Renal Disorders

Question 1

functions of the kidney

Answer 1

homeostasis of the internal environment
maintain fluid and electrolyte balance
secretion of : erythropoietin, renin, dihydroxy vitamin D

Question 2

Filtration pressure

Answer 2

net pressure forcing fluid out of the glomerulus

Question 3

GLomerular filtration rate (GFR)

Answer 3

the filtration of plasma per unit of time

Question 4

renal clearance

Answer 4

volume of blood plasma cleared of a waste produce in 1min

Question 5

filtration pressure

Answer 5

net pressure forcing fluid out of the glomerulus

Question 6

factors that affect filtration

Answer 6

changes in hydrostatic pressure
changes in the diameter of the afferent or efferent arterioles
large molecules like plasma proteins cannot move through small pores in glomerular membranes
negative charge along the filtration membrane impedes filtration of negatively charged particles as they repel

Question 7

GFR is dependent on

Answer 7

permeability of capillary walls
vascular pressure
filtration rate

Question 8

eGFR

Answer 8

based on blood and calculation of a formula using age, ethnicity and gender
results give the range of variation

Question 9

Obstructive Uropathy

Answer 9

any condition causing a change in the normal urine flow anywhere within the urinary tract

Question 10

Consequences of obstructive uropathy

Answer 10

pain caused by distension caused by blockage

urine output varies

Question 11

renal calculi

Answer 11

masses of crystals, proteins, other substances
usually bilateral
if flow blocked, urine backs up in pelvis

Question 12

Hydroureter

Answer 12

obstruction of the ureter with accumulation of urine

Question 13

Hydronephrosis

Answer 13

retrograde increases in hydrostatic pressure in the renal pelvis and calyces can increase accumulation of urine in the renal collecting system

Question 14

Clinical manifestations of hydroureter or hydronephrosis

Answer 14

pain - colicky with stones
bladder symptoms
unilateral obstruction, complete or partial is often asymptomatic
bilateral partial obstruction - cant concentrate urine
bilaterial complete obstruction - oliguria/anuria

Question 15

Types of kidney stones

Answer 15

calcium
struvite
uric acid
cysteine

Question 16

PAtho of kidney stones

Answer 16

high urinary concentration of stone forming substances
changes in pH and temp
drugs and diet
decreased urinary flow
grow in the renal papilla or pelvis

Question 17

Risk factors for kidney stones

Answer 17

calcium stones - smallest, hypercalciuria, hyperuricosuria
struvite stones - women infected by microbes
urice acid stones - ulcerative colitis or regionial enteritis with fluid and bicarbonate loss

Question 18

cyteinuria

Answer 18

rare hereditary disorder
disorder of amino acid metabolism
decreased tubular reabsorption of cysteine

Question 19

Patho of cyteinuria

Answer 19

high levels of stone forming substances in plasma and urine, some medications, loss of inhibitors of precipitation

Question 20

clinical manifestations of cyteinuria

Answer 20

colicky pain, flank pain, nausea and vomiting, haematuria

Question 21

Bladder-prostate enlargement

Answer 21

stone blocks exit from bladder when muscle contract

Question 22

treatment and management of bladder-prostate enlargement

Answer 22

adequate analgesia and high fluid intake
treat infection
dissolve stones and prevent reformation

Question 23

How to dissolve stones

Answer 23

increase fluid intake and urine output
decrease dietary intake of stone forming substances
durgical removal of stones greater than 0.5cm width
percutaneous puncture of kidney with forceps removal
shock wave lithotripsy for large calcium stones

Question 24

predisposing factors for kidney stones

Answer 24

family history
diabetes
chronic disease
renal calculi
urinary tract obstruction 
immunosuppression 
pregnancy
prostate disease in older men

Question 25

Autoregulation

Answer 25

the renin-angiotensin aldosterone system (RAA) and antidiuretic hormone (ADH) are the feedback loop systems maintaining homeostasis in the body keeps pressure in the glomerulus within a wide range of systemic blood pressures

Question 26

Kidney Dysfunction

Answer 26

inadequate urine output | Impaired homeostasis, conversion of vitamin D to the active form and secretion of erythropoietin

Question 27

Injury to glomerulus

Answer 27

increased permeability of the capillary membrane larger molecules can cross: RBC, epithelial casts, proteins decreased oncotic pressure = decreased GFR = urine output

Question 28

glomerulonephritis

Answer 28

characterised by inflammation of the glomerulus primary: rapidly progressive glomerulonephritis secondary: to other disease such as diabetes

Question 29

Patho of glomerulonephritis

Answer 29

glomerulus is the high pressure filtration component of the normal kidney tubules with damage there is swelling, increase permeability and decreased effectiveness of cell junction

Question 30

Classifications of glomerulonepthritis

Answer 30

``` Asymptomatic ACute nephritic syndrome rapidly progressing GMN Nephrotic Syndrome Chronic glomerulonephritis (CKD) ```

Question 31

Asymptomatic glomerulonephritis causes

Answer 31

IgA nephropathy with haematuria abnormal IgA binds to cells, complement stimulates inflammation and injury abnormal IgA produced by bone marrow binds to glomerular mesangial cells, stimulating them to proliferate and release inflammatory mediators

Question 32

Acute nephritis syndrome

Answer 32

a group of symptoms that occur with some disorders that cause swelling and inflammation of the glomeruli in the kidney acute onset of gross haematuria and mild-moderate proteinuria

Question 33

manifestations of acute nephritis syndrome

Answer 33

acute onset of fever, malaise, nausea, oliguria, haematuria red cell cause in the urine and mild proteinuria periorbital oedema and mild hypertension

Question 34

Rapidly progressing GMN

Answer 34

acute nephritis with glomerular damage resulting in proteinuria and rapid progression to AKI with severe oliguria or anuria and irreversible kidney disease

Question 35

causes of rapidly progressing GMN

Answer 35

immune-mediated posinfectious GMN systemic disease idiopathic

Question 36

Types of rapidly progressinv GMN

Answer 36

GOodpasture syndrome - characterised by pulmonary haemorrhage immune complex deposition Pauci immune glomerulonephritis

Question 37

Patho of Rapidly Progressing GMN

Answer 37

antiglomerular basement membrane antibodies and antineutrophil cytoplasmic antibodies are associated with glomerular injury extensive proliferation of cells into the bowman space with cresent formation

Question 38

Nephrotic Syndrome

Answer 38

heavy protein loss | generalised oedema with characteristic pitting

Question 39

Pathogenesis of Nephritic Syndrome

Answer 39

damage of alteration of glomerular basement membrane becmes excessively permeable to plasma proteins depletion of plasma proteins resulting in hypoalbuminaemia

Question 40

Causes of nephritic syndrome

Answer 40

systemic disease such as diabetes and SLE

Question 41

Chronic glomerulonephritis (CKD)

Answer 41

glomerular disease with a progressive course leading to chronic kidney diseases

Question 42

Diabetic nephropathy pathology

Answer 42

insulin deficiency and altered metabolism, thickening of glomerular basement membrane, in connective tissue matrix and hardening

Question 43

Acute kidney injury and chronic kidney disease

Answer 43

severe reduction in renal function

Question 44

Acute kidney injury

Answer 44

rapid and sudden deterioration of renal function | resulting in retention of metabolic wastes , impaired fluid and electrolyte balance

Question 45

Cases of AKI

Answer 45

prerenal - impaired blood flow: hypotension, ischaemia, low CO, haemorrhage, surgery Intrarenal - acute glomerulonepthritis or acute tubular necrosis - aminoglycoside antibiotics Post renal - urinary tract obstruction

Question 46

Clinical progression of AKI

Answer 46

1. initiation phase - reduced perfucion, renal injury evolving 2. maintenance phase - period of established renal injury and dysfunction 3. recoevery phase - interval when renal injury is repaired

Question 47

Chronic Kidney disease

Answer 47

gradual loss of nephrons until the remainder cannot carry out normal renal function results in end stage renal disease requiring dialysis

Question 48

Risk factors for CKD

Answer 48

intact nephrons can enlarge and increase function one kidney can take overall function may not see impaired function until 75-80% loss of nephrons

Question 49

Stages of CKD

Answer 49

1. normal or high GFR - no symptoms 2. mild CKD - asymptomatic 3. moderate CKD - possible signs of organ dysfunction 4. severe CKD - normal blood volume and concentrations not maintained 5. end stage CKD - uraemia, oligurua, anuria, vomiting, anorexia,