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Chemical Biochemistry > Chemical Pathology Of Renal Disease > Flashcards

Chemical Pathology Of Renal Disease Flashcards

1
Q

What are the 2 main functions of kidney

A

Excretion and haemostasis

Endocrine function

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2
Q

What does the excretion and haemostasis function of the kidney involve

A

Waste products of metabolism
Fluid electrolyte balance
Acid base balance
Removal of drugs and toxins

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3
Q

What are the endocrine functions of the kidney

A

Renin angiotensin aldosterone system
Erythropoietin production
Hydroxylation of vitamin d

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4
Q

When is the excretion and homeostasisis ditrupted

A

Early AKI

CKD

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5
Q

When is the endocrine distrubted

A

CKD

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6
Q

What is the definition of AKI

A

Rise in creatinine and low urine output

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7
Q

What are the stages of AKI

A

Stage 1 to stage 3

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8
Q

What is stage 1 AKI

A

Creatinine rise 1.5-1.9 times from baseline and

Less than 0.5ml/kg/h for 6-12 hours

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9
Q

What is stage 2 AKI

A

Creatinine rise 2-2.9 times from baseline and less than 0.5ml/kg/h for more than 12 hours

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10
Q

What is stage 3 AKI

A

Creatinine rise more than 3 time from baseline or rise to 353.6 or need for renal replacement therapy irrespective of serum creatinine and less than 0.3ml/kg/h for more than 24 hours or anuria for more than 12 hours

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11
Q

What happens to mortality in AKI as the stage increases

A

Increases with increased stage

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12
Q

What are the categorical causes of AKI

A

Renal underperfusion
Intrinsic renal damage
Post renal AKI

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13
Q

What are the common causes of renal underperfusion

A

Hypovolaemia- haemmorhage, dehydration
Sepsis: vasodilation
Renal artery stenosis
Pump failure: heart failure

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14
Q

What are the common causes of intrinsic renal damage

A

Ischaemia
Nephrotoxins: drugs, posison, myoglobulin, paraproteins
Infection: pyelonephritis
Trauma
Early stage of inflammation causes of chronic kidney disease

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15
Q

What are the causes of post renal aki

A

Stones
Tumours
Prostatic hypertrophy

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16
Q

What is the common cause of AKI

A

Underperfusion

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17
Q

When there is hypovaolemia, sepsis or renal artery stenosis i.e renal underperfusion how does it develop into AKI

A

Underperfusion causes pre renal failure
Prolonged renal underperfusion causes damage to the kidney resulting in acute tubular necrosis
Acute tubular necrosis results in intrinsic renal failure

18
Q

How can we recognise pre-renal and intrinsic renal damage AKI

A 
By looking are:
Urine volume 
Urine: plama osmolality
Urine sodium concentration
Plasma sodium
Serum elevation of urea vs creatinine
19
Q

What is the urine volume in pre renal and intrinsic renal damage

A

Pre renal: low- blood it not being delivered to kidney

Intrinsic renal damage: high- kidney cant absorb water and electroylytes so there is high ouput

20
Q

What is the urine: plasma osmolality in pre renal and intrinsic renal damage

A

Pre renal: more than 2:1 (high in urine)

Intrinsic renal damage: less than 1:1

21
Q

What is the urine sodium concentration in pre-renal and intrinsic renal damage

A

Pre renal: urine sodium concentration is low because aldosterone is switched on which promotes sodium retention to promote water retention

Intrinsic renal damage: high because the kidney cant absorbed sodium due to the intrinsic problems in the tubules

22
Q

What is the plasma sodium in pre-renal and intrinsic damage

A

Pre renal: high

Intrinsic: low

23
Q

What is the serum elevation of urea vs creatinine in pre renal and intrinsic renal damage

A

Pre renal: urea is more than creatinine

Intrinsic: urea and creatinine are the same

24
Q

Who do we give fluid replacement to, pre-renal or intrinsic damage

A

Pre renal because the kidney is underperfused

25
Q

Why do we not give fluid replcement in intrinic damage

A

Giving fluid will mean the patient cant pee it out as the kidney is damage so this will elad to fluid overload

26
Q

In AKI do we see endocrine problems

A

No

27
Q

Which process in AKi is lost first

A

Excretion and homeostasis

28
Q

What do we see in AKI

A

High potassium
High acidosis- from acidic waste
Retained nitrogenous waste
Hyponatraemia (due to fluid overload and fluid retention

29
Q

What symptomd foes hyperkalaemic metabolic acidosis lead to

A

Malasie

Nausea

30
Q

What is the management of AKI

A
  1. Identifying if pre-renal, intrinsic renal or post renal causes
  2. Identify the cause- stop ARBS, ACEi and NSAIDs, correct fluid, electroylyte and acid base abnormality, restore renal perfusion
31
Q

What is chronic kidney disease

A 
Diabetes
Hypertension
Polycytstic kidney disease
Recurrent pyelonephritis
Glomerulonephritis
Intersitital nephritis
Multi system disease
Drugs
32
Q

How to we monitor CKD

A

24 hour urine collection for protein
Estimated egfr - in early stages
Creatinine- in late stages
Albumine creatinine ratio

33
Q

Why do we look at egfr in early and creatinine in late stages

A

In early stage: creatinine is normal

In late stages: efgr is normal

34
Q

What are the stages in CKD

A

Stage 1 to 5

35
Q

What endocrine changes occur in stage 3-4 ckd

A

Reduced 1 alpha hydroxylation of vitamin d (so you dont get vitamin d to absorb calicum from the diet) this causes hypocalcaemia and secondary hyper parathyroidism (to compensate for low calcium)
Reduced erythropoietin production- leads to anaemia
Increased cholesterol- increases risk to CVD

36
Q

What changes do you see in stage 4-5 ckd

A

High phosphate
Anemia
Acidosis
Hyperkalaemia- offset by increased gut losses until late stage

37
Q

What is the water balance in ckd dependent on

A

Where the damage is

38
Q

How does CKD lead to bone disease

A
  1. When PTH cant correct the calcium it corrects it by bone resportion leading to osteitis fibrosa
  2. Lack of calcium alsoe leads to ostoemalacia i.e bone note being buily properly
  3. Reduced gfr means you cant get rid of phosphate, phosphate binds to calcium to cause calcium phosphate which deposit to arteris leading to metastatis calcification
  4. Reduced gfr also causes metabolic acidosis which casuses dissolved bone buffers that causes bone decay i.e osteoporosis
39
Q

What is the management of stage2-3a CKD

A

Monitor patients
Treat underlying cause eg diabetes
Avoid precipitatns of AKI
Slow progression by blocking the RRA system with ACEi/ARB is ACR raised

40
Q

What is the management of stage 3b-5 CKD

A

Correct endocrine abnormality:

  • give alfacidol (1,25, oh vitamind d) to correct calciuma dn hyperparathyrodisim
  • erythropoietin to prevent anaemia
  • low potassium diet
  • fluid

Chemical Biochemistry (5 decks)

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