Kidney diseases Flashcards
1
Q
What are the functions of the kidney?
(Hall, 2021)
A
- filtration of blood and production of urine
- excretion of metabolic waste products and forgein chemicals
- glucogenesis
- secretion, metabolism, and excretion of hormones
- regulation of water and electrolytes, blood pressure, blood fluid osmolality and electrolyte concentration, red blood cell production
2
Q
What is acute kindey injury (AKI)?
(Hall, 2021)
A
- abrupt decline in kidney function
- acute renal failure (ARF) is failure of the kiney requiring renal replacement therapy (RRT) e.g. dialysis
3
Q
What are causes of AKI?
(Hall, 2021)
A
- hypovolaemia/shock- due to low blood volume or septic shock, most common cause of AKI
- hypoxia- related to cardiovascular or repsiratory disorders
- drugs/toxins- effects the function of the kidneys, increasing prevalnce with recreational drugs
4
Q
How is AKI classified?
(Hall, 2021)
A
By where the probelm occurs.
Can be:
- pre-renal: probelms before the kidneys
- intra-renal: probelsm within the kidneys that may effect the blood vessels, glomeruili, or tubules
- post-renal: problems after the kindeys in the elimination of urine from the body due to an obstruction
5
Q
What is pre-renal AKI?
(Hall, 2021)
A
- hypovolemia leads to reduced blood flow and urine output,
- causes a reduction in blood pressure below 80mmHg. Once BP drops below this number there is a rapid decline in GFR which affects the kidneys ability to maintain function.
- due to reduced blood supply there is reduced oxygen supply to the kidney- hypoxia and ischemia may occur
- Prompt fluid replacement treatment may restore function by reversing the effects of hypovolaemia
6
Q
What is acute tubular necrosis?
(Hall, 2021)
A
- sudden and severe impairment of kidney function due to the death of tubular cells within the kidney nephrons.
- caused by insuffiecient blood supply or toxins
- toxins could be drugs, iatrogenic toxins (substances that are introduced into the body as a result of medical intervention or treatment and have toxic effects), exogenous toxins or endogenous toxins
- pre-renal disease
7
Q
How is acute tubular necrosis managed?
(Hall, 2021)
A
- normally the base membrane underneath the dead epithelium cells remains intact, allowing tubular cells to regenerate within 10-20 days
- supportive treatments like oxygen, drug therapy, fluids, and dialysis can be given as needed.
8
Q
What is Rhabdomyolysis?
(Hall, 2021)
A
- muscle necrosis leading to the release of muscle fibres into the blood stream
- causes include: crush injury, collapse, stroke, arterial occlusion caused by medical treatment or self-induced
- can cause muscle pain, weakness, dark urine, electrolyte imbalance and kidney damage (AKI)
- pre-renal disease
9
Q
What is intra-renal disease?
(Hall, 2021)
A
- usually affects either the glomeruili or tubules
- glomerular is usually autoimmune or drug induced, and can cause reduced or no urine output
- tubular is usually caused by drug use, can cause polyuria (excess urine production) and can progress to chronic kindey disease
10
Q
What is post-renal disease?
(Hall, 2021)
A
- an obstruction, either complete or parital to the flow of urine, to, through, and out of the bladder
- leads to back up or urine in the kindeys and renal failure
- caused by benign (e.g. en;larged protstate) or malignant tumors,
11
Q
What is chronic kindey disease?
(Hall, 2021)
A
- the presence of kidney damage for three or more months
- different from acute kidney injury which is a rapid decline over 2-3 days
- often associated with progressive and irreversible loss of functioning nephrons- symptoms dont normally occur until function is 70-75% below normal
12
Q
How does the kindey adapt to the loss of functioining nephrons?
(Hall, 2021)
A
- increasing the use of the remaining nephrons (called hyperfiltration)
- hyperfiltration maintains relativley normal blood concentration of electerolytes and normal body fluid volume
- however this overuse on healthy nephrons is not sustainable long term and they will show damage
13
Q
Does initial damage resolve in chonic kidney disease?
(Hall, 2021)
A
- in some cases, and recovery is good
- other cases there in ongoing progressive decline in function leading to end-stage kidney disease (ESKD) and kidney failure requiring dialysis or treatment
14
Q
What are the clinical indicators of chronic kindey disease?
(Hall, 2021)
A
- increase in urinary albumin secretion equal to or above 30mg per day
- decreased kidney function is shown by estimatated glomerular filtration rate below 60mg a per minute per 1.73m2, the surface area of the average adult
- moniterng eGFR allows the stage and progression of the disease to be seen
15
Q
Discuss the kidney function at different stages of chronic kidney disease.
(Hall, 2021)
A
o Stage 1 >90% normal
o Stage 2 90-60% mild
o Stage 3 30-60% moderate
o Stage 4 15-30% severe
o Stage 5 <15% kidney failure
