Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NME > Renal Disease > Flashcards

Renal Disease Flashcards

1
Q

How does renal disease present (4):

A
  • incidental finding
  • symptomatic
  • associated with a systemic disorder
  • inherited disease screening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Renal Disease: Incidental Finding:

A
  • abnormal renal function tests
  • urinary abnormalities
  • hypertension
  • small/dilated kidneys on imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Renal Disease: Asymptomatic Presentation:

A
  • kidneys have enormous excess
    capacity
  • GFR<50% before creatinine rises
    above normal range
  • symptoms related to reduced
    kidney function unusual until GFR
    <15
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Renal Disease: Renal Function Tests:

A
  • bloods: Na,K, urea, creatinine, bicarb
    (any abnormal)
  • ABG: pH decreases, lactate???
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Renal Disease: Hyperkalaemia:

A
  • mainly intracellular
  • if kidneys do not excrete potassium
  • plasma potassium high
  • disrupts electrochemical gradient
  • causing cardiac arrythmias/arrest
  • medical emergency if above 6.5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Renal Disease: Urine Dipstick:

A
  • ***blood (non-visible)
  • ***protein
  • glucose
  • ketones
  • billirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Only high molecular weight protein may appear in the urine.

True or False?

A

False
Low and high molecular weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Renal Disease: Measurement of proteinuria:

A
  • Urinary protein/creatinine ratio
    (PCR)
  • Urinary albumin/creatinine ratio
    (ACR)
  • ratio avoids 24hr urine collection
  • PCR/ACR x10=24hr excretion
  • screening for diabetes, CKD, CVD
  • albumin testing has become the
    standard assay
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Renal Disease: Interpretation of Serum Creatinine and ACR:

A
  • proteinuria increases as CKD
    progression risk increases
  • ACR (protein/albumin ratio) <3 =
    normal
  • ACR 3-30 = moderately increased
  • ACR >30 = severely increased
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Increased proteinuria is associated with faster decline in renal function.

True or False?

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Renal disease: Non-visible Haematuria:

A
  • urine microscopy vs dipstick
  • bleeding from kidney:
    - red cell cast on microscopy
    - indicates glomerular disease
  • bleeding from lower renal tract:
    - renal pelvis and downwards
    - tumours/stones
    - bladder catheter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Renal Disease: Symptomatic Presentation:

A
  • general malaise
  • uraemia
  • nephrotic syndrome
  • nephritic syndrome
  • AKI
  • CKD
  • visible haematuria
  • frequence, dysuria
  • pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Uraemia symptoms:

A
  • fatigue
  • lethargy
  • confusion
  • anorexia
  • nausea
  • cramps
  • restless legs
  • insomnia
  • itching
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Uraemia Signs:

A
  • amenorrhea
  • hiccough
  • reduced body temp
  • weight loss
  • pericarditis
  • pleuricy
  • seizures
  • encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

4 signs of renal disease:

A
  • peripheral oedema
  • periorbital oedema
  • purpura
  • muddy, brown, foamy, coco cola
    urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What sign of renal disease is this?

A

Purpura

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Causes of Renal Disease:

A

insert slide

1,2, = pre-renal can lead to renal
3, 4 , 5, 6= renal
7,8 = post-renal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

8 Causes of Renal Disease:

A

1) Pre-Renal AKI
2) Renal Artery/arteriole occlusion
3) Small Vessel Disease
4) Glomerular Disease
5) Acute Tubular Necrosis
6) Acute Interstitial Nephritis
7) Intra-Tubular Obstruction
8) Post-Renal Obstruction

AKIRASVDGDATNAINITOPRO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Key Features of Normal Glomerulus:

A
  • capillaries with fenestrated
    epithelium
  • basement membrane
  • single layer of podocytes
  • foot processes
  • supporting mesangial cells (support
    and can contract, decreasing SA for
    filtration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Podocyte Injury can be due to:

A
  • Cytokines
  • Pressure (hypertensive
    glomerulonephropathy)
  • Immunoglobulin deposition (IgA
    Nephropathy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Patterns and Causes of Glomerular Disease:

A
  • epithelial cell swelling
  • basement membrane thickening
  • electron dense deposits
    subendothelialy
  • capillary lumen narrowed
  • endothelial cell swelling
  • fused foot process
  • mesangial matrix deposits
  • slight proliferation of mesangial cells
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Renal Disease: Renal Biopsy:

A
  • renal biopsy gives an accurate
    diagnosis:
    - patterns of disease on light
    microscopy
    - patterns of disease on electron
    microscopy
    - immunoflorescent antibodies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Examples of Glomerularnephritis:

A

insert slide

24
Q

Immune Diseases of the glomerulus:
Type 1
Type 2
Type 3
Type 4

A
  • type 1: IgE: no known renal disease
  • type 2: IgG, IgM: membranous
    glomerularnephritis
  • type 3: immune complexus: Hep B,C
  • type 4: T cells: Sarcoid, sclerosis
25
Q

Immune Disease of the Glomerulus:
What types of mediation?

A
  • antibody mediated
  • antigen/antibody complex mediated
26
Q

Immune Disease of the Glomerulus: Antibody mediated:

A
  • antibodies directly bind to cell
  • causes damage through the
    activation of complement system
  • activates apoptosis
27
Q

Immune Disease of the Glomerulus: Antigen/antibody complex mediated:

A
  • immune complexes form in
    circulation elsewhere and get
    trapped in glomeruli
  • effects depend on location of
    deposition within the glomerulus
28
Q

Crescentic glomerulonephritis

A

accumulation of WBC and proliferated parietal cells
crescents compress the capillary tufut
associated with severe disease

histological finding

29
Q

Diffuse Proliferative Glomerulonephritis

A
  • poststreptococcal sore throat
  • increased cells in the glomerulus
  • capillaries occluded by inflammatory
    cells
  • sparse deposits of IgG immune
    complexes along capillary loops
30
Q

Membranous glomerulonephritis

A
  • diffusely thickened basement membranes
  • granular despoitis of IgG immune
    complexes across peripheral
    glomerular capillary walls
31
Q

Small Vessel Disease:
- vasculitis
- thrombosis
- atherosclerosis

A
  • inflammation of the vessels
  • blockage due to blood clot
  • narrowing due to hypertension or
    diabetes
32
Q

Hypertensive nephropathy leads to glomerulosclerosis

A

insert slide

33
Q

Clinical Features of hypertensive nephropathy:

A
  • blacks>caucasians
  • chronic hypertension
  • 2nd commonest cause of end stage
    renal disease
  • haematuria
  • visible proteinuria
34
Q

Treatment of Hypertensive Nephropathy:

A
  • antihypertensives (ACE inhibitor)
    aiming for 130/80
35
Q

Biopsy finding of hypertensive nephropathy:

A
  • LM: glomerular sclerosis, tubular
    atrophy, arteriosclerosis
  • IHC: no immune deposits
36
Q

Diabetic Glomerulonephropathy

A

insert slide

37
Q

Diabetic Nephropathy: Clinical Features:

A
  • increasing albuminuria before overt
    kidney disease
  • often presents with nephrotic
    syndrome
38
Q

Diabetic Nephropathy: Biopsy findings:

A

rarely done
nodular glomerulosclerosis

39
Q

Diabetic Nephropathy:

A
  • BP control
  • reduce proteinuria with ACE
    inhibitors
  • diabetic control
40
Q

Nephrotic Syndrome:

A
  • a triad of:
    - proteinuria
    - low albumin
    - oedema
  • associated features:
    - high cholesterol
    - tendency to thrombosis
  • tachycardia
  • oedema that begins in the face
  • pale skin fissures
  • vomiting
41
Q

Pathophysiology of Nephritic and Nephrotic Syndromes

A

insert slide

42
Q

Comparison of Nephritic and Nephrotic Syndromes:

A

insert

43
Q

Acute Tubular Necrosis Pathophysiology (4):

A
  • Induction:
    • initial event (afferent arteriole
      constriction)
    • reduced GFR
  • Extension:
    • ongoing hypoxia
    • inflammatory response
    • corticomedullary nephrons most
      affected
    • necrosis and cell death
  • Maintenance:
    - restoration of blood flow
    - reversal of hypoxia
    - cellular repair and proliferation
  • Repair:
    - restoration of tubular integrity
    - improvement in renal function
44
Q

What is interstitial nephritis?

A

inflammation within the mesangium of the kidney

45
Q

4 indications for urgent renal replacement therapy:

A
  • uncontrollable fluid overload
  • uncontrollable, severe metabolic
    acidosis
  • uncontrollable hyperkaelaemia
  • uraemic pericarditis/
    encephalopathy
46
Q

Acute or Chronic Renal Failure?

A

Acute:
- acidotic, unwell
- normal Ca2+
- normal size kidneys

Chronic:
- surprisingly well
- low Ca2+/ renal osteodystrophy
- small kidneys
- pigmented

47
Q

What is involved in Renal Replacement Therapy?

A
  • haemodialysis
  • peritoneal dialysis
  • renal transplant
48
Q

Renal Replacement Therapy: Haemodialysis:

A
  • vascular acess
  • 3-4hrs 3x a week
  • restrictive eg holidays
49
Q

Renal Replacement Therapy: Peritoneal Dialysis:

A
  • peritoneum used as dialysis
    membrane
  • electrolytes and toxins move down
    conc grad
  • 4-5 exchanges per day
  • no machine
  • infection is complication
50
Q

Renal Replacement Therapy: Kidney Transplantation:

A
  • live donor
  • cadavaric donor
  • original kidneys left behind
  • usually left kidney behind right iliac
    fossa
51
Q

Maximum Conservative Tratment:

A
  • low Na+/K+ diet
  • low sugar intake
  • no smoking
  • ACE inhibitor for hypertension
  • control of diabetes and cholesterol
52
Q

Cystic Renal Disease:

A
  • autosomal dominant polycystic
    kidney disease
  • recessive as well
  • simple cysts
  • cystic dysplastic: congenital,
    unilateral malformation
  • hydronephrosis: mistaken for cysts
53
Q

ADPKD

A
  • autosomal dominant polycystic kidney disease
  • autosomal dominant mutation in
    PKD1, chromosome 16, encodes for
    polycystin 1 protein in cilia
  • progressive increase in size, no.
    cysts
  • gradual decline in renal function
  • asymptomatic till 30-40
  • presents with renal insufficiency,
    haematuria and hypertension
  • abdominal mass and flank pain
  • end stage renal failure in 70s
54
Q

ARPKD:

A
  • autosomal recessive polycystic
    disease
  • multiple small cysts in renal cortex
    and medulla
  • multiple liver cysts, hepatic fibrosis
  • associated with pulmonary
    hypoplasia
  • presents in infancy with progressive
    often fatal renal failure
55
Q

Simple Renal Cysts:

A
  • acquired cysts
  • simple (water density, thin wall, no
    nodules)
  • differentiate from cystic cancers

NME (52 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions