302 Why kidneys fail

Question 1

What disease and outcome does an electrolyte balance cause?

Answer 1

Hyperkalaemia
Hyper/hypo natraemia

Outcome:
Tented T waves - widens QRS - asystole
Confusion - coma - death

Question 2

What disease and outcome does a fluid imbalance cause?

Answer 2

Oedema
Ascites
Pulmonary oedema

Outcome:
Breathlessness
Heart failure
Mitral regurgitation

Question 3

What disease and outcome does a acid imbalance cause?

Answer 3

Acidaemia

Outcome:
Reduced cardiac output
Bone destruction

Question 4

What disease and outcome does abnormal blood pressure cause?

Answer 4

Hypertension

Outcome:
Ischaemic heart disease
Stroke
Heart failure
AAA

Question 5

What disease and outcome is caused by imbalanced haemoglobin?

Answer 5

Anaemia

Outcome:
Fatigue
Heart failure

Question 6

What disease and outcome is caused by imbalanced vitamin D?

Answer 6

Hypoparathyroidism (secondary or tertiary)

Outcome:
Blood vessel wall calcification

Question 7

What disease and outcome is caused by decreased toxin clearance?

Answer 7

Uraemia

Outcome:
Weight loss
Sub fertility
Anorexia
Bleeding
Pericarditis
Encephalopathy

Question 8

What is kidney failure?

Answer 8

Loss of functioning nephrons
-Irreversible, slow, progressive….CKD
Urine output preserved
-Potentially reversible, rapid onset…AKI
Oliguria (low urine output)
Anuria (no urine output)

Degrees of failure
Stages 1-5 in CKD
Stages 1-3 in AKI

Question 9

How can the kidney tubules be damaged?

Answer 9

-Acute tubular injury (from sepsis or hypovolaemia)
-Myeolma
-Rhabdomyolysis

Question 10

What is myeloma?

Answer 10

Bone marrow cancer

Question 11

How can the kidney glomeruli be damaged?

Answer 11

Diabetes
Vasculitis
SLE
Glomerulonephritis

Question 12

What is SLE?

Answer 12

Systemic lupus erythematosus

Question 13

How can the kidney blood vessels be damaged?

Answer 13

Diabetes
Renal vascular disease
Hypertension
HUS (haemolytic uremic syndrome)

Question 14

What is HUS (haemolytic uremic syndrome)?

Answer 14

Infection with HUS causes destruction of red blood cells, which can then cause kidney failure

Mostly caused by E.coli

Question 15

What can cause damage to the kidney interstitium?

Answer 15

Final common pathway tubulo-interstitial nephritis (chronic hypoxia in the tubulointerstitium)

Question 16

What effects does diabetes have on the glomerulous?

Answer 16

Podocyte loss
Mesangial expansion
Mesangial matrix
Thickening of glomerular basement membrane (BGM)
Capillary loss

Question 17

What is the function of podocytes?

Answer 17

They prevent plasma proteins from entering the urinary ultrafiltrate

Question 18

What is the mesangial matrix?

Answer 18

It provides structural support for the mesangium, an extremely important component of the glomerulus, forming the supporting framework in which the glomerular tuft capillaries ramify

Question 19

What is the pathogenesis of diabetic kidney disease?

Answer 19

1. Podocyte damage leading to albuminuria
2. High glucose environment— reactive oxygen species - vascular endothelial cell damage
3. Tubulo-interstitial and glomerular fibrosis

Question 20

What is Acute Tubular Necrosis?

Answer 20

Damage to the tubule cells of the kidneys, which can lead to acute kidney failure

In the first hours, it can be corrected with fluids/antibiotics
But once enough tubules are ischaemic, patient becomes unresponsive to fluids

Question 21

What are the different types of ischaemic injuries that can cause acute tubular necrosis (ATN)?

Answer 21

-Diarrhoea, vomiting
-Bleeding
-Dehydration
-Burns
-Renal losses via diuretics or osmotic diuresis
-Third fluid sequestration (e.g nephrotic syndrome)
-Oedematous states such as heart failure and cirrhosis cause reduced kidney perfusion.
-Coagulopathy, such as disseminated intravascular coagulation

Question 22

What are the different types of toxic injuries that can cause acute tubular necrosis (ATN)?

Answer 22

-Aminoglycosides
-Amphotericin B
-Acyclovir
-Cisplatin
-Cidofovir
-Uric acid (gout)
-Light chain accumulation (myeloma)
-Myoglobin (rhabdomyolysis)
-Ethylene glycol

Question 23

What are the different types of septic injuries that can cause acute tubular necrosis (ATN)?

Answer 23

-Systemic hypoperfusion
-Endotoxins leading to vasoconstriction
-Inflammatory cytokines-ROS-injury

Question 24

How is AKI treated?

Answer 24

-Hydration (0.9% saline)
-Prevent hypotension
-Avoid nephrotoxins
-Treat obstruction
-Specific treatment (mostly immunosuppression)

Question 25

What is the interstitium of a kidney?

Answer 25

The intertubular, extraglomerular, extravascular space of the kidney

Question 26

Which vessels does the renal artery divide into?

Answer 26

Interlobar arteries
Arcuate arteries
Interlobar arteries

Question 27

What is renal vascular disease?

Answer 27

Affects the blood flow to kidney

Clinical presentations:
-Rapidly progressive
-Anuric
-Single kidney
-Treated with angioplasty
-Small vessel disease
-Low grade proteinuria
-Associated with vascular disease
elsewhere

Question 28

What is the final common pathway of kidney damage?

Answer 28

Renal injury causes renal scarring and the whole process is exacerbated by systemic hypertension

Question 29

What are the different types of dialysis?

Answer 29

Haemodialysis
-blood is directly dialysed and put back in the body
- 4 hours 3x a week

Peritoneal dialysis
-A cleansing fluid flows through a catheter into part of your abdomen. The peritoneum acts as a filter and removes waste products from your blood. After a set period of time, the fluid with the filtered waste products flows out of your abdomen and is discarded
-Happens every day

Question 30

What is the peritoneum?

Answer 30

The lining of the abdomen