Systems Pathology: Kidney Failure Flashcards Preview

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Flashcards in Systems Pathology: Kidney Failure Deck (17)
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Kidney functions

Excretion of nitrogenous waste
Salt, ion and water homeostasis
Secretion of erythropoietin
Secretion of renin

1

Acute kidney injury

Total renal failure
Sudden
High morality and common
Oliguria (decreased )leading to anuria (none)
Electrolyte imbalance-> Hyperkalaemia and metabolic acidosis-> can't compensate
Rapidly raising blood urea and creatine and nitrogen

2

Diagnosis of acute kidney injury

Serum creatine rises by 26 mmol in 48 hours
Serum creatine rise by 1.5 fold in a week
Urine output <0.5 ml/kg/h for more than 6 hours

3

Causes of acute kidney injury, pre renal

Pre renal causation
-> Hypovolemic shock, haemorrhage, cardiac failure
-> reduced renal perfusion
-> kidneys attempt to retain sodium and water-> RAA
-> renal excretory capacity is impaired
Teat by increasing perfusion pressure

4

Acute tubular necrosis

Tubular epithelial cells have high O2 demands
Central perfusion failure
Proximal and distal tubules most vulnerable
Tubular cells die-> no ion or water pumping-> kidneys swell
Most common cause of acute reversible kidney failure

5

Glomerular disease

Glomerulonephritis
Immune complex mediated damage when all glomeruli damaged at the same time
-> rapidly progressive
-> post infective
-> or linked to vasculitis
Occlusion of glomerular capillaries prevents ultrafiltration and also prevents blood flow though efferent arteriol-> reduced O2 to kidney-> AKI
Nephritic syndrome->obliteration or glomerular lumina

6

Vascular causes of AKI

Vasculitis-> immune mediated inflammation and destruction of small vessels
Disseminated intravascular co agulation
Malignant hypertension

7

Tubular and intersitial disease

Nephrotoxins
Infective damage-> acute pyelonephritis
Immune mediated
Hypoxia
-> whole nephron fails without tubule

8

Post renal AKI

Acute obstruction of lower urinary tract-> prostate
-> ureters
Lumen-> stone
Wall-> tumour or inflammation
Extrinsic-> massive tumour

9

Chronic renal failure

Slowly progressive and irreversible loss of enable function due to irreversible destruction of large numbers of nephrons
Lots of nephrons so gradual deterioration
Symptoms appear when compensation fails

10

Symptoms of renal failure

Insidious onset, variable symptoms
Polyuria
Malaise, lethargy
Increasing uraemia-> bone marrow suppression and platelet dysfunction
Confusion and eventual coma
Electrolyte imbalance
Na and water retention
Hypertension
Failure of renal activation of vit D-> secondary hyperparathyroidsim and bone disease
Destruction of parenchyma-> reduced erythropoietin-> anaemia

11

CKD initiating factors

Age
Family history
Nephrotoxins
Diabetes mellitus
Urinary infections, obstruction
Cardiovascular disease

12

CKD perpetuating factors

Hypertension
Proteinuria
Obesity
Anaemia
Nephrotoxins
Cv diseased
Smoking

13

Causes of CKD

Diabetic kidney disease
Congenital kidney disease
Immunological damage to glomerulus-> glomeruli nephritis
Chronic renal reflux
Infection-> hep b,c, malaria, TB, HIV

14

Partial renal failure syndrome

Nephritic syndrome-> disturbance of glomerular structure-> reactive cellular proliferation
-> reduced glomerular blood flow-> oliguria, hematuria, uraemia
-> RAA activation-> fluid retention and hypertension
Necrotic syndrome-> abnormality in glomerular basement membrane or mesangium-> loses capacity for selective filtering
-> protienuria, hypoalbuminemia, edema
-> susceptibility to infections, thrombosis and hyperlipideamia

15

Acute renal failure lab results

Plasma:
Na normal/low
K high
Bicarbonate low
Urea high
Creatine high
Osmolality high
Metabolic acidosis
Urine:
Sodium high
Osmolality same as plasma as can't dilute/concentrate urine

16

Chronic renal failure lab data

Plasma:
Na normal
K normal/ high
Bicarbonate low
Urea high
Creatinine high
Protein in urine

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