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Renal > Pathophysiology of Acute & Chronic Renal Failure > Flashcards

Pathophysiology of Acute & Chronic Renal Failure Flashcards

1
Q

What is acute renal failure?

A

Urine output of less than 500mL per day - a failure of filtration

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2
Q

Is acute renal failure reversible?

A

yes

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3
Q

What is chronic renal failure?

A

GFR of less than 72L/day

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4
Q

Is chronic renal failure reversible?

A

no

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5
Q

Does acute renal failure lead to chronic renal failure?

A

not usually

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6
Q

What causes different outcomes of acute renal failure?

A

the degree of tubular impairment relative to filtration impairment

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7
Q

What are the endocrine effects of chronic renal failure?

A

excessive activation of RAS which will vasoconstrict and impair renal blood flow, vitamin D activation which will cause osteodystrophy and rickets, and EPO which will cause anemia

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8
Q

Why is urea a poor indicator of GFR?

A

because it varies with diet and liver function and steroid use

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9
Q

What is a good measure of GFR?

A

creatinine

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10
Q

What is the hydrostatic pressure in the glomerulus?

A

55mmHg

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11
Q

What is the hydrostatic pressure in Bowman’s capsule?

A

15mmHg

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12
Q

What is the oncotic pressure in the glomerulus?

A

30mmHg

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13
Q

What is the net filtration pressure?

A

10mmHg

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14
Q

What is oliguria?

A

decreased urine production (less than 500mL)

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15
Q

What is anuria?

A

no urine

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16
Q

What are the three types of causes of acute renal failure?

A

pre renal, renal and post renal

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17
Q

What is the key cause in pre renal acute renal failure?

A

systemic blood pressure <45mmHg

18
Q

What are the causes of pre renal acute renal failure?

A

shock, haemorrhage, sepsis, hypoalbuminemia, renal artery stenosis, NSAIDs, ACE inhibitors, cardiac failure

19
Q

Why does hypoalbuminemia cause renal failure?

A

because it causes plasma volume to go down so leads to decreased perfusion of kidneys

20
Q

What are the causes of renal acute renal failure?

A

glomerular disease, interstitial nephritis or tubular damage from ischaemia or toxins (acute tubular necrosis)

21
Q

What toxins cause tubular damage?

A

antibioics, X-ray contrast media, myoglobin and haemoglobin

22
Q

When is there an increase in haemoglobin?

A

haemolysis

23
Q

When is there an increase in myoglobin?

A

rhabdomyolysis

24
Q

What is acute tubular necrosis?

A

death of tubular epithelial cells caused by hypotension and nephrotoxic drugs - one of the most common causes of acute renal failure

25
Q

What are the 2 ways that acute renal failure can cause death?

A

acidosis and hyperkalemia

26
Q

What are the post renal causes of acute renal failure?

A

obstruction - e.g. stones, tumours, benign prostatic hypertrophy

27
Q

What is chronic renal failure?

A

an irreversible loss of renal function

28
Q

What is glomerular hyper filtration?

A

in chronic renal failure the remaining nephrons hypertrophy which will cause them to function at too high a level which will cause glomerular hypertension causing further damage - furthermore the tubules are overwhelmed and can’t adequately reabsorb

29
Q

What is the urine like when there is glomerular hyper filtration?

A

high output of urine that is similar to plasma - has not been modified by tubules

30
Q

What is uraemia?

A

an accumulation of uraemic toxins - mostly urea = end stage renal disease

31
Q

What are the symptoms of uraemia?

A

fatigue, loss of appetite, skin pigmentation, nausea, vomiting, dehydrations, priuritus, thrombocytopaenia

32
Q

What are some common causes of chronic renal failure?

A

diabetes, high blood pressure, chronic glomerulonephritis, cystic disease

33
Q

What happens to salt and water balance in a glomerular chronic renal failure?

A

sodium retention and hypertension

34
Q

What happens to salt and water balance in a tubular chronic renal failure?

A

sodium wasting and low BP

35
Q

What happens to potassium in chronic renal failure?

A

tends to rise

36
Q

What happens to pH in chronic renal failure?

A

tends to fall

37
Q

What happens to phosphate in chronic renal failure?

A

increase

38
Q

What happens to calcium in chronic renal failure?

A

decrease

39
Q

What causes renal osteodystrophy?

A

low vitamin D3 and high PTH

40
Q

What can cause anuria?

A

renal artery occlusion and prostatic malignancy

41
Q

How is vitamin D activated?

A

dual hydroxylation - first in the skin and second in the kidney

42
Q

What type of diet should be given for chronic renal failure?

A

low protein diet

Renal (12 decks)

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