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PHA222 > Renal > Flashcards

Renal Flashcards

1
Q

What are the two types of renal disease?

A

Acute - rapidly progressive and reversible

Chronic - progressive and irreversible loss of renal function

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2
Q

What is renal insufficiency?

A

renal function decline to 25% of normal GFR

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3
Q

What is renal failure?

A

significant loss of renal function with <10% remains end stage renal failure

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4
Q

what is uremia?

A

it is a renal failure syndrome due retention of toxic waste and deficiency state.

High blood urea and Cr levels

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5
Q

what are the symptoms of uremia?

A

fatigue
nausea
anorexia
vomiting

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6
Q

what is azotemia?

A

High serum levels and Cr which are caused by Renal failure and Renal insufficiency

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7
Q

what does Uremia + Azotemia =

A

accumulation of nitrogenous waste in the blood

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8
Q

What is Acute Kidney Injury (AKI)?

A
  • It is rapid decline in renal function (hrs/days).

- Failure to maintain fluid, electrolyte and acid base homeostasis

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9
Q

What is Oliguria?

A

passing small volume of urine

< 30ML/400ML per 1hr/day)

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10
Q

How is AKI diagnosed?

A

High conc of urea and Cr

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11
Q

Why does Blood urea nitrogen (BUN) increase?

A

if the GFR decreases due to renal disease or decreased blood flow to the kidney then BUN increases

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12
Q

What is the normal range of Blood Urea Nitrogen (BUN)?

A

2.5-6.6 mmol/L

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13
Q

There are two biochemical tests. Name and describe them.

A

Metabolic acidosis - inability to excrete H+

Hyperkalaemia - impaired excretion of K+. The low threshold of initiation of action potential disturbs electrical conduction of the heart which results in cardiac arrest.

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14
Q

There are 3 classifications of AKI; Pre-renal, Post renal and intra renal. What is Pre renal?

A
  • Heart failure
  • Blood/fluid loss
  • Drugs (ACEIs, ARBs etc)
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15
Q

What falls under post renal classification?

A

obstruction of urinary tract

  • stones
  • tumors
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16
Q

what falls under intra renal classification?

A

renal parenchymal injury

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17
Q

If a patient is suspected to have an AKI, what clinical investigations need to be carried out?

A

Full history, physical examination, urine examination, blood examination and radiological

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18
Q

What happens to a patient who has oliguria, acute tubular necrosis has supervened and the plasma urea/Cr/K+ levels are rising?

A

DIALYSIS

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19
Q

What are the symptoms of AKI?

A

nausea/vomiting, dehydration. fatigue, decreased frequency of urinating and change in urine colour.

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20
Q

What are the risk factors of AKI?

A
  • > 65 years
  • AKI history
  • Chronic conditions such as HF, HPT and diabetes
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21
Q

What is Creatinine Clearance (CrCL) and what is it used for?

A

the indirect measure of GFR and renal blood flow and it is used to monitor changes in chronic renal function.

amount excreted = amount filtered

22
Q

What is creatinine?

A

end product of muscle metabolism

23
Q

What is the normal Cr Clearance level?

A 
Male = 64-111
Female = 50-98

lower in females

24
Q

Describe the RIFLE staging of AKI.

A

Risk of renal dysfunction - 50% increase in Cr and > 25% decrease in GFR
Injury of kidney - 2 fold increase in Cr and >50% decrease in GFR
Failure of kidney function - 3 fold increase in Cr and >75% decrease in GFR
Loss of kidney function - loss of kidney function for 1-3 months
End stage renal failure - loss of kidney function for <3 months

25
Q

State the intercellular and extracellular concentrations of K+ distributions.

A

IC - 140-150 mmol/L

EC - 3.5 - 5.0 mmol/L

26
Q

What are the 2 mechanisms involved in mechanism K+ regulation?

A
  1. Conserve/ eliminate K+

2. Transcellular shift between intercellular and extracellular fluid

27
Q

What does abnormal K+ cause?

A

Hypokalaemia and/or Hyperkalaemia

28
Q

What is hypokalaemia? What is it due to?

A

It is a decrease in plasma K+ (<3.5mmol/L)

This is due to:

  • low intake of K+ in diet
  • excess renal, GIT and skin losses
  • Redistribution between intercellular fluid and extracellular fluid compartments
29
Q

What is hyperkalaemia? What is it due to?

A

It is increase in plasma K+ (>5.0 mmol/L)

This is due to:

  • Decrease in renal elimination
  • Excess rapid admin
  • Movement of K+ from the intercellular fluid to the extracellular fluid compartment
30
Q

What is chronic kidney disease (CKD)?

A

Decrease in kidney function and/or structural damage for more than 3 months and the GFR is more than 60mL/min.

31
Q

What are the risk factors of Chronic kidney disease?

A

Diabetes, HPT, CVD, 50 yrs+, BMI, smoking, alcohol and family history of S5 chronic kidney disease

32
Q

What are the causes of Chronic kidney disease?

A
  1. Decrease in renal perfusion which results in hypotension due to drugs, poor cardiac function
  2. UTI/UT obstruction
  3. Nephrotoxic meds - ACEIs, metformin
33
Q

How is a diagnosis of chronic kidney disease reached?

A
  • Blood test - serum Cr and GFR levels
  • Morning urine sample to measure Albumin:Cr ratio (the higher the more sever)
  • Dipstick test for haematuria
34
Q

What are the stages of Albumin : Cr ratio?

A

A1 - less than 3mg/mmol - normal to mid
A2 - 3-30mg/mmol - moderate
A3 - more than 30mg/mmol - severe

35
Q

What are the investigations carried out on a patient with suspected chronic kidney disease?

A

Medical history
Physical examination
Tests: biochemistry, immunology, radiology, biopsy

36
Q

What would the blood test results of a patient with chronic kidney disease show?

A
  • Increase in urea, Cr and PO4- levels

- Decrease in Ca2+ and Hb

37
Q

What are the symptoms of chronic kidney disease?

A

Fatigue, Nausea, anorexia and weight loss

38
Q

If a patient has S4/5 chronic kidney disease, what would they present with?

A
  • hyperkalaemia
  • uraemia
  • anaemia
  • impaired Vit D
39
Q

In relation to CKD. What is the mechanism of action of loop diuretics?

A

increase urine volume and Na+ excretion

40
Q

In relation to CKD. What is the mechanism of action of Acetazolamide?

A

Treat metabolic acidosis due to renal failure

41
Q

In relation to CKD. What is the mechanism of action of ACEIs/ARBs?

A

To control HPT and decrease the rate of decline of renal function

42
Q

In relation to CKD. What is the mechanism of action of Antiemetics?

A

control nausea and vomiting with renal failure

43
Q

In relation to CKD. What is the mechanism of action of Erythropoietin?

A

Treat anaemia as it stimulates red cells production

44
Q

In relation to CKD. What is the mechanism of action of increasing CaCO3/Al2OH3 and decreasing PO4- in diet intake?

A

hyperphosphataemia control

45
Q

Describe Haemodialysis

A

Done through the artery in the arm.

  • efficient
  • 4hours, 3 times a week
  • 2-3 days between treatment
  • at hospital
  • Strict diet + fluid restrictions between treatments
  • vascular related infections may occur
  • Patient must depend on others
46
Q

Describe Peritoneal Dialysis

A

Done in the gut

  • Less efficient
  • 4 treatments a day for 30-60 mins
  • hours between treatments
  • at home
  • less restrictions
  • peritonitis and catheter related infections may occur
  • patient is independent for treatment
47
Q

When should a renal transplant not be considered?

A

Patient has:

  • severe heart or vascular disease
  • active malignancy
48
Q

When should a renal transplant be considered?

A

If the patient:

  • under 1 year or Over 75 years
  • High risk of disease recurrence
  • significant comorbidity
  • lower urinary tract disease
49
Q

What is Acute pylenephritis?

A

Infection of Upper UT of renal parenchyma and pelvis

50
Q

What are the symptoms of Acute pylenephritis?

A

rapid onset, fever, chills, nausea, urinary frequency

51
Q

Why does Acute pylenephritis affect women more than men?

A

Women have a shorter urethra therefore bacteria can enter bladder more easily

52
Q

What is Chronic pylenephritis?

A

Progressive infection of the upoper UT - scarring and deformation of renal calyces and pelvis

PHA222 (13 decks)

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