Kidney Failure

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  • Created by: ftpptf
  • Created on: 19-04-19 12:15
What are the main functions of the kidney?
Excretion of nitrogenous waste. Salt, ion and water homeostasis. Secretion of erythropoietin. Secretion of renin.
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What are the main clinical renal failure syndromes?
Acute kidney injury (AKI) and Chronic kidney disease (CKD).
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What is acute kidney injury?
Abrupt deterioration of renal function.
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Is acute kidney injury common?
Yes (7% of hospital in-patients and 25% of those in critical care affected).
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What is the mortality of AKI?
Dangerous. Mortality >50% in context of multi-organ failure.
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What are the features of AKI?
Oliguria leading to anuria. Electrolyte imbalance - hyperkalemia and metabolic acidosis. Rapidly rising blood urea and creatinine.
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What is oliguria?
Production of abnormally small amounts of urine. Less then 400-500mL per 24hrs in adults.
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What is anuria?
Failure of kidneys to produce urine. Clinically defined as less then 100mL of urine in a day.
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For the diagnosis of AKI, ONE of what criteria must be met?
Serum creatinine rises by 26mmol/L from baseline value within 24 hours OR serum creatinine rises 1.5 fold from baseline value within 1 week OR urine output is <0.5ml/kg/hr for >6 consecutive hours.
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What is normal serum creatinine?
50-110μmol/L.
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What are the 3 categories of causes of AKI?
Pre-renal causation, intrinsic acute kidney disease, post-renal acute injury.
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What is pre renal causation of AKI?
Response to reduced renal perfusion reduced. Kidneys attempt to retain sodium and water (RAA activation) but renal excretory capacity is impaired.
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What are some of the causes of this pre renal causation of AKI?
Shock - e.g. bleeding, burns, sepsis. Cardiac failure.
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How is pre renal causation of AKI treated?
By increasing perfusion pressure.
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What are the 3 categories of intrinsic acute kidney disease?
Glomerular, vascular, tubulo-interstitial.
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Give an example of a tubulo-interstital cause of kidney failure.
Acute tubular necrosis.
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What do tubular epithelial cells have high demands for?
Oxygen.
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What causes less oxygenated blood to get through to the tubules?
Central perfusion failure.
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What does this cause to happen to tubular epithelial cells?
They die and the function of tubular epithelial cells ceases.
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What does this cessation of tubular epithelial cells cause?
No ion, salt and water pumping taking place so kidneys swell.
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If corrected, pre-renal causation is .......... otherwise it goes on to ........ .
reversible, ATN.
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Can you recover from ATN?
Yes.
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How does recovery from ATN occur?
Necrotic tubules eliminated. Tubules become repopulated with epithelial cells from stem cells. Regain normal homeostatic control of ion, salt and water balance.
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Give an example of glomerular cause of kidney failure.
Glomerular disease - glomerulonephritis.
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What is glomerulonephritis?
Immune-complex mediated disease of glomeruli.
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Some glomerulonephritis are rapidly ........., some are ....... ............ and some are linked to ............ .
progressive, post infective, vasculitis.
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Give 3 examples of vascular causes of AKI.
Vasculitis, DIC (disseminated intravascular coagulation), malignant hypertension.
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What is vasculitis?
Immune-mediated inflammation and destruction of small vessels.
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What is disseminated intravascular coagulation?
Condition in which blood clots form throughout the body, blocking small blood vessels.
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What is malignant hypertension?
Extremely high blood pressure that develops rapidly and can cause organ damage.
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What can cause tubulo-interstitial disease?
Nephrotoxins (including drugs) or immune-mediated.
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What is lost if the tubule is lost?
The whole nephron.
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What can cause post-renal AKI?
Acute obstruction of lower urinary tract.
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What could cause this obstruction?
Prostate (male) and ureters (male and female).
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What parts of the ureter can become blocked and how?
Lumen - stone. Wall - tumour or inflammation. Extrinsic - mass (e.g. tumour).
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What can CKD progress to?
End-stage kidney disease.
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What does end-stage kidney disease require, in terms of treatment?
Dialysis and/or renal transplantation.
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What is the term for this type of treatment?
Renal replacement therapy.
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What is chronic renal failure?
Slowly progressive and irreversible loss of renal function due to irreversible destruction of large numbers of nephrons.
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Why does CKD cause gradual deterioration over many years?
Have large reserve capacity of nephrons.
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When do symptoms of CKD appear?
When compensation fails.
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What are the features of CKD?
Insidious onset with variable symptoms. Polyuria (conc. failure). Malaise, lethargy. Increasing uraemia, confusion and eventual coma. Electrolyte imbalance, Na+ and water retention, hypertension.
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How many stages are there of CKD?
1-5 with a 3a and 3b.
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What is stage 1 of CKD?
Kidney damage with normal or increased eGFR.
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What is stage 2 of CKD?
Kidney damage with a mild reduction in eGFR.
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What is stage 3 of CKD?
Moderate decrease in eGFR.
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What is stage 4 of CKD?
Severe decrease in eGFR.
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What is stage 5 of CKD?
Kidney failure.
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What is kidney damage defined as?
Pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies.
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What are some of the initiating/predisposing factors to CKD?
Age, family history, primary renal disease, nephrotoxins (includes some drugs), diabetes mellitus, urinary infection/obstruction, cardiovascular disease.
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What are some of the perpetuating factors of CKD?
Hypertension, proteinuria, obesity, anaemia, nephrotoxins, cardiovascular disease, smoking.
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What are some of the causes of CKD?
Diabetic kidney disease, congenital kidney diseases (e.g. polycystic), immunological damage to all glomeruli (glomerulonephritis), chronic renal reflux, infection (Hep B, Hep C, Malaria, TB, HIV).
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Give 2 examples of glomerular disease causing CKD.
Diabetic glomerular disease. Membranous glomerulonephritis (less common).
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What is membranous glomerulonephritis?
An immunologically mediated thickening of glomerular basement membrane.
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What can kidney failure due to nephrotic syndrome cause? (symptom wise)
Albuminuria, hypoalbuminaemia, oedema (usually peripheral, hands and feet).
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Other cards in this set

Card 2

Front

What are the main clinical renal failure syndromes?

Back

Acute kidney injury (AKI) and Chronic kidney disease (CKD).

Card 3

Front

What is acute kidney injury?

Back

Preview of the front of card 3

Card 4

Front

Is acute kidney injury common?

Back

Preview of the front of card 4

Card 5

Front

What is the mortality of AKI?

Back

Preview of the front of card 5
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