Renal Medicine Flashcards
(49 cards)
What is dysuria and what is uraemia?
dysuria = pain upon urination
uaraemia = increased urea
What are the methods of measuring renal function and how do they work?
- Serum UREA
Also rises with dehydration - Serum CREATININE
Good general guide to renal function - eGFR – Estimated Glomerular filtration rate
Modern quick way of looking at renal function calculated from U&Es measurement - 24hr urine collection
Creatinine clearance – best measure
What is the best way to measure renal function?
eGFR – Estimated Glomerular filtration rate
What does renal failure cause?
- loss of renal excretory function
- loss of water and electrolyte balance
- loss of acid base balance
- loss of renal endocrine function (erythropoietin, calcium metabolism, renin secretion)
What are the two types of renal failure?
Acute Renal Failure
* Rapid loss of renal function
* Usually over hours or days
Chronic Renal failure
* Gradual loss of renal function
* Usually over many years
What are the pre-renal causes of failure?
- Hypoperfusion of the kidney
- shock
- Renal artery or Aorta disease
What are renal causes of failure?
- Chronic disease, drug damage, trauma, infection
What are the post renal causes of failure?
renal outflow obstruction
enlarged prostate, kidney stones, tumours
What measurement is rapid loss of renal failure measured by in ARF?
Creatinine >200μmol/L
What are the intial symptoms of ARF?
- Anuric initially (no urine) with volume overload
- Ankle oedema (if ambulatory), sacral oedema (if bed bound)
- Pulmonary oedema & breathlessness
- Raised Jugular Venous Pressure (JVP)
What are the gradual symptoms of ARF?
- Gradually progresses to polyuria
- Healing restores filtration before concentration ability
What can develop due to ARF?
- development of Hyperkalaemia (high K+)
- Can lead to cardiac arrest
- development of Uraemia and Acidosis
- High urea
- Low bicarbonate
- Increased respiratory excretion of CO2
- Raised respiratory rate
What are the causes of ARF and what is the treatment?
- Usually a PRE-RENAL cause
- USUALLY reversible with TIME
- renal support until recover
- dialysis
- nutrition
Primary/ secondary causes of CRF?
Primary (rare)
* Glomerulonephritis
* Polycystic Kidney disease
Secondary
* Diabetes (30%)
* Hypertension (20%)
* drug therapy
* Vasculitis
* Renal Artery disease/Aorta disease
Symptoms of glomerulonephritis and progression
- haematuria/proteinuria
- otherwise healthy individual
- gradual progression to:
- hypertension
- chronic renal failure
What is nephrotic syndrome?
Complication of Glomerulonephritis
* excessive loss of protein in the urine - >3g in 24hrs
* Hypoalbuminaemia
* loss of plasma oncotic pressure * tissue swelling (oedema)
What does nephrotic syndrome result in?
HYPERcoagulable state
* Loss of clotting factors – AT3 deficiency (due to hypoalbuminaemia)
* Dehydration raises other coagulation factor concentrations
What drugs cause renal disease?
NSAIDs
* inhibit glomerular blood flow
* Cause interstitial nephritis
* Avoid in renal disease if possible
Nephrotoxic drugs
* cyclosporin
What is renal vascular disease?
Reduced blood flow to the kidney
* Atheroma of renal artery/aorta
* Hypertension – narrowing of renal artery
Microangiopathy
* Immune reaction causing small blood vessel damage, RBC damage and thrombosis
* E Coli 0157
Multiple myeloma
- Plasma cell tumour
- Excess light chain production ‘clogs’ kidney
- Tubular nephritis results
Goodpasture’s syndrome
- Anti-glomerular basement membrane antibody
(anti-gbm)
Vasculitis
inflammation of blood vessels that can affect the kidney due to systemic lupus erythematosus (SLE)
What is polycystic kidney disease?
gene mutation that causes multiple cysts in the renal parenchyma
*Enlarged kidney
* Progressive destruction of normal kidney
* Gradual renal failure
What is end stage renal disease classfied as?
measurements
- eGFR <15ml/min
- Creatinine 800-1000μmol/L
