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HMB > Pathology - KIDNEY DISEASE > Flashcards

Pathology - KIDNEY DISEASE Flashcards

1
Q

What happens if GFR fails?

A

If it drops:

  • Chronic kidney disease: Longstanding and irreversible drop in GFR (formerly chronic renal failure)
  • Acute kidney injury: Sudden and potentially reversible
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2
Q

What happens if GFR rises?

A

It’s referred to as ‘hyperfiltration’ It can occur:

  • Normally: Pregnancy, protein rich meals
  • Abnormally: Diabetes (early stage of diabetic neuropathy )
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3
Q

Idenfity 4 ways in which GFR can be measured

A
  • Inulin clearance
  • Serum creatinine
  • Creatinine clearance
  • Tc-99m-DTPA GFR
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4
Q

What is the normal GFR?

A

90-120ml/min with about 144L/ay

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5
Q

Clinically: How would you determine ‘normal kidney’ function? (What tests would you undergo?)

A

Normal structure:

  • Ultrasound
  • CT scan
  • IVP

Normal function:

  • Serum Creatinine levels
  • eGFR

Normal urine:
- Negative dipstick

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6
Q

What is “renal tubular acidosis”?

A

It is when the kidneys failure to acidify. In which it occurs due to the failure to reabsorb bicarbonate (proximal RTA) or failure to excrete H+ distal (RTA).

Characterized by:

  • Alkaline urine
  • Systemic acidosis
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7
Q

How would you assess tubular function?

A

Urine

  • Acid urine (urine pH <6) is normal
  • Normal protein excretion (<300mg/day). Protein can leak across glomerulus
  • No glucose in urine - indicates diabetes or difficulty with tubular function

Serum
- Normal Ca, PO4, K, Na

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8
Q

What is the function of the tubules? and what will happen if the tubules fail?

A

Function

  • Reabsorption - reabsorbs 99% of ultrafiltrate fails
  • Secretion - K, H+, NH3

Failure
- Polyuria, as reabsorption of ultrafiltrate fails.

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9
Q

What happens if urine fails to become concentrate?

A
  • This will result in polyuria (excess urine).

- Occurs/seen in diabetes insipidus patients and people after a renal transplantation

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10
Q

How does diabetes insipidus affect urine concentration?

A

Diabetes insipidus –> failure of ADH to be released –> failure to reabsorb water –> polyuria (excess pee) and polydipsia (excess drinking)

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11
Q

What are some causes of an acute renal injury (ARF)?

A
  • Pre-renal AKI: Shock, dehydration, severe CCF, haemorrhage
  • Intra-renal AKI: Glomerulonephritis, rug toxicity
  • Post-renal AKI: bladder outlet obstruction (kidney stones, tumours, prostate hypertrophy etc)
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12
Q

Identify some causes of stage 5 kidney disease?

A
  • Glomerulonephritis
  • Diabetic nephropathy
  • Cystic
  • Hypertension/vascular
  • Analgesic
  • Vesicoureteral reflux
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13
Q

What is the recommended eGFR formula to use? Give examples of other equations which could be used

A

Recommended: CKD-epi - Its even better than a 24 hour urine collection

Other

  • Cockcroft Fault equation
  • MDRD equation

CKD = Chronic Kidney Disease

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14
Q

How is chronic kidney disease (CKD) classified and what are the 5 stages?

A
  • GFR <60ml/min for >3months with or without evidence of kidney damage
    Stage - eGFR (mls/min) - Stage CRF
    Stage 1: >90 Normal
    Stage 2: 60 - 89 Mild CRF
    Stage 3: 30 - 59 Moerate CRF
    Stage 4: 15 - 29 Severe CRF
    Stage 5: < 15 ESRF
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15
Q

Identify various evidence of kidney damage which could result in chronic kidney disease

A
  • Microalbuminuria: Urinary albumin excretion of 30-300 mg/day
  • Proteinuria: Excess amount of protein in the urine 300mg/day
  • Glomerular haematuria: Microhematuria or macrohematuria
  • Pathological abnormalities
  • Anatomical abnormalities
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16
Q

Identify various cardiovascular complications which could occur as a result of kidney failure

A
  • Hypertension
  • Left ventricular hypertrophy (LVH)
  • Premature vascular disease
  • Increased mortality
17
Q

Identify various skeletal (bone) complications which could occur as a result of kidney failure

A
  • Hypokalaemia, hyperphosphatemia - secondary hyperparathyroidism
  • Vitamin D deficiency - osteomalacia
  • Mixed bone disease
  • Adynamic bone disease
  • Normal Ca, PO4, K, Na
18
Q

Identify various blood (anemia) complications which could occur as a result of kidney failure

A
  • Erythropoietin deficiency

- Iron deficiency

19
Q

What is haematuria?

A
  • Microscopic or macroscopic blood present in the urine
  • Approx 6% of AUS people have microscopic haematuria

After positive dipstick
- Follow up with CT/cystoscopy for kidney evaluation

20
Q

What is proteinuria?

A
  • Too much protein in water
  • It is an indication that there is a tubular disease

After positive dipstick
- Follow up 24hr urine test

21
Q

What is polyuria?

A
  • Peeing too much
  • Mostly a tubular disorder
  • Causes: Drugs (e.g. diuretics), poisons, chronic kidney disease, uncontrolled diabetes
22
Q

What is glomerulonephritis?

A
  • It is an immune mediated diseases causing inflammatory in the glomerulus and commonly causing CKD –> causing both haematuria and proteinuria
  • often microscopic haematuria
  • Proteinuria >300mg/day
  • rapid or slow deterioration GFR
23
Q

What is renal colic?

A
  • Sever pain in flank which radiates to iliac fossa and groin
  • Cause: kidney stones or ureter stones
  • May result in microscopic or macroscopic haematuria.
24
Q

Identity common structural abnormalities of the kidneys and collecting systems

A

Simple cysts
- NO CRF, benign, rarely problematic

Vesico-uretric reflux
- Bladder contraction causing reflux into the kidneys –> dilation of the ureters and kidney damage (usually congenital)

ADPKD
- Cyst disease

Pelvi-ureteric junction obstruction
- Blockage of the junction between renal pelvis and ureter can stop kidney function on that side

Renal cancer
- Grawitz tumour - renal carcinoma

Hydronephrosis
- Too much fluid in the collecting system –> dilation of the ureter and kidney structures

HMB (34 decks)

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