Flashcards in Renal Deck (216)
How do the kidneys regulate acid base balance in the body?
1) Regeneration of bicarbonate in the proximal tubules
2) Removal of fixed acid such a sulphate, sulphuric acid from the blood stream
In what part of the nephron would disease be indicated if amino acids were being lost in the urine?
The level of what protein is used to measure kidney function?
Creatinine from the break down of muscle
Which 4 drugs can accumulate in kidney disease?
The kidneys produce eryhtropoeitin in response to what?
Kidneys secrete the active form of vitamin D but the first stage of producing active vitamin D occurs in what organ?
Liver secretes 25-OH-D, Kidneys convert that to calcitriol
Low blood calcium stimulates the release of what hormone which stimulates the secretion of Calcitriol from the kidneys?
How does PTH increase blood calcium?
Causes release of calcitriol from the kidneys
Causes Release of calcium and phosphorus from bone
How does calcitriol released by the kidney increase blood calcium levels?
Causes increased absorption of calcium from the small intestine
Causes release of calcium and phosphorus from bone
Why can phosphorus levels rise in CKD?
Because the kidneys act to increase excretion of phosphorus
In CKD what 3 problems may occur as a result of decreased activation of vitamin D?
1) Secondary hyperparathryoidism
2) Decreased calcium level
3) Bone disease - renal osteodystrophy
What role do the kidneys have in RAAS and how?
Secrete renin which converts angiotensinogen into angiotensin 1
3 signals activate the release if renin from the juxtaglomerular apparatus of the kidney:
1) A drop in perfusion pressure of the afferent arterioles
2) A decrease in the flux of NaCl past the macula densa
3) Activation of sympathetic nerve supply to the afferent and efferent arterioles in the kidney
Why can the haematological disease myeloma lead to CKD?
Production of an immunoglobulin which is deposited in the kidneys
Why can cardiac failure result in CKD?
Decreased blood supply to the kidneys
After what age do you begin to get a gradual decline in kidney function?
What percentage of cardiac output is received by the kidneys (and how much is this per minute)?
In urinalysis what would nitrites and leucocytes in the urine indicate?
In urinalysis what is glucose in the urine likely to indicate?
In blood tests to investigate kidney function what 6 substances would you measure the levels of?
1) Sodium 133-146 mmol/L
2) Postassium 3.5-5.3 mmol/L
3) Urea 2.5-7.5 mmol/L
4) Creatinine 64-104 umol/L
(Above 4 are part of urea and electrolytes)
5) Bicarbonate 22-29 mmol/L
6) Chloride 95-108 mmol/L
What 6 things are you likely to be testing for in urinalysis to investigate kidney disease?
2) pH varies
When measuring urine what would you measure the protein in reference to?
Protein/Creatinine ratio ( 0.1-13 mg/mmol/L)
When would a midstream urine sample be required?
If infection was suspected
What 4 radiological investigations could be carried out on the kidneys and what would each identify?
1) Abdominal x-ray - may identify calcification
2) Renal tract ultrasound - Assesses the size of the kidneys and bladder and identifies any obstruction
3) CT KUB (Kidneys, ureter, bladder) - Calcification use with iodinated contrast
4) Magnetic resonance angiography (MRA) - Blood supply
What may a kidney biopsy be required to diagnose and under what guidance is it performed?
Required to diagnose AKI
Performed under ultrasound guidance
What is the length of a healthy kidney?
What is a nephron made up of?
Glomerulus surrounded by Bowman's capsule
Enveloped by a vascular network
Where do 80% of the kidney glomeruli lie?
In the cortex
How much urine does a healthy person produce in one day?
What are the 4 parts of the renal tubule?
Proximal convoluted tubule
Distal convoluted tubule
Loop of Henle