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Clinical 3rd Yr > Chapter 3- Kidney > Flashcards

Chapter 3- Kidney Flashcards

1
Q

Define glomerular filtration rate

A

Volume of fluid filtered from glomerular capillaries to bowmans capsule per unit time

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2
Q

What are the 4 clinically important functions of the kidney

A

Filtration
Salt and water control
Production of EPO
hydroxylation of vitD

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3
Q

Two types of markers used to measure filtration

A

Exogenous

Endogenous

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4
Q

Name the three types of exogenous markers used to measure filtration

A

Inulin
Cr51 EDTA
iohexol

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5
Q

Name two types of endogenous markers used to measure filtration

A

Creatinine

Cystatin C

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6
Q

What is creatinine

A

Waste product from muscle generated at a relatively constant rate in individuals

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7
Q

Is creatinine largely removed by filtration?

A

YES

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8
Q

What’s the downside of estimating GFR using actual creatinine clearance

A

24 collections are cumbersome

Inaccurate

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9
Q

What three main things is creatinine significantly affected by

A

Age
Race
Weight

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10
Q

The estimated GFR gives a result standardised for what?

A

BSA 1.73m^2

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11
Q

Which method of measuring filtration is inaccurate for GFR>60ml/min

A

Estimated GFR

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12
Q

What is CKDEPI and what does it aim to do

A

Chronic kidney disease epidemiology collaboration aims to improve accuracy of eGFR

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13
Q

When is CKDEPI better than MDRD eGFR

A

Better accuracy at higher GFR

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14
Q

When is CKDEPI less accurate that MDRD?

A

Obese
Black
Female

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15
Q

What are the stages of CKD

A 
1
2
3A
3B
4
5
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16
Q

If you’ve got stage 3A CKD what is your GFR?

A

45-59

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17
Q

If you’ve got stage 1 CKD what is your GFR?

A

> 90

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18
Q

Patient has stage 2 CKD what is there GFR?

A

60-89

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19
Q

Patient stage 3B CKD what’s their GFR?

A

30-44

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20
Q

Stage 4 CKD has what range GFR

A

15-29

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21
Q
A

5

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22
Q

What is normalised GFR appropriate for estimating?

A

How abnormal the kidney function is but NOT for dose adjustment

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23
Q

Name two drugs that have significant renal clearance

A

Aciclovir

Gabapentin

24
Q

Name two classes of drug that affect residual renal function

A

NSAID

ACEI/ARB

25
Q

What are the three types of AKI causes?

A

Pre renal
Intrinsic
Post renal

26
Q

Name three types of pre renal causes of AKI?

A

Volume depletion
Sepsis
Cardiogenic

27
Q

Name three types of intrinsic causes of AKI

A

Prolonged pre renal insult causing tubular necrosis
Inflammation/glomerulonephritis
Drugs

28
Q

Name the causes of post renal AKI

A

Outflow obstruction e.g bladder, prostate, ureter

29
Q

Why do you get renal anaemia?

A

Reduction in red cell production and increased red cell turnover

30
Q

How do you treat renal anaemia?

A

EPO replacement

Iron replacement

31
Q

Why are target ESA and Hb lower in patients with renal failure

A

Because three major studies showed suggested harm with higher/normal targets: increased risk of VTE

32
Q

What does ESA stand for

A

Erythropoiesis stimulating agent

33
Q

What is alfacalcidol

A

Post renal vitD used to treat renal bone disease

34
Q

Two ways of treating tertiary hyperparathyroidism

A

Parathyroidectomy

Calcimimetics (cincalcet)

35
Q

What’s the causes of tertiary hyperparathyroidism in renal patients

A

After prolonged stimulation of parathyroid glands
Sustained CKD
High phosphate

36
Q

What does haemofiltration require

A

Anti coagulation:
Heparin
Prostaglandins
Citrate

37
Q

Explain process of haemofiltration

A

Water and solutes filtered and discarded
Blood re-diluted with solution
Constant low efficiency RRT

38
Q

Does haemodialysis require anticoagulation

A

YES

39
Q

Give two examples of a drug that is not dialysed so would required dose adjustment in dialysis?

A

Warfarin

Diazepam

40
Q

If a drug is dialysed when would you give it? Give two examples

A

End/post dialysis

E.g tazocin, meropenem

41
Q

Explain the process of haemodialysis

A

Removal of solute only (water possible to- ultrafiltration)
Semi permeable membrane allows movement of solutes from high to low
Three 4hr sessions per week

42
Q

Explain peritoneal dialysis

A

Fluid placed in peritoneum
Peritoneum forms semipermeable membrane
High conc to low conc solutes
Once fluid reached equilibrium it is removed and replaced

43
Q

Define acute kidney injury

A

A rapid deterioration in kidney function, rise in creatinine, reduction in urine output

44
Q

Prostaglandins cause what at the afferent blood vessels

A

Vasodilation

45
Q

NSAIDs inhibit the synthesis of prostaglandin which has what result on afferent blood vessels

A

Vasoconstriction

46
Q

What’s the bodies normal response to a reduction in renal blood flow

A

Vasodilation of afferent blood vessels

Vasoconstriction of efferent blood vessels

47
Q

What does CANDA mean

A 
C- contrast media 
A- ACEI
N- NSAID
D- Diuretics
A- ARB
48
Q

Does CKD often exist with other conditions

A

YEAH

49
Q

Name 9 further complications of CKD

A 
Anaemia
Hyperphosphataemia
Renal bone disease 
Oedema
Hypertension 
Itching
Nausea 
Electrolyte imbalance 
Restless legs/cramps
50
Q

In renal patients what’s the aim for Hb levels?

A

10-12 g/dL

51
Q

How do you manage anaemia in renal patients

A

Erythropoiesis stimulating agents and iron

52
Q

In renal patients how do you manage high phosphate levels?

A

Dietary control and phosphate binders

53
Q

Give the 5 options of phosphate binders

A 
Calcium acetate 
Calcium carbonate
Sevelamer
Lanthanum
Aluminium capsules
54
Q

What’s 2 key problems for phosphate binders

A

Large tablet burden

Can bind to other meds

55
Q

List 4 things that make a drug less likely to removed by dialysis

A 
>500Da
>80% protein bound 
>1L/kg
Lipid soluble
Not normally cleared by kidney

Clinical 3rd Yr (11 decks)

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