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26 Cards in this Set

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What are the two barriers to filtration at the glomerulus

Size of endothelial pores and epithelial (podocyte) filtration slits


Negative charges in filtration membrane repelling negative molecules (most plasma proteins are -ve)

How does capillary HSP work

High pressure at the start and lower at the end, so at the start the HSP moves fluid int othe interstitium, to deliver oxygen and nutrients, and at the venous end the oncototic (plasma proteins esp albumin) pressure brings water back again, along with wastes


What are the 3 mechanisms of oedema

Increased hydrostatic pressure


Reduced COP


Lymphatic blockage.

Why do kidney disease patients have lipiduria

In proteinuria, the liver increases protein synthesis which also increases lipoprotein synthesis which then leaks into the urine

Why do kidney disease patients get anaemia (aside from anaemia of chronic disease and EPO)

Transferrin, which is involved in iron transport, is lost in urine so get iron deficiency anaemia

What are two reasons that kidney disease patients are prothrombotic

Are haemoconcentrated so blood flow is slow


Antithrombin III protein is lost in urine forming procoagulant state

How do you differentiate glomerular haematuria from e.g. bladder haematuria - 2

The RBCs are irregularly shaped in glomerular haematuria from squeezing through the filtering mechanism.


Also the RBCs can get stuck in the tubule and get smushed together to form a plug that when it is pushed out by the buildup of pressure is a RBC cast

Why do renal patients get oliguric

Because of trouble passing blood through the diseased glomerular afferent/efferent artery so reduced GFR (this also causes strong stimulation of RAAS developing hypertension)

How can you get more cells and less cells at the glomerulus

If you have severe glomerular disease with fibrin lost into bowmans capsule this acts as an epithelial cell growth product and attracts more fibrin so the whole thing ends up full of cells.


If you have a chronic kidney disease, fibroblasts will form collagen in the glomerulus causing irreversible shrinking damage

How is body water distributed

The body is 60% water (60% body mass)


2/3 of this is intracellular (40% body mass), 1/3 is extracellular (20% body mass)


Of the extracellular third : 3/4 (15% body mass) is interstitial (between and around cells) and 1/4 (5% body mass) is in vascular space.

What are some biomarkers that can be used for early ID of kidney injury before azotaemia

Research/clinical trials : kidney injury molecule-1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL).


Also proteinuria, glucosuria, urinary casts

What are some common causes of renal renal AKI

Lepto (dogs), pyelonephritis, extension of post renal disease, neoplasia esp lymphoma, extension of systemic condition eg sepsis, toxins cephalosporins NSAIDs, lilies in cats, ethylene glycol, raisins/grapes in dogs

What is level of normal and oliguric urine production

Normal 1-2ml/kg/h, oliguric <1 ml/kg/h

What are the indications for dialysis

Severe metabolic acidosis, hyperkalaemia, dialyzable toxins eg ethylene glycol, volume overload unresponsive to diuretics, persistent oliguria, progressive azotaemia .

Define dialysis

Moving waste solutes and water across a semipermeable membrane according to their concentration gradient

What are the different kinds of dialysis

Carporeal = peritoneal dialysis


Extra-carporeal = intermittent haemodialysis or continuous renal replacement therapy

What is the key to early treatment of AKI

Recognition of risk factors

How is cylindriuria detected

With in-house urinalysis - they dissolve rapidly in stored urine

What is the cut off for glucosuria being caused by hyperglycaemia

Glucosuria shouldn't occur at BG < 10 in dogs and < 16 in cats

What are the crystals you get in ethylene glycol toxicity

Calcium oxalate

What test can you not use reliably when a patient is on colloids

USG - colloids increase USG

When calculating fluid ins from IV / oral fluids, and fluid outs from urine, what else do you need to consider

Insensible losses (respiration, GIT etc) of 1 ml/kg/h.

3 factors determining toxin dialysability

Size - close to pore size in the filter, the less likely they are to filter


Have to be non-protein bound


Distribution - dialysis will only remove what is in the vasculature

What is the prognosis for an AKI patient

50% mortality


25% survive but have CKD


25% survive without CKD


Highly variable by aetilogy - ethylene glycol 90% mortality, lepto 80% survival with early intervention

What are the USG ranges

Hyposthenuric= 1.001-1.008


Isosthenuric = 1.008-1.012


Normal 1.015-1.045 dog


Normal 1.035-1.050 cats

Factors affecting USG

Kidney function


Protein and glucosuria


Colloids


Hydration and renal blood flow