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Flashcards in Normal functions of the kidneys Deck (21)
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1
Q

What are the 5 functions of the kidneys?

SwwABED

A
Excretion of salt, water, and waste products of metabolism
Regulate acid - base
Regulate BP
Produce erythropoetin, activates Vit D
Excrete drugs / metabolites
2
Q

How do we measure excretory renal function?

A

1) PLASMA / SERUM CREATININE - but this is related to muscle mass. It may not be elevated above normal range until 50% GFR lost.
2) ESTIMATED GFR :MDRD FORMULA
3) CREATININE CLEARANCE
4) ISOTOPE GFR

3
Q

How does serum creatinine (Scr) relate to GFR?

A

If Scr is high but eGFR is low then kidney failure

If Scr high because of high muscle then need high eGFR too

4
Q

What is normal rate of eGFR?

A

60 - 100 but only need 10 to live so large reserve

5
Q

What is creatinine?

A

A waste product of muscle metabolism. It will increase or decrease depending on the efficiency of the kidney

6
Q

What does protein in the urine indicate?

A

Leakage of kidney filters - glomerula disease

7
Q

What are the two types of renal failure?

A

Acute and chronic:
Acute kidney injury (AKI)
Chronic kidney disease (CKD)

8
Q

What is AKI?

A

Acute kidney injury - a rapid loss of renal excretory function. Implies reversibility if underlying condition is treated

9
Q

What is CKD?

A

Chronic kidney disease - slow progressive loss of excretory renal function. Cause often unknown, usually irreversible and so management is aimed at slowing the progression

10
Q

What are the causes of pre renal AKI? (before the kidney)

A

Salt and water loss (diarrhoea/vomit/diuretics)
Haemorrhage
Hypotension
Renovascular disease

11
Q

What are the causes of renal AKI?

A

Tubular necrosis
Interstitial nephritis
Acute glomerulonephritis

12
Q

What are the toxic substances that cause AKI?

A
Antibiotics
Radiographic contrast media
Chemo agents
Rhabdomyolysis
Intravascular haemolysis
Tumour lysis
Solvents
Hepatorenal syndrome
13
Q

What is a hepatonephrotic kidney?

A

The collecting system dilates, increasing the pressure

Occurs from an obstruction of ureter or bladder

14
Q

What are the causes of post renal AKI? (after the kidney)

A

Obstruction to outflow from one / both kidneys

15
Q

What are the causes of CKD?

A
Diabetic nephropathy
Genetic - polycystic kidney disease
Vascular disease
Chronic glomerulonephritis
Chronic outflow urinary obstruction
16
Q

How is CKD classified?

A

5 stages:
1 = normal kidney funtion with some other evidence of disease
5 = eGFR

17
Q

What are the consequences of renal failure?

A

Accumulation of K+, urea, creatinine, H+, water,
Deficiency of erythropoetin (anaemia) and Vit D (hyperPTH)
Delayed drug excretion

18
Q

What is renal replacement therapy?

A
erythropoetin
VIt D
sodium bicarbonate
Dialysis and transplant (to clean blood)
Anticoagulants - heparin, warfarin and aspirin
19
Q

What are the general consequences of immunosuppression?

A

Infection
Viral transmission with transplant
Malignancy

20
Q

What effects do cyclosporins have?

anti-rejection drug for transplants

A

nephrotoxicity
tremor
hirsuitism
gingival hypertrophy

21
Q

What drug interactions involve cyclosporins?

A

Cyclosporins +: macrolides, diltiazem, enzyme inhibitors