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How is circulating active vitamin D produced?

by 1a hydroxylation in the proximal tubule


How does CKD affect vitamin D production?

increased FGF-23 production which inhibits 1a-hydroxylation, inhibiting vitamin D production


Function of calcitrol?

increases calcium and phosphate absorption from the gut and suppresses the parathyroid hormone


What causes calcitrol deficiency?

advanced CKD, leading to secondary hyperparathyroidism


What nerves drive detrusor contraction?

PNS s3-5 (cholegenic)


What nerves inhibit detrusor contraction?

SNS t10-l2 (noradenergic)


How much fluid can a full bladder hold?



How much is in an empty bladder?


Who is more likely to become incontinent and why?

women, due to a shorted urether, so less resistance and higher pressure


What is acute renal failure?

a reversible decrease in GFR caused by damage to the kidneys, leading to a rise in serum urea and creatinine and loss of normal water and solute homeostasis


Main causes of acute renal failure?

pre renal (40-70%) - failure of cardiac/liver/skin/vascular, sepsis, infection, haemorrhage, thrombosis

intrarenal (10-15%) - renal vascular, glomerulinephritis, nephrotic syndrome, nephrotoxis drugs, microangiopathy, hypertension, inflammation, autoimmune disease

post renal (10-25%) - urinary tract obsturction, stones, tumour, prostatic hypertrophy, extrinsic compression


Stages of acute renal failure with serum creatinine and urine output?

early - creatinine >26.5umol/L or 1.5-2xrise - urine output 6h

moderate - creatinine 2-3x baseline - urine output 12h

severe - creatinine >3x baseline or >350u/mol/L or start RRT - urine output 24h or >12h anaemia


In who is acute renal failure common?

hospital admissions, elderly, critically ill


Mortality of acute renal failure?



Risk factors of acute renal failure?

>75yrs, CKD, HF, Chronic liver disease, diabetes, new drugs, spesis, poor fluid intake, history of urinary symptoms, blockage of urinary tract, dehydrated, infection, aminoglycosides


Most common cause of acute renal failure and types of this?

intra renal

acute glomerularnephritis - from SLE, erythromyetosis

acute tubular necrosis (50% of AKI)

acute interstitial nephritis - in allergic reactions and infection



Pathophysiology of acute renal failure?

vascular change causes inflammation and tubular change causes back leakage of urine


What do investigations show in acute renal failure?

decrease GFR and urine output, increase nitrogenous waste in blood (urea, creatinine)

apoptosis, loss of adhesion

pericardial rub, suprapubic percussion dull

CT, CXR, avoid imaging with contrast, US (priotity if anuric)


Symptoms of acute renal failure?

lethargy, nausea, anorexia, itch, confusion, rash, joint pain, red eyes, nasal stiffness, GI bleeding, haemoptysis, reduced urine output, impaired platelet function, abdominal flank pain, oedeme, pruritis


Treatment of acute renal failure?

treat underlying cause, stop nephrotoxins, fluid, electrolytes, improve perfusion, restrict sodium and potassium, prevent pressure sores, antibiotics, dialysis, nutrition, sequele, prevent further complications, MDT, catheter if obstruction, percutanous nephrostomy, prevent ischemic renal injurt


When should you use dialysis in acute renal failure?


acidosis -metabolic
electrolyte abnormalities e.g. K
ingestions of toxins - salicylates, methanol, barbityrates
overload of fluid
uremic symptoms e.g. pericarditis


What is the classification of acute renal failure?


risk, injury, failure, loss, end stage


When would you do a urology referral in acute renal failure?

infected or obstructed urinary tract, renal stone, urological malignancy, renal trauma, frank haematuria,


Management of pulmonary oedema?

o2, diureticsm nitrates, opiates, venesection, haemodialysis, ventilatory support


What complications can acute renal failure lead to?

metabolic acidosis, hyperkalaemiam hyperphosphataema, pulmonary oedema


What does prognosis of acute renal failure depend on?

underlying cause, most common cause of death is sepsis from impaired immune defence from uaemia, malnutrition or dialysis//catheters

it is reversible

cortical necrosis can heal with scar tissues, tubule regenerate


What can you use to determine pre renal or intra renal acute renal failure?

urine specific gravity and urine osmolarity are higher in pre renal, urine sodium and fractional excretion of sodium are less in pre renal


What is the onset like in post renal AKI?

insidious rather than acute


What are the 2 phases in acute tubular necrosis?

initialoliguric phase from decrease GFR, microvascular vasoconstriction, ischemia, but then tubular cells can regenerate , reversing it

diuresis during recovery phase - improved GFR but still impaired tubular reabsorpton


How does acute tubulointerstitial nephritis cause acute renal failure?

interstitial inflammation with oedema and tubular damage, occurs do to infection (acute pyelonephritis) or hypersensitivity reaction to drugs (penicillin, NSAIDs)