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26 Cards in this Set
- Front
- Back
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) |
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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
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What are the 3 mechanisms of oedema |
Increased hydrostatic pressure Reduced COP Lymphatic blockage. |
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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 |
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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 |
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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 |
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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 |
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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) |
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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 |
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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. |
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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 |
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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 |
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What is level of normal and oliguric urine production |
Normal 1-2ml/kg/h, oliguric <1 ml/kg/h |
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What are the indications for dialysis |
Severe metabolic acidosis, hyperkalaemia, dialyzable toxins eg ethylene glycol, volume overload unresponsive to diuretics, persistent oliguria, progressive azotaemia . |
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Define dialysis |
Moving waste solutes and water across a semipermeable membrane according to their concentration gradient |
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What are the different kinds of dialysis |
Carporeal = peritoneal dialysis Extra-carporeal = intermittent haemodialysis or continuous renal replacement therapy |
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What is the key to early treatment of AKI |
Recognition of risk factors |
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How is cylindriuria detected |
With in-house urinalysis - they dissolve rapidly in stored urine |
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What is the cut off for glucosuria being caused by hyperglycaemia |
Glucosuria shouldn't occur at BG < 10 in dogs and < 16 in cats |
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What are the crystals you get in ethylene glycol toxicity |
Calcium oxalate |
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What test can you not use reliably when a patient is on colloids |
USG - colloids increase USG |
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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. |
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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 |
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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 |
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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 |
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Factors affecting USG |
Kidney function Protein and glucosuria Colloids Hydration and renal blood flow |