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Nursing Science 3 > WEEK 3 - Renal Injury > Flashcards

WEEK 3 - Renal Injury Flashcards

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1
Q

What is the primary function of the renal system?

A

To regulate blood volume and composition of body fluids and to excrete wastes

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2
Q

What are the three additional functions of the kidneys?

A
  1. Synthesis of the active form of vitamin D
  2. Blood pressure regulation via the RAAS
  3. Erythropoietin synthesis for blood cell production via the bone marrow
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3
Q

Where are the kidneys located anatomically?

A

They lie in the retroperitoneal space, posterior to the abdominal wall, outside of the abdominal sac

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4
Q

Which kidney is located lower than the other?

A

The right is lower than the left (due to the presence of the liver)

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5
Q

How do the kidneys regulate pH?

A

Via the excretion of protons or the retention of bicarbonate

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6
Q

How do the kidneys regulate BGLs?

A

Via gluconeogenesis - conversion of amino acids to glucose

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7
Q

How much cardiac output do the kidneys receive? Via which artery?

A

20-25% via the renal artery

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8
Q

Major vessels, nerves and the ureters enter and exit the kidneys via which structure?

A

The hilum

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9
Q

What does the renal cortex contain?

A

85% of nephrons (outer region of the kidney)

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10
Q

What does the renal medulla contain?

A

15% of nephrons and the renal pyramids (inner region of the kidney)

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11
Q

How is the renal pelvis formed?

A

Minor calyces join to form the major calyces, major calyces join to form the renal pelvis

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12
Q

What is the structural and functional unit of the kidney?

A

The nephron

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13
Q

Which area of the nephron is responsible for filtration?

A

The glomerulus and Bowman’s capsule

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14
Q

Which areas of the nephron are responsible for reabsorption?

A
  • Proximal convoluted tubule

- Distal convoluted tubule

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15
Q

Which area of the nephron is responsible for concentration?

A

The loop of Henle (via the peritubular capillaries)

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16
Q

Which area of the nephron is responsible for secretion?

A

The distal convoluted tubule

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17
Q

By what means substances reabsorbed via the nephron?

A

Water and urea = passive transport (descending LoH)

Ions and salts = active transport (ascending LoH)

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18
Q

There are three ions that are resorbed or excreted depending on hormonal influences. Which ions are these?

A

Na+
Ca2+
Mg2+

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19
Q

Define GFR (not just what the letters stand for)

A

Glomerular Filtration Rate

The quantity of glomerular filtrate produced each minute by ALL NEPHRONS in BOTH KIDNEYS

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20
Q

Normal GFR?

A

125mL/min OR

180L/hour

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21
Q

What proportion of filtrate is resorbed by the kidneys?

A

99%

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22
Q

When are you no longer considered to have a healthy GFR and why?

A

After the age of 30 due to age-dependent loss of nephrons

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23
Q

What three factors is GFR reliant on?

A
  1. Net filtration pressure
  2. Filtration membrane permeability
  3. Total surface area available
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24
Q

Renal injury is characterised by?

A

A sustained decline in GFR

25
Q

Acute renal injury is characterised by?

A

A decline in GFR over a period of minutes-days, leading to elevated BUN and decreased urinary output

26
Q

How long can acute renal failure last for and what does it become after this period?

A

Can last for up to 12 months

After 12 months, if ARF has not resolved, this becomes chronic kidney disease or end stage kidney disease (ESKD)

27
Q

What are some causes of acute renal failure?

A
  • Hypotension (decreased CO to kidneys)
  • Tubular injury
  • Interstitial injury (caused by E Coli)
  • Glomerular injury (caused by strep infection)
  • Obstruction eg. PCa, renal calculi, neoplasms
28
Q

What are the three forms of renal failure?

A
  1. Pre-renal
  2. Intrinsic or Intra-renal
  3. Post-renal
29
Q

What is the primary cause of pre-renal failure?

A

Impaired blood flow

May be due to

  • Hypotension
  • Renal hypo-perfusion
  • Renal vasoconstriction
  • Hypovolaemia
30
Q

Clinical manifestations of pre-renal failure depend on?

A

Pt age, health status, increased HR, variable BP (low or normotensive), decreased urinary output

31
Q

What test is used in the diagnosis for pre-renal failure? Is this test accurate in all groups?

A

Creatinine test
Not accurate in older populations due to age dependent changes in skeletal muscle mass - creatinine is a byproduct of skeletal muscle activity

32
Q

Creatinine clearance depends on which three factors?

A
  • Age
  • Gender
  • Weight
33
Q

Primary cause of intra-renal failure

A

Damaged nephron components - glomerulus, interstitium and tubules

May be due to:

  • Glomerulonephritis
  • Acute tubular necrosis
  • Inflammation
  • Renal trauma
  • Transfusion reaction
34
Q

Clinical manifestations of intra-renal failure?

A
  • Oligouria and fluid overload
  • Uremia, nausea and vomiting
  • Decreased EPO production = anaemia, decreased blood cell count
  • Decreased production of vit. D = hypocalcaemia, hyperparathroidism
35
Q

How is intra-renal failure diagnosed?

A
  • Imaging to exclude pre-/post-renal failure

- Urine microscopy for RBCs and casts

36
Q

Post-renal failure is associated with?

A

Urinary tract obstruction

Caused by neoplasms, PCa, renal calculi

37
Q

Clinical manifestations of post-renal failure?

A

Fluid retention (or anuria (no peeing)), pain, electrolyte changes

38
Q

Diagnostic criteria of post-renal failure?

A
  • An abrupt reduction in renal function (in less 48 hours)

- An increase in creatinine (>50%) or anuria for at least 12 hours

39
Q

First line pharmacological therapy for acute renal failure?

A

Thiazide diuretics eg. Hydrochlorothiazide

40
Q

What characterises chronic renal failure?

A

The progressive destruction of renal parenchyma wit irreversible sclerosis, loss of nephrons and decline in glomerular function.

41
Q

Primary clinical manifestation of chronic renal failure?

A

Extracellular fluid expansion and total body volume overload as a result of a failure in the kidneys’ abilities to excrete Na+ and H2O

42
Q

What are the biochemical markers tested in the diagnosis of chronic renal failure?

A
  1. Urea
  2. Creatinine
  3. Sodium
  4. Potassium, phosphate and calcium
43
Q

What are the three imaging studies used in the diagnosis of chronic renal failure?

A
  1. Plain film X-ray
  2. CT/MRI
  3. Voiding Cystoutererogram (VCUG)
44
Q

Why is creatinine a better marker for chronic renal failure than urea?

A

As creatinine is not influenced by non-renal factors such as a high protein diet and steroids

45
Q

Management for chronic renal failure is aimed at?

A

Delaying or halting renal failure (no cure)

46
Q

When does end stage kidney failure occur?

A

When GFR is less than 15%

47
Q

What must happen in end stage kidney failure for symptoms to be exhibited?

A

The loss of at least 80% of nephrons

48
Q

Characteristics of STAGE 1 of ESKD?

A
  • Asymptomatic

- Normal BUN and creatinine

49
Q

Characteristics of STAGES 2-4 of ESKD?

A
  • Increased BUN and creatinine
  • Polyuria
  • Nocturia
50
Q

Characteristics of STAGE 5 of ESKD?

A
  • Marked BUN and creatinine
  • Anaemia
  • Hypocalcaemia
  • Oliguria
  • Uremic syndrome
51
Q

What is the mechanism of action of hydrochlorothiazide?

A

Decreases reabsorption of Na+/Cl- in the proximal segment of the distal convoluted tubule - stimulates Na+/K+ and H2o excretion

52
Q

What are the adverse effects of hydrochlorothiazide?

A
  • Hypokalaemia/natraemia
  • Hyperuricaemia
  • Hypotension
  • Dizziness, weakness, muscle cramps (due to low K)
  • Increased plasma glucose
53
Q

What is the mechanism of action of frusemide?

A

Inhibits the absorption of Na+ and Cl- in the ascending limb of the Loop of Henle, short acting, causes a rapid decrease in blood volume

54
Q

What are the adverse effects of frusemide?

A
  • Dose-dependent disturbances in electrolytes Na+ and K+
  • Dehydration
  • Syncope
  • Postural hypotension
55
Q

What is the mechanism of action of mannitol?

A

Increases osmolality of blood = osmotic diuresis

56
Q

What are the adverse effects of mannitol?

A
  • Electrolyte loss
  • Thirst, dehydration
  • Headache, blurred vision, fluid shifts (pulmonary congestion)
57
Q

What is the mechanism of action of Spironolactone?

A

Inhibits Na+ reabsorption in the distal convoluted tubule by blocking Na+ channels and aldosterone = increased Na+ and decreased K+ excretion

58
Q

What are the adverse effects of Spironolactone?

A
  • Gynaecomastia in men
  • Post-menopasual bleeding in women
  • Hyperkalaemia

Nursing Science 3 (21 decks)

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