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Clinical Biomedicine > W3: Kidneys > Flashcards

W3: Kidneys Flashcards

1
Q

2 main parts of kidney

A

glomerulus
tubule

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2
Q

6 kidney functions

A
  • reg vol of fluid in blood
  • electrolyte balance
  • acid-base balance
  • excretion of waste prods
  • vit D metabolism
  • prod of erythropoietin
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3
Q

3 waste products that kidneys excrete

A
  • creatinine (from skeletal muscle)
  • urea
  • uric acid
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4
Q

what component filters the fluid?

A

Bowman’s/ glomerular capsule

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5
Q

2 renal function tests

A
  • GFR (glomerular filtration rate
  • measurement of waste prods in plasma
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6
Q

what does GFR measure

A

vol of fluid filtered through all glomeruli per time unit

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7
Q

normal GFR

A

60-120ml/ min

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8
Q

what is eGFR + what’s it based on

A

estimated glomerular filtration rate
based on an equation validated against gold standard renal clearance test

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9
Q

normal eGFR

A

> 90ml/ min

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10
Q

what does decreasing eGFR indicate

A

impairment of renal function

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11
Q

2nd renal function test?

A

measurement of waste prods in plasma e.g creatinine + urea

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12
Q

problem of using creatinine as measure of renal function

A

not a sensitive marker of renal function - stays within normal ranges even when chronic renal disease already established

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13
Q

what is urea a waste prod of

A

protein + AA metabolism

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14
Q

problem w urea measuring for renal function? when may it be useful?

A
  • poor indicator of renal function (influenced by protein metabolism, the state of dehydration + use of steroids)
  • may be useful in elderly/ children w dehydration as starts to rise b4 creatinine - becomes more concentrated
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15
Q

how is acid-base balance maintained?

A

by renal:
- secretion of H+
- reabsorption of HCO3-

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16
Q

high [H+] w/out renal buffering causes?

A

metabolic acidosis

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17
Q

low [H+] w/out renal buffering causes?

A

metabolic alkalosis

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18
Q

2 renal function-related test that are indirectly affected in renal failure?

A
  • plasma phosphate bc kidney involved in phosphate excretion
  • plasma Ca2+ - bc kidney involved in active vit D prod
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19
Q

what may cause low calcium in ACUTE renal failure?

A

raised phosphate in plasma

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20
Q

what may cause low calcium in CHRONIC renal failure?

A

low 1,25 diOHvitamin D3

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21
Q

what does glomeruli damage cause?

A

protein to leak into tubules + they can’t reabsorb enough protein back into bloodstream

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22
Q

when small-middle sized proteins can’t be reabsorbed it can lead to?

A

albuminuria

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23
Q

as renal disease progresses bigger proteins get through leading to?

A

proteinuria

24
Q

what particular renal condition shows considerable proteinuria?

A

nephrotic syndrome

25
Q

what can cause acute onset of decr renal function?

A
  • hypovolaemia secondary to blood loss, dehydration, shock
  • glomerulonephritis
    drugs affecting glomeruli/ tubules
  • rhabdomyolysis
  • obstruction of renal blood/ urine flow
26
Q

define glomerulonephritis

A

acute inflammatory process affecting glomeruli

27
Q

define rhabdomyolysis

A

massive muscle breakdown

28
Q

what does decr GFR in acute renal failure (RF) lead to?

A

rapid decr of urine vol
may show anuria (no urine output) in severe cases

29
Q

how does acute renal failure (RF) affect waste prods

A

incr in waste prods e.g plasma urea + plasma creatinine

30
Q

how does acute RF affect electrolytes

A

incr in electrolytes e.g plasma K+ + plasma phosphate

31
Q

how does acute RF affect acids

A

incr as kidneys are not excreting them

32
Q

how does acute RF affect plasma Na+

A

incr/ decr/ normal dpending on cause
usually decr due to H2O retention making plasma more dilute

33
Q

muscle test determined based on quantity of which enzyme

A

creatine kinase

34
Q

what can be present in urine indicating acute RF that is usually absent

A

myoglobin (toxic to kidneys)

35
Q

creatine kinase high or low in acute RF + why

A

high bc leaks out into blood when skeletal tissue damaged

36
Q

define chronic renal failure (CRF)/ chronic kidney disease (CKD)

A

GRADUAL decline of renal function over yrs

37
Q

causes of CRF/ CDK

A
  • diabetes (diabetic nephropathy)
  • hypertension
  • diseases affecting glomeruli/ tubules/ interstitium
38
Q

abnormal if eGFR is

A

<60ml/ min

39
Q

abnormal value range of GFR

A

60-90 w other features of CDK

40
Q

why is creatinine not a good marker for CDK

A

only starts rising when >70% of renal function has been lost

41
Q

how does CDK affect waste prods

A

incr in them:
- plasma urea
- plasma creatinine

42
Q

how does CDK affect electrolytes

A

incr plasma K+ (late on)
incr plasma phosphate (late on)

43
Q

what happens to plasma Ca+ in CDK + why

A

normal or decr due to decr active vit D prod

44
Q

what hormones affect Na+, H2O & K+

A

adrenals: renin/ angiotensin/ aldosterone axis

45
Q

what hormone only affects H2O

A

post pit: ADH/ AVP

46
Q

define hyponatraemia

A

[Na+] in your blood is abnormally low and/ or excess H2O

47
Q

why is hyponatraemia important

A

can dilute conc of ions a lot

48
Q

define hypernatraemia

A

incr [Na+]
usually due to loss of H2O
rarely bc excess Na+

49
Q

why is hypernatremia important

A

water drawn out of cells by osmosis, cells get smaller

50
Q

acidosis usually associated w incr or decr serum K+?

A

incr

51
Q

alkalosis usually associated w incr or decr serum K+?

A

decr

52
Q

value for hyperkalaemia

A

plasma K+ >5.5 mmol/L

53
Q

causes of hyperkalaemia

A
  • artefacts: haemolysis, cold weather, delayed sample processing, high platelets
  • incr intake of K+
  • incr renal reabsorption
  • decr loss e.g. chronic/ acute RF
54
Q

why is hyperkalaemia important

A

changes to heart rhythm (arrhythmia)

55
Q

value for hypokalaemia

A

plasma K+ < 3.5 mmol/L

56
Q

causes of hypokalaemia

A
  • artefacts: hot weather during blood storage
  • decr intake of K+
  • decr renal reabsorption
  • incr loss: vomiting/ diarrhoea / kidneys
57
Q

why is hypokalaemia important

A

changes to heart rhythm (arrhythmia)
muscle weakness

Clinical Biomedicine (23 decks)

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