsorption in the whole nephron
Side effect = increased extracellular volume before producing diuresis

32
Q

Give 2 examples of osmotic diuretics

A

Mannitol

Sorbitol

33
Q

Define: Diuresis

A

Large volume of substances present

= Excessive volume of urine produced

34
Q

How do thiazides treat hypertension?

A

Increased urine flow = reduction in plasma volume = decreased cardiac output = lower BP

35
Q

What is a side effect of thiazides?

A

Increased potassium excretion = hypokalaemia

36
Q

Do thiazides affect the GFR?

A

No GFR stays the same

37
Q

How do thiazides prevent kidney stones

A

Reduced excretion of calcium = stops build up of calcium in the kidney

38
Q

What should thiazides be taken in conjunction with

A

Potassium-sparing diuretics to prevent hypokalaemia

39
Q

In which situation are loop diuretics the most suitable treatment for a patient?

A

For those with blood volume overload

Greatly increases GFR and so liquid flow into the kidneys = large volume of urine

40
Q

How do loop diuretics have their effect?

A

They are actively secreted in the proximal convoluted tubule

41
Q

List 3 consequences of using loop diuretics

A

Hypokalaemia
Increased Ca and Mg excretion
Hyperglycaemia

42
Q

What is the main indication of loop diuretics?

A

Oedema of the lung
Anuria (failure of kidneys to produce urine)
Poisoning
As loop diuretics can greatly increase GFR = large volume of urine

43
Q

List 2 side effects of potassium-sparing diretics

A

Hyperkalaemia

Slight acidosis

44
Q

Give an example of a potassium-sparing diuretic

A

Spironolactone

45
Q

Which is the most potent diuretic?

A

Loop diuretics

46
Q

How do osmotic diuretics work?

A

Prevent water being reabsorbed throughout the entire nephron by sitting on tubule walls

47
Q

What is the result of taking osmotic diuretics?

A

Excretion of large volume of electrolyte-poor urine

48
Q

How is acidosis caused and treated?

A

Kidney unable to excrete H+

Therefore give sodium bicarbonate or calciumgluconate

49
Q

When is dialysis used?

A

If patient has:
Persistent oliguria or ATN
Rising urea, potassium or creatinine levels

50
Q

What is Chronic Renal Failure (CRF) usually caused by?

A

Intrinsic renal diseases (glomerular origins)

51
Q

List 4 causes of CRF

A

Glomerulonephritis
Diabetes
Hypertension
Drug nephrotoxicity

52
Q

List 4 common problems associated with CRF

A

Sickness
Tiredness
Hypertension
Polyuria

53
Q

Describe the timecourse of CRF

A

Diagnosis
Monitoring (creatinine levels)
Careful management
May delay end stage renal failure (ESRF)

54
Q

How does CRF cause kidney shrinking?

A

Fewer nephrons working
= Hyperfiltration
= Glomerular sclerosis (hardening), tubular atrophy (wate away)
= Kidney shrinking

55
Q

What causes the fluid and electrolyte imbalance in CRF?

A

Initially: dilute polyuria = dehydration, electrolyte depletion
Later stage: urine volume drops so retention of sodium and water = hypertension, hypervolaemia, oedema, heart failure

56
Q

What is uraemia?

A

Urea in the blood
Co-accumulation of electrolytes and toxins
Urea levels = indicator of toxin level

57
Q

How does CRF cause anaemia?

A

Caused by damage to peritubular cells
= Decreased secretion of erythropoietin (hormone)
= Red cell proliferation and differentiation in bone marrow
= Haemoglobin levels decrease
= Ability of blood to carry oxygen is decreased

58
Q

Define: Anaemia

A

Deficiency of RBCs or haemoglobin in the blood = ability of blood to carry oxygen is decreased

59
Q

How does CRF cause proteinuria?

A

Results from:
Glomerular leaks - protein can enter tubular fluid
Infection
Failure of protein reabsorption

60
Q

How can CRF cause cardiovascular disease?

A

Hypertension results from fluid retention and renin/angiotensin abnormalities

61
Q

How can CRF cause renal bone disease (renal osteodystrophy)?

A 
Disturbed calcium and phosphate mechanism = vitamin D deficiency
Results in:
Impaired bone mineralisation
Bone demineralisation
Deposition of calcium phosphate
62
Q

What physical signs are there of renal osteodystrophy?

A

Rickets (lack of vitamin D)

Bones soften due to decreased calcium levels = bowed legs and possible fracture

63
Q

Describe the management of CRF

A

Early detection
Identification and removal of cause
Preparations for renal replacement therapy

64
Q

How are fluids and electrolytes managed in CRF

A

Water restricted to urine output + 500ml
Salt and potassium restriction
Acidosis = sodium bicarbonate or calcium bicarbonate

65
Q

How should anaemia be managed in CRF?

A

No response to iron or folic acid in CRF

So treat with red blood cell transfusions

66
Q

How should hypertension from CRF be treated?

A 
Fluid control
ACE inhibitors
Beta-blockers
Diuretics
Calcium-channel blockers

PM2A Spring Amy L (15 decks)

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