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Chemical Pathology > Renal Function and Disease > Flashcards

Renal Function and Disease Flashcards

1
Q

What is the best measure of renal function?

A

Glomerular filtration rate

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2
Q

What is used to measure GFR?

A

In day to day practice, creatinine is used.

For more serious measurements, Cr-EDTA is used.

The gold standard (used in research) is to use Inulin.

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3
Q

What can a simple sample be now used to investigate?

A
  • Dipstick (blood, nitrites, glucose, leucocytes, ketones)
  • Protein quantification
  • Microscopy
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4
Q

What is a 24 hour urine needed for?

A
  • Creatinine clearance estimation

- Stone forming elements

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5
Q

What can urine microscopy be used to investigate?

A
  • Crystals
  • Red blood cells
  • White blood cells
  • Casts
  • Bacteria
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6
Q

In urine microscopy, what does the presence of calcium oxalate crystals mean?

A

Anti-freeze (ethylene glycol) poisoning

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7
Q

What types of renal imaging are there?

A
  • USS
  • CT
  • Dynamic renal imaging (paediatrics)
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8
Q

What renal imaging is best for renal stones?

A

CT KUB

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9
Q

What is acute kidney injury?

A

AKI is a rapid decline in renal function, measured in stages.

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10
Q

What are the stages of AKI?

A

Urine output of <0.5ml/kg/hour

Stage 1: 1.5-1.9x serum creatinine
Stage 2: 2-2.9x serum creatinine
Stage 3: >3x serum creatinine

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11
Q

What are the causes of AKI?

A

These can be pre-renal, renal or post-renal

Pre-renal:
- Reduced perfusion

Renal:
- Vascular/glomerular/tubular/interstitial pathology

Post-renal:
- Obstruction

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12
Q

Describe the pre-renal causes of AKI

A

This is majorly an issue of perfusion. Reduced perfusion reduces the GFR, and causes AKI. This usually responds well to volume replacement.

If left too long, it can cause irreversible ischaemic damage, becoming a renal AKI.

An example cause is renal artery stenosis and drugs (ACEi, ARBs, NSAIDs, calcineurin inhibitors, diuretics)

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13
Q

Describe the renal causes of AKI

A

This can be a long range of causes from glomerular, to vascular, interstitial or tubular pathologies. Treatment will be based on the cause.

They can be caused by drugs, contrast, ischaemia, endogenous toxins or exogenous toxins.

Endogenous toxins:

  • Myoglobin
  • Immunoglobulins

Exogenous toxins:

  • Aminoglycosides
  • Amphotericin
  • Acyclovir
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14
Q

Describe post-renal causes of AKI

A

This is majorly caused by obstruction. Obstruction can be in the kidneys, ureters, bladder or urethra and then can intra or extra luminal. Treatment will be based on the pathology (e.g. stones or prostatic hypertrophy)

If left too long, it can lead to renal scarring, ischaemia and permanent renal impairment.

It can be seen on ultrasound.

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15
Q

What are the indications for emergency dialysis in a case of AKI?

A
  • Pulmonary oedema
  • Refractory hyperkalaemia
  • Metabolic acidosis
  • Uraemic encephalopathy
  • Drug toxicity
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16
Q

What are the functions of the kidneys?

A
  • Excretion of water soluble waste
  • Water and electrolyte balance
  • Acid base balance
  • Hormone production (EPO, VitD, RAS)
17
Q

What are the main differences between acute kidney injury and chronic kidney disease?

A

AKI:

  • Abrupt
  • Sometimes reversible
  • Treatment based on pathology

CKD:

  • Chronic and long standing
  • Irreversible
  • Treatment is based on preventing worsening
18
Q

How do NSAIDs, calcineurin inhibitors, ACEi/ARBs and diuretics cause pre-renal AKI?

A

NSAIDs and calcineurin inhibitors: reduce afferent arteriole dilatation

ACEi/ARBs: reduce efferent arteriole constriction

Diuretics: tubular damage and reduces cardiac preload

19
Q

Define chronic kidney disease

A

A long-standing reduction in renal function, measured in stages.

20
Q

What are the stages of chronic kidney disease? What are the associated prevalence?

A

They are based on the GFR (ml/min)

Stage 1: <90 GFR
Stage 2: >60 GFR <89
Stage 3: >30 GFR <59
Stage 4: <15 GFR <29
Stage 5: <15 GFR

Most patients are in Stage 3, as Stage 1 and 2 are not diagnosed, and treatment keeps patients at stage 3.

21
Q

What are the most common causes of chronic kidney disease?

A
  • Diabetes
  • Atherosclerotic disease
  • Hypertension
  • Chronic glomerulonephritis
  • Infective or obstructive uropathy
  • Polycystic kidney disease
22
Q

What are the consequences of chronic kidney disease?

A

Failed homeostasis

  • Metabolic acidosis
  • Hyperkalaemia

Failed hormonal function

  • Anaemia (reduced EPO)
  • Bone disease (Reduced VitD)

Cardiovascular disease

  • Vascular calcification and subsequent atherosclerosis
  • Uraemic cardiomyopathy

Uraemia and death

23
Q

What is the main cause of death in patients with CKD?

A

Cardiovascular disease (calcification and atherosclerosis)

24
Q

Describe renal acidosis in patients with CKD

A

There is no hydrogen ion excretion so a build up causes acidosis. As an attempt to rectify, cells will pump out potassium and take in hydrogen, causing a hyperkalaemia.

Treat with oral bicarbonates

25
Q

What is the danger of high potassium?

A

Reduced cardiac and muscle function

On ECG: flattened P waves, tall tented T waves

26
Q

Describe the bone disease in chronic kidney disease patients

A

Fibrotic changes to the bone, and reduced mineralisation can cause:

  • Osteotitis fibrosa
  • Osteomalacia
27
Q

What phosphate abnormality do CKD patients have, and how is this rectified?

A

They have a very high phosphate, which makes the body think there is a low calcium, so the parathyroid glands go into overdrive.

To rectify:

  • Phosphate restricted diet and phosphate binders
  • Vitamin D analogues
  • PTH suppression (cinacalcet)

Chemical Pathology (15 decks)

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