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My Own Renal Biochem > Biochemistry of renal disease > Flashcards

Biochemistry of renal disease Flashcards

1
Q

Nephrons in kidney

A

600,00-1.5 million

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2
Q

Impaired function of a kidney is generally as a result of

A

decrease in the number of functioning nephrons and not decreased function of individual nephrons

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3
Q

What is the nephron dose

A

The number of nephrons an individual is born with

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4
Q

Nephron dose effect on developing renal dx

A

If youre born with a low nephron dose youre more succeptible to developing kidney dx and vice versa

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5
Q

Acute renal faluire

A

This is a condition where the kidneys suddenly stop working and cant filter waste from the body

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6
Q

Causes of renal failure

A

Prerenal- Disorders of renal perfusion
Renal- Conditions present in kidney itself
Postrenal- Conditions that cause an obstruction to renal outflow

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7
Q

Examples of preranal causes of ARF

A
  1. Severe blood loss and low blood pressure
  2. Medicines that interfere with blood supply to the kidney
  3. Severe dehydration
  4. Severe burns
  5. Vomiting, diarrhea
  6. Diuretics
  7. Sequestration of fluid in extravascular space i.e hypoalbuminemia, peritonitis
  8. Low cardiac output
  9. Infections causing systemic vasodilation
  10. Renal vasoconstriction i.e hypercalcemia
  11. Cirrhosis with ascites

Generally conditions that reduce blood flow to kidney

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8
Q

How intrinsic renal disease is expressed

A

Tubular necrosis
interstitial nephritis
glomerulonephritis
Vascular disorders

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9
Q

Post renal causes of renal failuire

A

Generally Blockage of urine outflow

Kidney stones in ureters
A bladder that wont empty properly
Enlarged prostate
Cancer of prostate,cervix etc
Stricture in urethra
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10
Q

Tubular necrosis will develop from

A

Ischemia
Toxins
Pigments

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11
Q

Is ARF reversible?

A

YES.

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12
Q

Prerenal ARF also known as

A

Prerenal azotemia

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13
Q

Renal parenchymal tissue is not damaged in ARF if

A

Perfusion is rapidly restored. If not ischemia and damage to renal parenchyma occurs

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14
Q

Prolonged hypoperfusion will cause

A

intrinsic renal azotemia or a problem with the kidney itself

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15
Q

How the kidney protects itself in hypoperfusion

A

Hypoperfusion—>Release of epinephrine, NE, endothelin, ADH, Angiotensin 2—> vasoconstriction of abdominal viscera—>constriction of afferent arteriole to increase blood flow and constriction of efferent to reduce blood outflow—>Intraglomerular pressure preserved

In severe hypoperfusion, these mechanisms prove inadequate and ARF sets in

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16
Q

Causes of intrinsic renal azotemia

A 
Renal artery obstruction
Renal vein obstruction
Diseases of glomeruli
Acute tubular necrosis
Interstitial nephritis
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17
Q

Toxins that cause acute tubular necrosis

A

Exogenous - Aminoglycosides, Amphotericin B, Chemotherapeutic agents (cisplatin), ethylene glycol

Endogenous- Uric acid, hemolysis, rhabdomyolysis,oxalate, plasma cell dyscrasia

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18
Q

Interstitial nephritis is caused by

A

Antibiotics i.e beta lactams,sulfonamides
Infections i.e acute pyelonephritis, cytomegalovirus,candidiasis
Infiltrations - lymphomasleukemias, sarcoidosis
idiopathic

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19
Q

Ischemic insult to kidney parenchyma causes

A

Tight junction disruption,
Apical basolateral polarity disruption
Microfilament disruption

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20
Q

Pathophysiology of prerenal azotemia

A

In case of obstruction–> continuous build up of materials due to constant filtration—-> swelling of proximal ureters, renal pelvis,calyces—> decreased GFR

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21
Q

Chronic renal failure

A

Longstanding disease of the kidneys leading to renal failure characterised by reduction of renal mass and compensatory hypertrophy of remaining nephrons

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22
Q

Causes of CRF

A

Glomerulonephritis
DM
Hypertension
Tubulointerstitial disorders

23
Q

Uremia

A

A clinical syndrome that results from profound loss of kidney function nd which depends on the extent in reduction of functioning renal mass and how fast renal function is lost.

There is high amounts of waste in body

24
Q

Toxins of uremia

A

By products of protein metabolism

Urea
Guanidinho compounds
Urates
Aliphatic amines
Peptides
Derivatives of aromatic amino acids- tryptophan, tyrosine, phenyl alanine
25
Q

Extrarenal cause of fluid loss in CRF patient will cause

A

Loss of excessive RCF volume since there is no water and salt reabsorption

low ecf will further deteriorate residual renal fxn

26
Q

Serum K in CRF patients

A

normal till end stages of uremia due to adaptation in distal tubules and colon where aldosterone enhance k secretion

27
Q

However hyperkalemia can still be caused by

A

abrupt disruption of adaptive measures like reduction in blood ph and oliguria

28
Q

How is metabolic acidosis from CRF caused

A

Due to decreased production of bicarbonate and ammonia as a result of reduction in renal mass

29
Q

Hypocalcemia in CRF

A

Impaired production of vitamin D due to impaired production of 1,25 dihydroxyvitamin

30
Q

Hyperphosphatemia in CRF

A

due to decreased GFR and urine output, phosphate levels increase

31
Q

Parathyroid hormone in CRF

A

Increased levels since vitamin D and calcium will be low

32
Q

Lipid metabolism in CHF

A

lipoprotein lipase activity depressed in uremia–>increased triglycerides in system

Decreased levels of hdl

Normal cholesterol

33
Q

Atherosclerosis in CRF patients

A

HIGH. it is premature and especially for those on premature dialysis

34
Q

Symptoms of uremia

A

nausea
vomiting
lethargy

35
Q

Symptoms of renal failuire

A

symptoms of uremia
disorder of micturition i.e dysuria. nocturia. frequency
disorders of urine volume
Alteration in urine composition - i.e haematuria
Pain
Edema

36
Q

When you should assess renal fxn

A 
old age
family history of ckd
low birth weight
atrophy of kidneys
after taking some drugs
diabetes mellitus
hypertension
blockade in ureters
systemic infections
autoimmune dx
UTI
Nephrolithiasis
37
Q

First step in assessing kidney function

A

Screening test where urine is collected to be examined physically fr i.e color appearance, odor etc

Chemically for protein, glucose, pH

Microscopically for rbcs wbcs etc

38
Q

Anuria

A

No passage of urine.

Or less than 100 ml of urine is produced in a day

39
Q

Causes of anuria

A

Total obstruction of ureter by i.e prostatic hyperplasia and tumors

Heart failure or hypotension leading to renal ischemia

Glomerular nephritis

Hemolytic reaction caused by blood transfusion can cause anuria

40
Q

Oliguria

A

Reduction in urine volume

41
Q

Causes of oliguria

A

Prolonged vomiting, diarrhea

Sweating, ascites,AKI,, Terminal phse of uremia/CKD, glomerulonephritis

41
Q

Causes of oliguria

A

Prolonged vomiting, diarrhea

Sweating, ascites,AKI,, Terminal phse of uremia/CKD, glomerulonephritis

42
Q

Polyuria

A

High urine output

43
Q

Causes of polyuria

A 
DM
ADH deficit
Diuretics
High caffeine intake
high alcohol inttake
high protein intake
Polydipsia
44
Q

Specific gravity

A

A test that compares specific gravity of urine with water…

45
Q

Normal specific gravity in adults

A

1005-1020

46
Q

Normal specific gravity in a child

A

1001-1018

46
Q

Normal specific gravity in a child

A

1001-1018

47
Q

Urine concentration index

A

Urine to plasma ratio of creatinine levels

48
Q

Urine concentration index is determined by

A

sodium chloride
urea
sulfates
phosphates

49
Q

Diseases causing high specific gravity or hypostenuria

A

ADH insufficiency
diabetes insipidus
pyelonephritis
Glomerulonephritis

50
Q

Hyperstenuria causes

A 
DM
Nephrosis
increased ADH
Heart dx
Toximea in pregnancy
Dehydration
51
Q

hyperuriceamia

A

plasma uric acid concs of higher than 7.0 mg/dl in men and greater than 6.0 mg/dl in women

52
Q

cistatin C produced by

A

nuclear cells

better than creatinine

My Own Renal Biochem (7 decks)

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