Flashcards in liver and renal disease Deck (45):
1
functions of the kidnye
regulate vol of fluid in blood
electrolyte balance
acid-base balance
excretion of waste products
vit D metabolism
EPO
2
what electrolytes does the kidney control
sodium
potassium
chloride
calcium
magnesiom
phosphate
3
glomerular filtration rate
GFR
measreument of wast products in plasma
vol of fluid filteresd through all glomeruli per time unit
4
eGFR
estimated glomerular filtration rate
based on equation validated against gokd standard of renal clearance test
5
what waste products can be measured for the kidney
creatinine ( waste of muslce breakdown)
urea (breakdown of proteins and amino acids)
6
renal function releated tests
acid0ase balance
plasma phosphate
plasma calcium
urinary proteins
7
acid base balance relevance to kidneys
decreased excretion by the kidney
renal failure leads to metabolic acdosis, more H ions and more carbonic acid
8
relevance of urinary protein measurements in kiendye
glomeruli manage causes proteins to leake into tubules and these cannot reabsorp the protein back
as renal disease progresse, proteins get larger leading to proteinurina
9
low GFR
low renal function or failure
10
causes of acute renal failure
hypovolaemia due to blood loss dehydration/shock
acute glomerular inflamation
drugs
muscle breakdown
obstrution of renal flow
11
biochem changes due t actue renal failure
-low GFR
-rapid loss of urine vol
-accumulation of waste products, urea and creatinine
-accumulation of electrolytes, potassium and phosphate
- accumulation of acids, noHion excretion
- impairment of other renal function
12
causes of chronic renal failure
gradual decline of function over years
- diabetes
-hypertention
-disases affecting glomeruli
13
rhabdomylosis
breakdown of muscle
myoglobin leaked into blood
filtered by kidney but damages it leading to severe renal issues
14
what is type 2 renal failure
chronic
eGFR between 0-15
very bad, most dever
15
biochem changes in chronic renal failure
same as acute but slowly
-accumulation of wast products, urea and ceantnine
- accumulation of electrolytes
- no H ion excretion
- functions impaired
- low vit D production
16
why is creatinine a bad measure of renal function and failure
only starts rising and accumlating whne over 70% of function is lost
17
role of the kidney in electrolyte balance
sodium and water, balance coupled
kidney balances this using hormones
- adrenals: renin, angiotensin,aldosterone axis(Ha, H2O and K)
- pos pit ADH affects water balance
18
what is electrolyte imbalance (too little)
hyponatraemia
loss of Na and or excess water
low osmotic pressure
can lead to fluid moving to brain causing swelliing which is bad
19
too much electrolytes
hypernatramiae
loss of water, too much NA
water drawn out of brain cells leading to shrinkage which is bad
20
hyperkalaemia
higher plasma potassium
caused by:
- haemolysis, high intake, high rena absoption or chronic renal failure
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why is hyperkalaemia important
can lead to arrythmias
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hypokalamiae
low serum potasium levels
reduced renal absoption and low nintake of K
leads to arrythmias and muscle weakness
23
outline of bilirubin metabolism
Hb processed in spleen to haem then biibrin then to plasma when bound to albumin
this goe to liver
conjugated with glucoronicacid
now to small intestine
processed by bacteria
sterocolbilin made
24
liver functions
- bilirubin excretion
- gucose hoemostaisis
- cholesterol metabolism
- clotting factors production
- detoxification of drugs
- amino acid catbolism
- protein synthesis
25
liver function tests
ALT (alanine aminotransferase)
AST (aspartate aminotransferase)
ALP (alkaline phosphatase)
Total bilirubin
Albumin
GGT (gamma glutamyl transpeptidase)
26
3 main liver function tests
bilirubin
albumin
prothombin time clotting
27
ALT and AST tests
alanine aminotransferase
aspartate aminotransferase
enzymes involved in tranfer of amino groups and metabolism
released into blood when hepatocytes damaged
28
ALP test
alkaline phosphatse test
enzymes found in blood whne pressure in billlary ducts increases
29
gamma glutamyl transpeptiade test
enzyme present in hepatocytes
enzyme blood lvels increase:
- when pressure inside ducts increaases
- sysnthesis induced by alchocol and drugs
30
albumin test
this protein is made in the liver and carriers things in the blood maintaining osmotic pressure
low albulin: sever liver disase
31
bilirubin test
product of RBC cycling
high levels indicate liver problem or hepatic block
32
use of prothombin time for liver test
measures clotting time
If liver isn't working well, less clotting factors being made therefore blood will take longer to clot
33
when is ammonia measured for liver function
in neonates only with severe ilness
in adults it doesnt correlate with liver disease so not helpful
34
main ctegories of liver disease
-Hepatitis: Inflammation/infection and hepatocyte damage
-Cholestasis: impairment of bile flow
-Mixed hepatitis /cholestasis
-Tumours and other infiltrative diseases
-Alcoholic liver disease
35
hepatitiscasues
-viral infection of liver
- epstein barr virus
- overdose of alchol or drugs
-autoimmune
- Ischaemia
36
what does hepatiis lead to
hepatocytes damages
- they relese enyes into blood leading to high levels which is bad
- ALt and AST HIGH
- serum bilirubin high
clotting may also be impaired
37
fulminant hepatitis
massive liver inflamation
- hypoglycamia, hypoalbinuaemia
sever clotting impairement
high ALT and AST
high ammonia
38
Cholestasis
impairment of blood flow
eg gall stones
bilirubin appears in urine and its brown but pale stools
39
functional tests for cholestasis
ALP very high
very high bilirubin
40
what is mixes hepatitis and cholestasis
damage of both herpatocytes and bile duct cells
- sepsis
- immunosuressant drugs
- autoimmune liver disease
aminotransferases and ALPmildly raised
41
effect of liver tumours or finction
usualy normlal functions untill very advanced tumour
42
what does chronic alchol intake do to the liver?
high GGT
large red cell vol, macrocytosis
43
what happens to someone with chonic
alchol liver disease after stopping intake
GGT goes back to normal in 3-4 weeks
44
consequences of chonic alchol liver diseae
- fatty liver
- acute hepatitis
- liver cirrhosis
45