Systems Pathology: Kidney failure

Question 1

Kidney functions

Answer 1

Question 2

Which part of kidney secretes renin

Answer 2

Juxtaglomerular apparatus

Question 3

Two main forms of clinical renal syndromes

Answer 3

Acute kidney injury

Chronic Kidney Disease

Question 4

Define acute kidney injury

Answer 4

AKI describes “abrubt deterioration of renal function”

Question 5

Features of AKI

Answer 5

• Oliguria: Abnormally small amounts of urien production
• Electrolyte imbalance: Hyperkalaemia and metabolic acidosis
• Rapidly Rising blood urea and creatine

Question 6

Diagnostic criteria for AKI

Answer 6

• Serum creatinine rise by 26mmol/l from baseline within 48hr OR
• Serum creatinine rises 1.5. fold formbaseline value within 1 week OR
• Urine output is <0.5 ml/kg/hour for >6 hours

Question 7

What happens in acute tubular necrosis

Answer 7

• Tubular epithelial cells have high oxygen demands so central perfusion failure means less oxygen getting through
• Tubular epithelial cells are hypoxic and die
• Function of tubular epithelial cells lost so NO ion, salt and water pumping takes palce
• Kidneys swell

Question 8

Different causes of glomerular disease

Answer 8

• Glomerulonephritis; acute inflammation of the kdiney
• immune complex mediated disease of glomeruli e.g. SLE
• Post-infective
• Some linked to vasculitis

Question 9

Vascular causes of AKI

Answer 9

• Vasculitis - immune-mediated inflammation and destrucion of small vessels
• DIC (disseminated intravascular coagulation)
• Malignant hypertension

Question 10

Causes of post-renal AKI

Answer 10

• Acute obstruction of lower urinary tract e.g. enlarged prostate in males, ureters in both males and females
• Blockage of ureter by kidnyes stones
• Tumour or inflammation in the walls
• Extrinsic masses e.g.g tumour of sorrounding areas

Question 11

Defien Chronic renal failure

Answer 11

Slowly, progressive and irreversible loss of renal fucntion due to irreversible destruction of large numbers of nephrons. Thus, gradual deterioration over many years due to large reserve capacity of nephrons. Symptoms appear when compensation fails

Question 12

Symptoms of CRF

Answer 12

• Polyuria: increased urine output
• Malaise, lethargy
• Increasing ureamia, confusion and eventual coma
• Hypertension from Na+ and water retention

Question 13

eGFR at point of dialysis

Answer 13

<15

Question 14

CDK initiating factors

Answer 14

Question 15

CKD perpetuating factors

Answer 15

Question 16

Causes of CKD

Answer 16

Question 17

Diabetic nephropathy

Answer 17

Diabetic nephropathy (DN), also known as diabetic kidney disease, is the chronic loss of kidney function occurring in those with diabetes mellitus. Protein loss in the urine due to damage to the glomeruli may become massive, and cause a low serum albumin with resulting generalized body swelling (edema) and result in the nephrotic syndrome

Question 18

Nephrotic VS nephritic syndrome

Answer 18