Renal Biochemistry - Medicine

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What hormones does the anterior pituitary release?
TSH, ACTH, GH, Prolactin, FSH and LH
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What hormones does the posterior pituitary release?
Oxytocin and ADH
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What is released from the hypothalamus to inhibit prolactin?
Dopamine
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What type of epithelium lines the proximal convoluted tubule?
Brush border cuboidal
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What type of epithelium lines the distal convoluted tubule?
Cuboidal epithelium
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What type of epithelium lines the collecting ducts?
Columnar epithelium
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How does water leave the distal tubule and collecting ducts?
It leaves passively via AQUAPORINS down the conc gradient
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At what site in the kidneys is BP change detected and how?
Juxtaglomerular apparatus, by the macula dense by detecting Na+ concentrations
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Describe the stages of the renin-aldosterone system when BP lowers
1. low BP detected by MD; 2. renin synthesised from prorenin by B blockers; 3. circulation renin -> angiotensin I; 4. angiotensin I -> angiotensin 2 via ACE; 5. aldosterone released in adrenal gland => Na+ retention = increase BP
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What is the role of ADH?
Increase water resorption
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In disease, what would be measured to indicate a decreased GFR?
increased urea and creatinine
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What is urea influenced by?
Protein intake and tissue catabolism
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What is creatinine dependent upon?
Age, muscle mass, sex
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What is investigated to measure a direct GFR?
Creatinine clearance -> UO/24hrs
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What are pre-renal causes of AKI?
hypovolaemia (haemorrhage, sepsis), pump failure
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What would happen to urea and creatinine in pre-renal causes of AKI?
increased urea, normal Cr (due to decreased renal blood flow)
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What are renal causes of AKI?
ischaemia, nephrotoxins (drugs, poisons, metals, myoglobin - trauma, paraproteins), glomerulonephritis, interstitial nephritis
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What are the post-renal causes of AKI?
BLADDER stones, tumour, prostate
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What the biochemical consequences of an AKI? And what Sx do they then produce?
1. retained Na+ -> malaise, nausea, confusion; 2. fluid overload -> cardiac failure, oedema, decreased GFR; 3. retain waste products -> acidotic; 4. increased K+
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What is a severe consequence of low plasma volume?
=> decreased renal perfusion -> low GFR => Acute tubular necrosis
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How would you treat an increase in K+?
insulin + dextrose, calcium gluconate, fluid restrict
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Describe chronic kidney disease
gradual irreversible changes in renal function
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At what stage of CKD do Sx begin?
stage 2-3
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What is there evidence of stage 2 CKD?
proteinuria
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What is Sx (and why) occur during stage 3 CKD?
bone disease due to decreased Ca2+ and decreased VitD; increased lipids; secondary increase parathyroid hormone
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What additional Sx begin during stage 4 CKD?
anaemia due to decreased EPO secretion by the kidneys; anorexia; increased phosphate
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What additional Sx begin during stage 5 CKD? And what Tx is the patient dependent on to live?
salt+water retention; acidosis/increased K+ -> DIALYSIS
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What is osteomalacia?
Softening of bones due to impaired bone metabolism primarily caused by inadequate levels of phosphate, calcium and VitD
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What is secreted by the kidneys to convert VitD into it's active bioform from calcifediol?
1 alpha hydroxylase
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What are the biochemical causes of osteomalacia?
Decrease secretion of 1-alpha-hydroxylase, decreased VitD, decreased Ca2+ gut absorption
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What causes metastatic calcification?
decreased GFR, increased plasma phosphate which causes calcium to be deposited in fissures
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What are the renal causes of osteoporosis?
Decreased GFR, metabolic acidosis, dissolved bone buffers
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How do you treat renal causes of osteoporosis?
Phosphate binders + carbonate buffers
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Describe renal tubular acidosis type 1, how is it Tx?
In the distal tubule, it is the failure to excrete H+ from the blood to the urine. As Na+ needs to be reabsorbed there is an increase in K+ exchange with Na+ instead => low serum K+. Tx = bicarb and K+
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Explain what type 2 renal tubular acidosis is
bicarb 'leaks' from the proximal tubule, so Tx is bicarb
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What is type 4 renal tubular acidosis?
there is a decrease in the renin-aldosterone system => can't excrete H+/k+ from the distal tubule
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What is the definition of glomerular filtration rate?
The quantity of glomerular filtrate formed each minute in all nephrons of both kidneys
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Define acute kidney injury
any physical, chemical, toxic or ischaemic insult causing a rise in creatinine OR fall in urine output over a timescale of hours to days
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What are the 3 Rs of AKI prevention? Explain them.
RISK - >75y/o, HTN, underlying CKD, DM, chronic liver disease,CCF, myeloma, sepsis, drugs | RECOGNITION - review results, telephoned by lab, electronic alerts | RESPONSE - fluid imbalance (resus, replace, maintain), remove/avoid nephrotoxins
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What is the normal plasma Na+ concentration?
140
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Card 2

Front

What hormones does the posterior pituitary release?

Back

Oxytocin and ADH

Card 3

Front

What is released from the hypothalamus to inhibit prolactin?

Back

Preview of the front of card 3

Card 4

Front

What type of epithelium lines the proximal convoluted tubule?

Back

Preview of the front of card 4

Card 5

Front

What type of epithelium lines the distal convoluted tubule?

Back

Preview of the front of card 5
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