Renal and Genito-urinary system Flashcards Preview

IHD Part 2 306 > Renal and Genito-urinary system > Flashcards

Flashcards in Renal and Genito-urinary system Deck (101)
Loading flashcards...
1

kidney and renal tract: What are the functions of the kidney?

Filter 180L fluid daily
Clear waste
Balance acid/base

Produce hormones:
Control blood pressure (renin)

Help to make blood (erythropoietin)

Regulate bone health (Ca, P) (vit. D)

selectivity barrier

2

kidney and renal tract: What is creatine?

End product of skeletal muscle catabolism

3

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

4

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

5

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
Uraemia
Acidosis eg lactic acid, ketoacids
Others: Potassium, Phosphate, Uric acid
Clearance of drugs

Humoral disturbance
Anaemia
Renal bone disease - bones go soft
Hypertension

Barrier failure
- haematuria
- proteinuria - froth in the test-tube, ben's Jone's proteins come out of solution
- lipiduria

6

kidney and renal tract: What investigations are done to investigate kidney disease?

Blood tests
- 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)

7

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

8

kidney and renal tract:What are the problems with kidney disease?

high blood pressure - beta blockers, ACE inhibitors, calcium channel blockers

anaemia -

bone problems - osteoporosis, renal bone disease, rickets

9

kidney and renal tract: What is nephrotic syndrome?

3 things

Heavy proteinuria
(>3.5g/24hrs or >350mg/mmol uPCR)
Low albumin (<30g/L) (normal 35-50g/L)
Peripheral Oedema

possibly…
Thrombosis – DVT, PTE
Hyperlipidaemia

10

kidney and renal tract: How is mild/moderate chronic kidney disease treated?

Diet/Fluid balance
Supplements- Alkali, Vitamin D, Iron
Drugs – Phosphate, Hypertension, Anaemia

11

kidney and renal tract: how is severe chronic kidney disease treated?

Dialysis
Transplantation

12

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

13

kidney and renal tract: What are the top 5 causes of kidney disease in the UK 2005?

Glomerulonephritis - glomerular disease
pyelonephritis - tubular disease
diabetes
polycystic kidney disease
hypertension/renovascular disease (problem of atherosclerosis)

14

kidney and renal tract: What are the complications of people with end stage renal failure?

CVD - hypertension, K related arrhythmias, cardiac valvular calcifications

infections
malnutrition
immunocompromised
renal osteodystrophy

15

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))
-Hypertension, Diabetes,

Cardiovascular disease
Recurrent disease

at 5 years - 70% of kidneys still working

16

Pathology of renal disease: How much fluid do your kidneys filter and reabsorbs per day?

180 litres per day

reabsorbs 178 litres per day

17

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

18

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

19

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

20

Pathology of renal disease: why may you get blocked/inflamed tubules?

neutrophil casts?
crystals/calcification blocking
blood clots

bacteria, neutrophils, macrophages?

21

Pathology of renal disease: Why may tubules die off?

Pyelonephritis
papillary necrosis
tumours can develop - renal cell carcinoma (pain in loin, or blood in urine)

22

Pathology of renal disease: What are the risk factors for renal cell carcinoma?

obesity
cigarette
von hippel Lindau syndrome
acquired renal cystic disease (dialysis)

23

Pathology of renal disease: what is the treatment of RCC?

Surgical resection, radiotherapy

24

Pathology of renal disease: Where does RCC spread?

Direct, lymphatic, peritoneum, blood/bone

25

Pathology of renal disease: What are the risk factors for transitional cell carcinoma of the renal pelvis?

cigarette smoking
industrial dyes e.g. aniline
long term painkillers

26

Human herpesviruses: What is the structure of the herpes virus?

Small virus
120-200 nm
Icosahedral (viral shape) capsid surrounding ds (double stranded)DNA
80 genes coding for ~ 100 proteins

27

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
HHV-4 HHV-8

28

Human herpesviruses: What diseases are caused by herpes virus?

check slides

29

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

30

Human herpesviruses: Where does HSV1 and HSV2 infect?

HSV 1
n Mainly Oral Infections
HSV 2
n Mainly Genital Infections

1° Herpes Simplex (infection) n also called Herpetic Gingivostomatitis
2° Herpes Simplex (reactivation) n Herpes Labialis (cold sores)