💊370: Renal

Question 1

What is Uremia?

Answer 1

Renal function declines to 10% of normal

Uremic toxins accumulate

Question 2

What is Acute Kidney Injury (AKI)?

Answer 2

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

Can progress to CKD

Question 3

What are life threatening complications of AKI?

Answer 3

1. Hyperkalemia
2. Pulmonary edema
3. Heart failure

Question 4

What are supportive management measures for AKI?

Answer 4

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

Question 5

What is the cause of Hyperkalemia?

Answer 5

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

Drugs (ACEIs)

Can cause arrhythmia and cardiac arrest

Question 6

What lab values indicate hyperkalemia?

Answer 6

Severe: >= 7.0 mmol/L

K+ = 6.0-6.9 with ECG changes

Question 7

What are the interventions for hyperkalemia?

Answer 7

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

Question 8

What are erythropoiesis stimulating agents (ESA) used for?

Answer 8

Anemia of CKD

Structurally identical to endogenous EPO

Release reticulocytes from bone marrow

Question 9

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

Answer 9

Epoetin alfa (Eprex)

Question 10

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

Answer 10

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

Question 11

What are non-pharmacological therapies for Hyperphosphatemia?

Answer 11

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

Question 12

What are examples of Phosphate binders?

Answer 12

1. Calcium

2. Sevelamer (Renagel)

Question 13

What are pharmacological treatments of Hypocalcemia and Hyperparathyroidism?

Answer 13

1. Vitamin D ⬆️ Ca absorption and suppresses PTH synthesis

Question 14

What are common nephrotoxic drugs?

Answer 14

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

Question 15

What are the 3 major functions of the nephron?

Answer 15

1. Filtration
2. Reabsorption
3. Secretion

Question 16

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

Answer 16

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

Stops cells, platelets, and proteins

Question 17

What is the major functions of the Proximal Tubule?

Answer 17

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

Question 18

What is the major functions of the Loop of Henle?

Answer 18

Concentration of urine

Descending:

1. Water reabsorption
2. NaCl diffuses in

Ascending:

1. Na+ reabsorption
2. Water stays in

Urea secretion in thin segment

Question 19

What are the major functions of the Distal Tubule?

Answer 19

Reabsorbs:

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

Secretes:

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

Question 20

What are the functions of the Collecting Duct?

Answer 20

Reabsorbs:
1. Water (ADH required)

Absorbs/secretes:

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

Urea secretes in medulla

Question 21

What are signs associated with kidney disease or injury?

Answer 21

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

Question 22

What is the average urinary output in healthy patients?

Answer 22

180 L/day

GFR > 90mL/min

Question 23

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

Answer 23

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

Question 24

What is the most common cause of AKI?

Answer 24

Dehydration (hypovolemia) leading to poor perdición to kidneys

Question 25

What is Acute Tubular Necrosis (ATN)?

Answer 25

Damage to tubules from toxins or ischemia

Question 26

What is Glomerulonephritis?

Answer 26

Inflammation of the glomeruli caused by immune response

Question 27

What is the pathophysiology of Glomerulonephritis?

Answer 27

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

Question 28

What are signs of Glomerulonephritis?

Answer 28

1. Hematuria 2. Proteinuria 3. Hypertension 4. Edema (hypoalbuminemia ➡️ third spacing)

Question 29

What is the pathophysiology of Pyelonephritis?

Answer 29

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

Question 30

What are signs and symptoms of Pyelonephritis?

Answer 30

1. Fever 2. Abdominal pain 3. Dysuria 4. Cloudy urine 5. Polyuria or urgency 6. Urinary odour

Question 31

What is Nephrotic Syndrome?

Answer 31

Manifestation of kidney failure Caused by group of diseases that damage kidneys filtering system

Question 32

What are signs and symptoms of Nephrotic Syndrome?

Answer 32

1. Proteinuria >3g protein/ day 2. Edema 3. Foamy urine 4. Weight gain 5. Hypoalbunemia 6. Hematuria

Question 33

What is Nephritic Syndrome?

Answer 33

Nephron inflammation | Acute onset

Question 34

Azotemia

Answer 34

Nephrotoxicity that involves excess nitrogen compounds (urea, creatinine, etc) ⬆️ BUN + SCr Crystallized urea deposits Can occur in all types of AKI

Question 35

What is the normal pH of urine?

Answer 35

4.8-8.0 Diabetes and starvation ⬇️pH Infections ⬆️pH

Question 36

What is the normal range of urinary Specific gravity?

Answer 36

1.025-1.032 ⬆️dehydration, UTI, glucosuria, renal artery stenosis, decreased perfusion ⬇️ renal failure, pyelonephritis, Acute tubular necrosis, excess fluid

Question 37

Casts in urinary microscopic analysis

Answer 37

Precipitate from cells lining the renal tubules

Question 38

Crystals in urinary microscopic analysis

Answer 38

1. Infection 2. Inflammation 3. Stones

Question 39

Epithelial cells in urinary microscopic analysis

Answer 39

Degeneration, necrosis of tubule cells

Question 40

What is the normal range for BUN?

Answer 40

3.6-7.1 mmol/L | 10-20mg/dL

Question 41

What is the normal range of serum creatinine?

Answer 41

Women: 45-90 Men: 60-110 micromol/L

Question 42

What is the best estimation of functioning renal tissue?

Answer 42

GFR

Question 43

Creatinine is primarily excreted by the GF after being constantly released by which tissue?

Answer 43

Muscle

Question 44

What conditions result in prerenal injury?

Answer 44

1. Renal Artery vasoconstriction 2. Renal Artery thrombosis 3. Hemorrhage 4. Hypotension

Question 45

What hormone is synthesized and secreted by the kidneys?

Answer 45

Erythropoietin to produce RBC in bone marrow

Question 46

What are causes of infra-renal AKI?

Answer 46

1. Acute Tubular Necrosis | 2. Glomerular, tubular or interstitial damage

Question 47

What are causes of postrenal AKI?

Answer 47

1. Renal calculi 2. Ureteral stricture 3. Benign prostatic hyperplasia (BPH) 4. Tumor 5. Blood clots in ureters/urethra

Question 48

What are causes of prerenal AKI?

Answer 48

1. Hypovolemia 2. Decreased cardiac output 3. Thrombo-embolitic obstruction of renal vasculature

Question 49

What are signs of Azotemia?

Answer 49

1. ⬆️ BUN + SCr 2. Uremic frost Can occur in all types of AKI