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28 Cards in this Set
- Front
- Back
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What are some common causes of chronic renal failure?
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* Glomerulonephritis
* Diabetes * Polycystic renal disease * Reflux renal disease * HT * Analgesics (Bex) & other nephrotoxic drugs * Obstructive nephropathy |
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What are some important measures in screening/preventing renal disease?
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* Early detection & control of HT & diabetes
* Early detection of clinical rapidly progressive glomerulonephritis (RPGN) |
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What mechanisms kick in after renal function drops below 35% that ensure progression of renal impairment? What can we do to minimise the effects of these processes?
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* Increase in intrarenal vascular resistance
* Glomerular HT * Tubular cell injury * Hypertrophy * Progressive interstitial inflammation and fibrosis We can give Angiotensin II receptor blockers and ACE inhibitors, which reduce HT & have a renoprotective effect. |
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What factors affect uraemic symptoms in a patient with CRF?
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* Dietary intake
* Residual CRF * Length of time CRF has been present |
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Why does being uraemic make you feel so sick?
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* Toxic metaolites (products of protein & amino acid metabolism, including urea, guanido compounds & acidosis), nitrogenous compounds
* Impaired metabolism causing disorders of ion transport, lipid, protein & amino acid metabolism * Impaired glucose tolerance (peripheral insulin reistance) * Increased protein catabolism |
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What dietary recommendations can you make to improve the life of someone with CRF?
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Restricted dietary protein - extremely effective. Incidentally reduces intake of Na, K, phosphates, sulfates & acids as food rich in proteins contain high amounts of these compounds.
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By what mechanisms can kidney failure cause heart disease?
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* Fluid retention
* Anaemia * Secondary hyperparathyroidism * Metastatic vascular calcification * Hyperlipidaemia * Presence of AV fistula in dialysis patients. |
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What cardiovascular abnormalities may be seen in patients with CRF?
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* HT
* Ischaemic heart disease * LV hypertrophy * Pericarditis * Valvular heart disease. |
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What are some of the gastrointestinal effects of CRF?
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* Anorexia, nausea & vomiting (uraemia)
* Weight loss & malnutrition (due to restricted diet) * Peptic ulceration |
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What are some of the haematological effects of uraemia?
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* Decrease in erythropoietin leads to decrease in production of RBCs leading to anaemia
* Iron & folate deficiency, * occult bleeding and * Shorted RBC survival * Abnormal platelet function - bleeding, leading to widespread ecchymoses and purpura. |
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What effects does CRF have on bones?
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Abnormalities in Vit D metabolism as well as calcium & phosphate homeostasis lead to:
* Secondary hyperparathyroidism (associated with itchiness) * Osteodystrophy |
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What are some of the behavioural signs of uraemia?
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* Apathy
* Restlessness * Altered sleep patterns Due to central encephalopahy. Can progress to stupor and coma. |
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What are some of the neurological signs associated with uraemia?
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* Asterixis
* Twitching & fasciculations * Convulsions * Mixed motor and sensory peripheral neuropathy (restless legs, burning feet, paraesthesia, weakness, autonomic neuropathy). |
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What are some of the general effects of CRF on growth, immune system and thyroid & sexual function?
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* Impaired immune response
* Retarded growth in children * Sexual dysfunction * Thyroid dysfunction |
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If the normal glomerular architecture is disrupted, what happens to
a. filtration of toxins b. filtration of blood cells c. filtration of plasma proteins? |
There is
a. loss of filtration surface area, impairing the ability to filter out toxins b. excessive filtration of RBCs, leading to haematuria c. Inavertent filtration of plasma proteins |
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In IgA nephropathy, is the immune response an antigen-specific one?
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NO - circulating IgA could be directed at multiple different antigens.
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What are some infections you should test for when a patient is suspected to have glomerulonehpritis?
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1. Hep B & C;
2. Streptococcus 3. Autoantibodies 4. Circulating immune complexes 5. Depletion of complement levels in serum (as it is activated, and deposited) 6. Ig & complement deposition within glomerulus |
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What is the name of the one disease caused by DIRECT antibody mediated damage to the glomerulus?
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Goodpasture's Disease (also known as anti-glomerular basement membrane disease).
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How is Goodpasture's treated?
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The plasma is cleaned of IgG antibodies directed at the GBM using plasmaphoresis.
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In Goodpasture's disease, what is the target of circulating IgG?
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A collagen epitope in the GBM.
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How does immune complex wind up being deposited in the kidney?
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Either the antigen is trapped in the glomerulus following filtration ('planted antigens'), or there is deposition of antibody complexes within the glomerular capillaries, as in lupus.
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How do you treat immune complex nephropathy?
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Remove the antigen if possible, and reduce antibody production with immunosuppressive treatment.
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How does IgA nephropathy occur?
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IgA normally circulates, however mucosal antigen stimulation (e.g. bacteria, viruses) can lead to higher levels circulating in the blood. Where there is a high propensity for mesangial deposition of IgA, nephropathy occurs.
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How does Wegener's granulomatosis cause kidney damage & how is it treated?
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Injury due to damage to extraglomerular blood vessels, or glomerular capillaries. Treated with immunosuppressive medication.
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When does nephrotic syndrome occur, and what is its major symptom?
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When proteinuria is severe enough to cause hypoalbuminaemia which leads to OEDEMA (usually occurs when patient is losing >3g/day of protein in urine).
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What is the main cause of nephrotic syndrome in children?
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* Minimal lesion disease
* Focal sclerosing glomerulonephritis |
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What is the main cause of nephrotic syndrome in adults?
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* Membranous glomerulonehpritis
* Focal sclerosing glomerulonephritis (can be primary or secondary, e.g. due to vasculitis) |
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Where is albumin made?
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In the liver.
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