week 8- renal

Question 1

kidney functions

Answer 1

Kidneys eliminate water & waste products,
3 ways
-renal clearance- substances removed from plasma then filtered by glomeruli and then either reabsorbed or excreted
-sodium and pottasium elimination-controlled by hormones and GFR.
-pH regulation- H+ excreted and bicarbonate saved

Question 2

acid-base balance

Answer 2

Respiratory disorders causing acidosis or alkalosis initiate a kidney response

• acidimia-kidneys excrete excess hydrogen ions
• alkamia-kidneys excrete excess bicarbonate ions

Question 3

how much water people require

Answer 3

people require ~100ml water per 100 calories metabolized for dissolving & eliminating metabolic wastes

Question 4

ARF

pre-renal failure

Answer 4

Pre-renal failure: diminished blood flow to kidney, resulting in hypoperfusion and hypoxia. The tubules are particularly susceptible to hypoxia, causing impaired blood flow, decreased GFR and increased tubular reabsorption of sodium and water. This causes electrolyte imbalances and metabolic acidosis.

Question 5

ARF post-renal failure

Answer 5

Post-renal failure: bilateral obstruction of urine outflow, typically in the bladder, ureters or urethra.

Question 6

UTI

Answer 6

-Infection usually ascends from urethra to bladder
Typically caused by E. coli – resident flora of intestine
-Bacteria invade bladder mucosa & multiply
-Bacteria cannot be eliminated readily with normal micturition

-Women more anatomically vulnerable

Question 7

lower UTI’s

Answer 7

Urethritis: urethra inflamed, red, swollen
Cystitis: bladder wall inflamed, red, swollen
Bladder becomes hyper-reactive with reduced capacity

Question 8

Kidney Infection (Pyelonephritis)

Answer 8

-Sudden inflammation caused by bacterial infection
can include one or both kidneys.
-Purulent exudate (pus) fills kidney pelvis & calcyces, & medulla is inflamed
-exudate can compress renal artery & vein, & obstruct urine outflow to ureter
Bilateral obstruction likely to cause acute renal failure

Question 9

kidney stones

Answer 9

Form anywhere along urinary tract, but most commonly on renal pelves or calyces

• Once any solid debris forms, deposits continue to accumulate, forming a large stone
• increased fluid intake can help dislodge

Question 10

how to define renal failure

Answer 10

when glomerular filtration rate (GFR) less than 60ml/min/1.73m2 for 3 months or longer

Question 11

why dialysis needed

Answer 11

Affects all body systems  difficult to maintain homeostasis of fluids, electrolytes, & acid-base balance
Pharmaceutical management of serum levels, in addition to hypertension, arrhythmias, heart failure
Drug doses carefully considered as reduced kidney function affects drug excretion (prolonged)
Intake of fluid, electrolytes & protein must be restricted due to limited ability of kidney to excrete excess wastes/fluids

Question 12

chronic renal failure-

Answer 12

-over time
gradual and irreversible destruction of the kidneys.
-secondary to chronic kidney disease or systemic disorders (hypertension and diabetes).
- is a loss of functioning kidney nephrons, with progressive deterioration of GFR, tubular reabsorptive capacity, and the endocrine functions of the kidneys. -The loss of nephrons is asymptomatic until it is well-advanced (end stage renal failure).
-patient will need to begin dialysis or requires a renal transplant.

Question 13

End-stage renal failure (uremia)

Answer 13

• > 90% of nephrons, and therefore has a
• useless GFR (causing oliguria, and then anuria).
• electrolytes and wastes are all retained in the body, and acid-base balance becomes difficult to maintain. -This affects all body systems.
• They also require pharmaceutical management of serum levels, hypertension, arrhythmias and heart failure.

Question 14

ARF acute renal failure

Answer 14

-sudden blockage
ARF is the rapid failure of bilateral renal function. This is due to reduced blood flow to the kidneys, or inflammation and necrosis of the tubules, resulting in obstruction of backflow. Consequently, there is a great reduction of GFR, and therefore leads to oliguria (reduced urine output). It can be divided into pre, intra or post-renal failure.

Question 15

who is dialaysis an indication for?

Answer 15

Dialysis is indicated for patients in end stage renal failure is present, resulting in uraemia or serious electrolyte imbalances.

Question 16

Haemodialysis

Answer 16

Haemodialysis: an artificial external kidney is used to filter blood.

• A shunt is implanted in a patient’s arm to support the removal of their blood, and it’s return to their body.
• The blood goes into the dialyser – a hollow cylinder with bundles of capillary tubes that allows blood to circulate through,
• A semi-permeable membrane separates the patient’s blood from the dialysate, allowing the exchange of wastes, fluid and electrolytes.
• This movement is completed by ultrafiltration, diffusion and osmosis. After this exchange, the blood is returned to the patient’s vein. Complications of haemodialysis may include an infected shunt, blood clots, increased risk of hepatitis B, C or HIV, and the blood vessels involved in the shunt eventually become damaged, requiring a new site.

Question 17

peritoneal dialaysis

Answer 17

-utilises the peritoneal membrane, a thin, highly vascular surface area in the abdomen.
-A catheter is surgically implanted into the peritoneal cavity, tunnelled through the subcutaneous tissue and exiting on the side of the abdomen.
-A dialysing solution (dialysate) of 1 – 3L is instilled into the abdomen through the catheter,
-It then dwells in the peritoneal cavity for a prescribed amount of time, allowing exchange of wastes and electrolytes, via diffusion and osmosis.
Glucose may be added to this solution to encourage water removal (as water follows glucose).
-the dialysis fluid is then drained from the peritoneal cavity by gravity, into a sterile bag. This may be completed at night while sleeping, or continuously while the patient is ambulatory (most common form – continuous ambulatory peritoneal dialysis (CAPD)). Complications of this include infection, resulting in peritonitis.

Question 18

transplant

Answer 18

Renal transplantation is also indicated for patients in end stage renal failure. However, the choice of renal failure or transplantation is affected by patient age, donor availability and personal preference. transplant patients have to take immunosupressors for the rest of there lives and could reject at any moment.