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HSC2008 Pathology & Pharmacology > Week 3 > Flashcards

Week 3 Flashcards

1
Q

creatinine

A

waste from muscle metabolism

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2
Q

GFR

A

glomerular filtration rate; estimates how much blood passes through glomeruli each minute

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3
Q

normal GFR

A

> 60

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4
Q

proteinuria

A

protein presence in urine

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5
Q

hematuria

A

blood in urine

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6
Q

not graded AKI defined as ___

A

increased serum creatinine
- > 0.3 mg/dl (>26.5 micromol) within 48 hrs
- 1.5x baseline occurred within 7 days

urine volume < 0.5ml/kg/h for 6 hrs

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7
Q

non-oliguric AKI

A

> 400 ml daily

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8
Q

oliguria

A

< 400 ml daily

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9
Q

anuria

A

< 100 ml daily

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10
Q

etiology of vasculitis

A

small vessel disease

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11
Q

etiology of glomerulonephritis

A

glomerular disease

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12
Q

etiology of acute tubular necrosis

A

toxins / ischemia

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13
Q

pre-renal pathophysiology phases

A

1) initiation (ischemia)
2) extension (corticomedullary junction hypoxia)
3) maintenance
4) recovery

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14
Q

what happens during initiation of pre-renal pathophysiology phases

A

tubular obstruction, exfoliation, BBM Loss

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15
Q

what happens during extension of pre-renal pathophysiology phases

A

obstruction, coagulopathy, microvascular injury inflammation,

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16
Q

what happens during maintenance of pre-renal pathophysiology phases

A

dedifferentiation, migration, proliferation

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17
Q

what happens during recovery of pre-renal pathophysiology phases

A

redifferentiation & repolarization

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18
Q

ionizing radiation causes ___ at renal blood vessels

A

renal injury & function loss

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19
Q

effects of radiation therapy on renal injury

A

radiation disrupts chemical bonds & knocks e- out of atom; ROS created leading to DNA damage & death

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20
Q

effects of radionuclide therapy on renal injury

A

radioisotope protein conjugate filtered at glomeruli and reabsorbed by tubular epithelium, radioemitter lodged in kidney leading to renal injury

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21
Q

what is the acceptable threshold of photon irradiation that can cause radiation nephropathy

A

both kidneys irradiated total dose of 23G and fractionated in 20 doses over 4 weeks

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22
Q

CKD will not occur from irradiation if total irradiated renal volume is ___

A

<30% of both kidneys

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23
Q

renal failure from radiation nephropathy will not occur if ___

A

only 1 kidney irradiated with threshold/higher dose

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24
Q

what is done prior to stem cell transplant

A

chemo-irradiation conditioning

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25
Q

___ potentiates radiation effects

A

preceding / concurrent chemotherapy

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26
Q

patient related factors for radiation nephropathy

A

2C3D
- CKD
- concomitant nephrotoxins
- DM
- decreased IV volume
- decreased CO

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27
Q

procedure related factors for radiation nephropathy

A
  • increased radiocontrast dose
  • intra-arterial administration
  • hyperosmolar radiocontrast
  • many procedures within 72 hrs
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28
Q

renal failure evaluation

A

history = family, drug, past, complications

physical exam = fluid status, uraemia, kidney ballot, renal bruit, distended bladder

investigation = blood, urine, imaging, renal biopsy

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29
Q

kidney function includes

A

regulating RBC, BP, bone mineral metabolism, blood pH, excretion

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30
Q

drugs used to counter renal hemodynamic changes

A

atrasentan, ruboxistaurin, sulodexide, baricitinib

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31
Q

drugs used to counter ischemia & inflammation

A

bardoxolore methyl, pyridoxamine, pirfenidone, PTF

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32
Q

drugs used to counter overactive RAAS

A

finerenone, vitamin D, PTF

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33
Q

pxt with anemia have reduced RBC lifespan of __

A

60 - 90 days

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34
Q

anemia treated using

A

SCr EPO, iron supplement

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35
Q

presence of uraemic toxins lead to __

A

platelet dysfunction & increased bleeding

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36
Q

what happens in kidneys during lactic acidosis

A

kidneys cannot produce ammonia in proximal tubules to excrete endogenous acid into urine in ammonium form

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37
Q

lactic acidosis causes __

A

increased bone + muscle loss & CKD progression

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38
Q

high BP treated using

A
  • low salt diet
  • beta blockers
  • Ca2+ channel blockers
  • diuretics
  • ACEi / ARB
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39
Q

ACEi

A

angiotensin converting enzyme inhibitors

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40
Q

ARB

A

angiotensin II receptor blockers

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41
Q

how does decreased GFR lead to increased bone loss

A

decreased GFR = decreased vitamin D + increased PO43-, FGF-23 = decreased Ca2+ & increased PTH = bone loss

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42
Q

PTH

A

parathyroid hormone

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43
Q

leading factors of CVS which is the leading cause of death in CKD pxt

A

smoking, obesity, diabetes, hypertension, lipids

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44
Q

how to treat pruritus (itchy skin)

A

UV therapy, Gabapentin, Anti-histamines, suu balm

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45
Q

how to treat nausea

A

metoclopramide

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46
Q

how to treat appetite loss

A

supplements

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47
Q

how to treat AKI / CKD pxt

A

low salt, K+, PO43- diet

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48
Q

hyperkalaemia

A

low K+ excretion

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49
Q

hyperphosphataemia

A

low PO43- excretion

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50
Q

hypocalcaemia

A

decreased Ca2+ absorption due to decreased plasma calcitrol, increased Ca2+ & PO43- binding leads to increased SCr

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51
Q

low Na+ & H2O excretion leads to ___

A

increased extracellular volume expansion

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52
Q

how to treat fluid overload

A

diuretics, fluid restriction, low salt diet

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53
Q

semi-permeable membrane for dialysis

A

peritoneal dialysis + hemodialysis

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54
Q

peritoneal dialysis inserted into

A

abdomen

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55
Q

peritoneal dialysis exchange timing

A

30 mins (10 mins inflow, 20 mins outflow)

56
Q

peritoneal dialysis benefits

A

can be done anywhere daily = less strict diet and painless

57
Q

continuous ambulatory peritoneal dialysis

A

3 - 4x daily, PD solution remains in abdomen 4-6hrs, kept dry overnight / night dwell

58
Q

automated peritoneal dialysis

A

cycler used as pxt sleeps 8 - 10 hrs
- continuous cycling PD w/ day dwell
- nocturnal intermittant PD w/ day dry

59
Q

peritoneal dialysis infective complications

A

PD peritonitis, exit site infection, tunnel infection

60
Q

peritoneal dialysis non-infective complications

A

mechanical
- hernia, leaks, abdominal pain, catheter obstructions

metabolic
membrane complications

61
Q

hemodialysis

A

3x / week for 4hrs per session

62
Q

hemodialysis uses 2 needles which are for

A

removing blood & returning cleansed blood

63
Q

hemodialysis access channels

A

1) vascular catheter
2) arteriovenous fistula
3) arteriovenous graft

64
Q

hemodialysis vascular catheter includes

A

tunneled & temporarily non-tunneled

65
Q

hemodialysis arteriovenous fistula includes

A

radiocephalic, brachiocephalic, brachiobasilic

66
Q

hemodialysis arteriovenous graft includes

A

loop & small

67
Q

hemodialysis complications

A

infections, thrombus, stenosis, occlusions (kink, fibrinsheath, blood clot)

68
Q

intermittent hemodialysis

A

3x / week for 4hrs per session

69
Q

nocturnal hemodialysis

A

3x / week for 6-8 hrs per session

70
Q

intradialytic complications

A

ABCD DMH
- air embolism
- BP
- cardiac arrhythmia
- dialysis disequilibrium syndrome
- dialyser reaction
- hemolysis
- muscle cramps

71
Q

what is an independent predictor of ESRD pxt

A

VO2 peak

72
Q

CVS activity recommended for ESRD

A

30 mins x 5 / week

73
Q

high Vd =

A

low protein binding, high tissue binding

74
Q

drug dosing is adjusted to __

A

GFR; maintained using lower doses & more intervals

75
Q

drug dosing includes

A

diuretics, antimicrobials, oral hypoglycaemic agents, analgesics

76
Q

dialysate resembles __

A

electrolytes of human blood

77
Q

contrast induced nephropathy is ___

A

reversible AKI after radiocontrast media administration with renal function decline 48 - 72 hrs after IV, SCr peaks at 3-5 days

78
Q

latent period of acute radiation nephropathy

A

6-12 months

79
Q

latent period of chronic radiation nephropathy

A

> 18 months

80
Q

latent period of malignant hypertension

A

12 - 18 months

81
Q

latent period of benign hypertension

A

> 18 months

82
Q

radiated nephropathy occurs as a late phenomenon due to

A

decreased renal cell turnover rate & delayed expression of renal injury post radiation

83
Q

steps that occur in nephron

A

filtration, reabsorption, secretion, excretion

84
Q

CKD

A

abnormal kidney structure / renal function for > 3months

85
Q

administration of ___ remains an uncertain benefit for eGFR

A

N-acetylcysteine & intravenous sodium bicarbonate

86
Q

loss of nephrons triggers what system

A

renin angiotensin aldosterone system

87
Q

medications for glomerular hypertrophy & sclerosis

A

ruboxistaurin
sulodexide
baricitinib

88
Q

medications for tubulointerstitial fibrosis & tubular atrophy

A

pirfenidone & PTF

89
Q

PTF used for

A

tubulointerstitial fibrosis & tubular atrophy & mesangial cell expansion

90
Q

high phosphate levels prevented by

A

restrict high phosphate foods, PO43- binders, dialysis

91
Q

high PTH levels prevented by

A

parathyroidectomy

92
Q

common complication in ckd

A

malnutrition

93
Q

conservative management of CKD

A

kidney transplant, peritoneal dialysis, hemodialysis

94
Q

donor after cardiac death

A

death must be due to CVS reasons rather than neurological

95
Q

expanded criteria deceased donor includes

A

> 60 years old

OR 50 - 59 years old w/
- terminal Cr >1.5mg/dl
- death due to CVA
- hypertension

DM of any age

96
Q

difference between diffusion, ultrafiltration, osmosis

A

diffusion = solution moves by concentration gradient

osmosis = water moves by concentration gradient

ultrafiltration = solution moves by pressure gradient

97
Q

peritoneal dialysis non-infective metabolic complications

A

hyperglycemic, insulin resistant, weight gain, dyslipidaemia

98
Q

peritoneal dialysis non-infective mechanical complications

A

hernias, leaks, catheter obstrction, abdominal pain

99
Q

peritoneal dialysis non-infective membrane complications

A

encapsulating peritoneal sclerosis, membrane failure

100
Q

types of hernias

A
  • inguinal / femoral
  • ventral
  • umbilical
  • paraumbilical
101
Q

peritoneal equilibrium test initiated __

A

4-8 weeks after initiation

102
Q

peritoneal equilibrium test analyses ___

A

urea, creatine & glucose

103
Q

why is glucose used as a solvent in peritoneal dialysis

A

cheap, safe & effective, proven to work for 2 decades

104
Q

if severe heart failure, should u use PD or HD

A

PD first

105
Q

low vitamin D countered using

A

calcitriol

106
Q

high phosphate level countered by using

A

phosphate binders, decrease phosphates, dialysis

107
Q

high PTH countered by using

A

parathyroidectomy

108
Q

catether obstructions lead to

A

constipation, kink, fibrin, omentum wrapping, tip migration

109
Q

vasopressin / adh promotes

A

h2o resorption

110
Q

aldosterone promotes

A

Na+ resorption

111
Q

atrial natriuretic peptide regulates

A

Na+ & K+

112
Q

mechanical causes of edema

A

increased capillary hydrostatic pressure, and capillary permeability

decreased plasma osmotic pressure & lymphatic function

113
Q

causes of fluid dehydration

A

vomit / diarrhea
sweating
diabetic ketoacidosis
insufficient fluid intake

114
Q

primary cation in extracellular fluid

A

sodium

115
Q

Na+ mainly controlled by

A

kidney via aldosterone

116
Q

Na+ used in

A

muscle contraction, nerve conduction, maintaining extracellular fluid

117
Q

K+ main cation in

A

intracellular fluid

118
Q

K+ influenced by

A

aldosterone, insulin, acid-base balance

119
Q

Ca2+ controlled by

A

PTH, calcitonin, Vitamin D, phosphate levels, acid-base balance

120
Q

urine filtration occurs in

A

bowman capsule

121
Q

urine resorption occurs in

A

loop of henle, proximal and distal convoluted tubules

122
Q

urine resorption controlled by

A

ADH, aldosterone, atrial natriuretic hormone

123
Q

blood tests for acute renal failure

A

elevated serum urea nitrogen & creatinine test

metabolic ketoacidosis

hyperkalemia

124
Q

chronic renal failure key indicators

A

azotemia, anemia, acidosis

125
Q

CKD levels

A

1 = 90 - 120
2 = 60 - 89
3 = 30 - 59
4 = 16 - 29
5 < 15

126
Q

3 types of renal management

A

thiazide, loop diuretics, K+ sparring

127
Q

thiazide targets

A

distal tubules for hypertension

128
Q

loop diuretics targets

A

loop of henle for fluid retention, heart failure, kidney disease

129
Q

K+ sparring targets

A

collecting tubules for heart, kidney and liver disease

130
Q

side effects of diuretics

A

dizzy, excessive electrolyte loss, hyponatremia, hypokalemia

131
Q

contra-indications for diuretics

A

anti-depressants, cyclosporine, digitalis, insulin

132
Q

contra-indications of antidepressants

A

thiazide & loop acting diuretics

133
Q

contra-indications of cyclosporine

A

K+ sparring

134
Q

contra-indications of digitalis

A

decreased K+ pxt

135
Q

contra-indications of insulin

A

thiazide & loop acting diuretics

HSC2008 Pathology & Pharmacology (14 decks)

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