💊370: Renal Flashcards

(49 cards)

1
Q

What is Uremia?

A

Renal function declines to 10% of normal

Uremic toxins accumulate

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2
Q

What is Acute Kidney Injury (AKI)?

A

Abrupt loss of renal function
⬆️SCr ⬆️BUN >10-15% baseline

Can progress to CKD

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3
Q

What are life threatening complications of AKI?

A
  1. Hyperkalemia
  2. Pulmonary edema
  3. Heart failure
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4
Q

What are supportive management measures for AKI?

A
  1. Correct intravascular volume status with pRBCs, plasma expanders, or diuretics
  2. Treat precipitating condition
  3. Withdraw nephrotoxic drugs
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5
Q

What is the cause of Hyperkalemia?

A

Kidney unable to excrete K+
➡️ redistributed our of cells during metabolic acidosis

Drugs (ACEIs)

Can cause arrhythmia and cardiac arrest

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6
Q

What lab values indicate hyperkalemia?

A

Severe: >= 7.0 mmol/L

K+ = 6.0-6.9 with ECG changes

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7
Q

What are the interventions for hyperkalemia?

A
  1. Reduce risk of arrhythmias
    ➡️ IV Calcium
  2. Shift K+ into cells
    ➡️ Insulin (+glucose)
    ➡️ Sodium bicarbonate
    ➡️ Inhaled salbutamol
  3. Remove K+
    ➡️Cationic exchange resins
    ➡️ Dialysis
    ➡️ Diuresis
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8
Q

What are erythropoiesis stimulating agents (ESA) used for?

A

Anemia of CKD

Structurally identical to endogenous EPO

Release reticulocytes from bone marrow

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9
Q

What is a prototype of erythropoiesis stimulating agents (ESA)?

A

Epoetin alfa (Eprex)

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10
Q

What are side effects of erythropoiesis stimulating agents (ESA)?

A
  1. Hypertension
  2. Risk of CV events
  3. Pure red-cell aplasia (PRCA)
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11
Q

What are non-pharmacological therapies for Hyperphosphatemia?

A
  1. Dietary restrictions (no dairy, beans, beer, meats)
  2. Dialysis
  3. Subtotal or Total parathyroidectomy
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12
Q

What are examples of Phosphate binders?

A
  1. Calcium

2. Sevelamer (Renagel)

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13
Q

What are pharmacological treatments of Hypocalcemia and Hyperparathyroidism?

A
  1. Vitamin D ⬆️ Ca absorption and suppresses PTH synthesis
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14
Q

What are common nephrotoxic drugs?

A
  1. NSAIDs
  2. Aminoglycosides
  3. Vancomycin
  4. Sulfonamides
  5. Amphotericin B
  6. Cyclosporine
  7. Radio-contrast media
  8. Cisplatin
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15
Q

What are the 3 major functions of the nephron?

A
  1. Filtration
  2. Reabsorption
  3. Secretion
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16
Q

What is the function of the Glomerulus/Bowman’s Capsule?

A

Filtration
Allows passage of small molecules (H2O, NaCl, glucose, amino acids, urea)

Stops cells, platelets, and proteins

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17
Q

What is the major functions of the Proximal Tubule?

A

Reabsorbs:

  1. NaCl
  2. Glucose
  3. K+
  4. H2O/water
  5. Protein
  6. Urea
  7. Amino acids
  8. HCO3
  9. PO4

Secretes:

  1. H+
  2. Foreign substances
  3. Anions + cations
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18
Q

What is the major functions of the Loop of Henle?

A

Concentration of urine

Descending:

  1. Water reabsorption
  2. NaCl diffuses in

Ascending:

  1. Na+ reabsorption
  2. Water stays in

Urea secretion in thin segment

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19
Q

What are the major functions of the Distal Tubule?

A

Reabsorbs:

  1. NaCl
  2. Water (ADH required)
  3. HCO3

Secretes:

  1. K+
  2. Urea
  3. H+
  4. NH3+
  5. Some drugs
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20
Q

What are the functions of the Collecting Duct?

A

Reabsorbs:
1. Water (ADH required)

Absorbs/secretes:

  1. Na+
  2. K+
  3. H+
  4. NH3+

Urea secretes in medulla

21
Q

What are signs associated with kidney disease or injury?

A
  1. Albuminuria
  2. Hematuria
  3. Reduced GFR
  4. Low blood protein
  5. Edema
22
Q

What is the average urinary output in healthy patients?

A

180 L/day

GFR > 90mL/min

23
Q

What are the forces that influence glomerular filtration rate (GFR)?

A
  1. Glomerular blood hydrostatic pressure
  2. Plasma colloid osmotic pressure
  3. Capsular hydrostatic pressure
24
Q

What is the most common cause of AKI?

A

Dehydration (hypovolemia) leading to poor perdición to kidneys

25
What is Acute Tubular Necrosis (ATN)?
Damage to tubules from toxins or ischemia
26
What is Glomerulonephritis?
Inflammation of the glomeruli caused by immune response
27
What is the pathophysiology of Glomerulonephritis?
1. Antigen-antibody complexes produced in response to infection become trapped in glomerulus 2. Causes inflammatory damage, reducing capacity for selective permeability 3. Allow larger molecules to enter filter ➡️ proteinuria + hematuria
28
What are signs of Glomerulonephritis?
1. Hematuria 2. Proteinuria 3. Hypertension 4. Edema (hypoalbuminemia ➡️ third spacing)
29
What is the pathophysiology of Pyelonephritis?
1. Fibrosis and scar tissue formation of kidney pelvis and parenchyma after infection 2. Interferes with tubular absorption and secretions Recurrent infections increase scar tissue
30
What are signs and symptoms of Pyelonephritis?
1. Fever 2. Abdominal pain 3. Dysuria 4. Cloudy urine 5. Polyuria or urgency 6. Urinary odour
31
What is Nephrotic Syndrome?
Manifestation of kidney failure Caused by group of diseases that damage kidneys filtering system
32
What are signs and symptoms of Nephrotic Syndrome?
1. Proteinuria >3g protein/ day 2. Edema 3. Foamy urine 4. Weight gain 5. Hypoalbunemia 6. Hematuria
33
What is Nephritic Syndrome?
Nephron inflammation | Acute onset
34
Azotemia
Nephrotoxicity that involves excess nitrogen compounds (urea, creatinine, etc) ⬆️ BUN + SCr Crystallized urea deposits Can occur in all types of AKI
35
What is the normal pH of urine?
4.8-8.0 Diabetes and starvation ⬇️pH Infections ⬆️pH
36
What is the normal range of urinary Specific gravity?
1.025-1.032 ⬆️dehydration, UTI, glucosuria, renal artery stenosis, decreased perfusion ⬇️ renal failure, pyelonephritis, Acute tubular necrosis, excess fluid
37
Casts in urinary microscopic analysis
Precipitate from cells lining the renal tubules
38
Crystals in urinary microscopic analysis
1. Infection 2. Inflammation 3. Stones
39
Epithelial cells in urinary microscopic analysis
Degeneration, necrosis of tubule cells
40
What is the normal range for BUN?
3.6-7.1 mmol/L | 10-20mg/dL
41
What is the normal range of serum creatinine?
Women: 45-90 Men: 60-110 micromol/L
42
What is the best estimation of functioning renal tissue?
GFR
43
Creatinine is primarily excreted by the GF after being constantly released by which tissue?
Muscle
44
What conditions result in prerenal injury?
1. Renal Artery vasoconstriction 2. Renal Artery thrombosis 3. Hemorrhage 4. Hypotension
45
What hormone is synthesized and secreted by the kidneys?
Erythropoietin to produce RBC in bone marrow
46
What are causes of infra-renal AKI?
1. Acute Tubular Necrosis | 2. Glomerular, tubular or interstitial damage
47
What are causes of postrenal AKI?
1. Renal calculi 2. Ureteral stricture 3. Benign prostatic hyperplasia (BPH) 4. Tumor 5. Blood clots in ureters/urethra
48
What are causes of prerenal AKI?
1. Hypovolemia 2. Decreased cardiac output 3. Thrombo-embolitic obstruction of renal vasculature
49
What are signs of Azotemia?
1. ⬆️ BUN + SCr 2. Uremic frost Can occur in all types of AKI