Flashcards in Renal and Genito-urinary system Deck (101)
kidney and renal tract: What are the functions of the kidney?
Filter 180L fluid daily
Control blood pressure (renin)
Help to make blood (erythropoietin)
Regulate bone health (Ca, P) (vit. D)
kidney and renal tract: What is creatine?
End product of skeletal muscle catabolism
kidney and renal tract:
1. glomerulus filtration - h2o and solutes move from blood into nephron
2. tubular reabsorption - useful substances move from the filtrate in the to the blood
3. tubular secretion - waste and excess substances move from blood into filtrate
4. water reabsorption - h20 moves from filtrate into blood
kidney and renal tract: What 3 hormones does the kidney make?
Vitamin D - kidney hydroxylates to activate
makes erythropoietin - stimulates bone marrow to make red blood cells
makes renin - part of renin/angiotensin system
kidney and renal tract: What are 3 ways the kidney may dysfunction?
Salt and water homeostasis
Changes in total body water
Changes in blood pressure
Changes in urine volume or concentration
Excretion of waste products
Acidosis eg lactic acid, ketoacids
Others: Potassium, Phosphate, Uric acid
Clearance of drugs
Renal bone disease - bones go soft
- proteinuria - froth in the test-tube, ben's Jone's proteins come out of solution
kidney and renal tract: What investigations are done to investigate kidney disease?
- measured glomerular filtration rate GFR (between 60 and 100 may have signs of early kidney disease, below 60 is abnormal, below 15 as kidney failure)
kidney and renal tract: What is the classification of chronic kidney disease?
1 Kidney damage (structural/urinary/other)
and Normal GFR >90
2 Mildly reduced renal function 60-89
3 Moderately reduced renal function 30-59
4 Severely reduced renal function 15-29
5 Very severe to End-stage Kidney Failure <15
May require dialysis/transplantation
kidney and renal tract:What are the problems with kidney disease?
high blood pressure - beta blockers, ACE inhibitors, calcium channel blockers
bone problems - osteoporosis, renal bone disease, rickets
kidney and renal tract: What is nephrotic syndrome?
(>3.5g/24hrs or >350mg/mmol uPCR)
Low albumin (<30g/L) (normal 35-50g/L)
Thrombosis – DVT, PTE
kidney and renal tract: How is mild/moderate chronic kidney disease treated?
Supplements- Alkali, Vitamin D, Iron
Drugs – Phosphate, Hypertension, Anaemia
kidney and renal tract: how is severe chronic kidney disease treated?
kidney and renal tract: how does dialysis work?
take blood from the patient, pass it through a dialysis machine to purify and put it back through again
catheter into the jugular or subclavian vein
risk of infection/sepsis, fistula is made
dialysis membrane is semi permeable and fluid sent in a counter current way
kidney and renal tract: What are the top 5 causes of kidney disease in the UK 2005?
Glomerulonephritis - glomerular disease
pyelonephritis - tubular disease
polycystic kidney disease
hypertension/renovascular disease (problem of atherosclerosis)
kidney and renal tract: What are the complications of people with end stage renal failure?
CVD - hypertension, K related arrhythmias, cardiac valvular calcifications
kidney and renal tract: What are the complications of kidney transplant?
Immunosuppression but leads to:
-Infection (atypicals) - oral thrush is common, gingival overgrowth (cyclosporin, calcium channel blockers - amylodopine etc)
-Cancer (skin, post Tx lymphoproliferative (EBV))
at 5 years - 70% of kidneys still working
Pathology of renal disease: How much fluid do your kidneys filter and reabsorbs per day?
180 litres per day
reabsorbs 178 litres per day
Pathology of renal disease: Why may there not be enough filtration?
Not enough blood flow - acute
Blocked filter (minimal change, membraneous blockage (proteins blocking), cells blocking (proliferative) - acute
lack of glomeruli - over years and can lead to chronic hypertension
Pathology of renal disease: Why may there be too much filtration?
Leaky membranes - pores are bigger than they should be so bigger molecules like albumin can get through e.g. proteinuria - acute
Pathology of renal disease: Why may there be too little reabsorption?
faulty tubules - pass too much urine
causes of tubule dysfunction - lack of blood supply so g et acute tubular necrosis - too much urine produced, cannot reabsorb, but tubules can regenerate
and because of toxins, myoglobin, ethylene glycol
Pathology of renal disease: why may you get blocked/inflamed tubules?
bacteria, neutrophils, macrophages?
Pathology of renal disease: Why may tubules die off?
tumours can develop - renal cell carcinoma (pain in loin, or blood in urine)
Pathology of renal disease: What are the risk factors for renal cell carcinoma?
von hippel Lindau syndrome
acquired renal cystic disease (dialysis)
Pathology of renal disease: what is the treatment of RCC?
Surgical resection, radiotherapy
Pathology of renal disease: Where does RCC spread?
Direct, lymphatic, peritoneum, blood/bone
Pathology of renal disease: What are the risk factors for transitional cell carcinoma of the renal pelvis?
industrial dyes e.g. aniline
long term painkillers
Human herpesviruses: What is the structure of the herpes virus?
Icosahedral (viral shape) capsid surrounding ds (double stranded)DNA
80 genes coding for ~ 100 proteins
Human herpesviruses: how do you classify human herpes viruses classification?
α-herpesviruses - epidermal/neuronal viruses with a wide host range
Type 1 Herpes Simplex Virus Type 2 Herpes Simplex Virus Varicella-Zoster Virus (VZV)
HHV-1 HHV-2 HHV-3
β-herpesviruses - slow growth, primarily in T-cells and leukocytes
Cytomegalovirus (HCMV) Human Herpesvirus 6
Human Herpesvirus 7
γ-herpesviruses - primarily B-lymphocytes Epstein-Barr virus (EBV)
Human Herpesvirus 8
HHV-5 HHV-6 HHV-7
Human herpesviruses: What diseases are caused by herpes virus?
Human herpesviruses: How does the herpes virus infect and replicate?
virus binds to host receptor - binds to glycoproteins, then receptor
taken inside cell
dna released from virus particle - (uncoated)
translocates to the nucleus
viral dna in the nucleus interacts with host polymerases
Transcription occurs - mrna of viral protein, gets translated then,
viral proteins produced
viral protein binds to host polymerase - makes it more efficient
machinery replicates viral dna - lots of copies
everything is assembled - translocates to nucleus to get packaged to make new viral particles
host cell membrane bursts and releases viral particles to infect other cells
lots of cell damage occurs