Where does filtration occur
Glomerus
What is filtration dependent upon
Glomerular pressure
What does the juxta-glomerular apparatus contain
RAAS
Function of prostaglandins
Control glomerular functions
Definition of polyuria
Excess urine
Definition of dysuria
Pain when passing urine
Definition of haematuria
Blood in urine
Definition of proteinuria
Protein in urine
Definition of uraemia
Excess urea in blood
Renal function is measured by (3)
Serum urea
Serum creatinine
24hr urine collection (creatinine clearance)
Renal failure involves (4)
Loss of renal excretory function
Loss of water and electrolyte balance
Loss of acid base balance
Loss of renal endocrine function (EPO, calcium metabolism, renin secretion)
Renal failure can be (2)
Acute (usually reversible)
Chronic
Features of acute renal failure
Rapid loss of renal function, usually over hours/days
Features of chronic renal failure
Gradual loss of renal function, usually over many years
Causes of renal failure (3)
Pre-renal
Renal
Post-renal
Definition of pre-renal failure and examples (3)
Hypo-perfusion of kidney
Shock
Renal artery disease
Aorta disease
Examples of renal failure (4)
Chronic disease
Drug damage
Trauma
Rhabdolysis
Definition of rhabdolysis
Breakdown of skeletal muscle
Examples of post-renal failure
Renal outflow obstruction
Acute renal failure involves (5)
Rapid loss of renal function Anuric initially with volume overload Gradual progression to polyuria Development of hyperkalaemia Development of uraemia and acidosis
Creatinine level in acute renal failure
> 200umol/l
Symptoms of acute renal failure (5)
Ankle oedema (ambulatory) or sacral oedema (sedentary) Pulmonary oedema Breathlessness Raised JVP Weight gain
Effects of acidosis (3)
Low bicarbonate
Increased respiratory excretion of CO2
Raised respiratory rate
Main cause of acute renal failure
Pre-renal cause
Specific cause and example of acute renal failure (2)
Trauma/drug-induced
Crush injury –> muscle breakdown –> uraemia –> kidneys blocked –> acute failure
Types of chronic renal failure (2)
Primary
Secondary
Causes of primary renal failure (2)
Glomerulonephritis
Polycystic kidney disease
Causes of secondary renal failure (6)
Diabetes (30%) HTN (20%) Drug therapy Vasculitis Renal artery disease Aorta disease
Presentation of glomerulonephritis (4)
Haematuria
Proteinuria
In an otherwise healthy individual
Gradual progression to HTN and chronic renal failure
Complications of glomerulonephritis
Nephrotic syndrome
Nephrotic syndrome involves (4)
Excessive loss of protein in urine (leads to hypoalbuminaemia)
Loss of plasma oncotic pressure
Tissue swelling (oedema)
Hypercoagulable state (loss of clotting factors)
Why should NSAIDs be avoided in renal failure (2)
Inhibit glomerular blood flow
Causes interstitial nephritis
Nephrotoxic drugs include
Cyclosporin
Renal vascular disease involves (2)
Reduced blood flow to kidney (atheroma, HTN)
Microangiopathy
Immune-mediated renal damage can be (3)
Multiple myeloma (plasma cell tumour/tubular nephritis)
Goodpasture’s syndrome
Vasculitis (lupus)
Polycystic kidney disease causes (2)
Gene mutation (PKD 1, 2, 3) Multiple cysts in renal parenchyma (enlarged kidney, progressive destruction, gradual renal failure)
When does end stage renal disease (ESRD) occur (2)
When eGFR <15ml/min
Creatinine is 800-1000umol/l
Chronic renal failure management involves (5)
Reduce rate of decline (control underlying cause) Correct fluid balance Correct deficiencies Remove outflow obstruction Treat infection
Signs of chronic renal failure (3)
Anaemia
HTN
Renal bone disease (low Ca, high PO4, hyperparathyroidism, osteomalacia)
Symptoms of chronic renal failure (6)
Insidious (may be few) Polyuria Nocturia Tired Weak Nausea
Renal malignancies include (2)
Renal cell carcinoma (HTN, polycythaemia)
Transitional cell carcinoma (haematuria, asymptomatic)
Secondary oral effects of anaemia include (2)
Oral ulceration
Dysaesthesia