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Medicine Notes Renal System Notes

Chronic Kidney Disease Notes

Updated Chronic Kidney Disease Notes

Renal System Notes

Renal System

Approximately 31 pages

These notes helped me achieve a mark of 78% in my renal system exam, which is the equivalent of a 1st. The notes are based on a series of lectures on the subject. This is a very good, thorough and in depth review of the nervous system. They are very clearly laid out and easy to follow. They cut out unnecessary information on the topic, making the notes very concise, and fast to get through. Anyone studying medicine, or any other subject requiring knowledge of the renal system (e.g. physiology or ...

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Lecture 17

Chronic Kidney Disease

  • Definition

    • Renal failure

      • In essence

        • Decreased renal excretory function

        • Decreased GFR

        • Raised serum creatinine and urea

      • Chronic or acute

      • Chronic= weeks or months, often IRREVERSIBLE

      • Acute= days or weeks, maybe/often REVERSIBLE

    • Chronic Kidney Disease

      • Evidence of structural or functional kidney abnormalities (abnormal urinalysis, imaging studies, or histology)

      • Persist for >3/12 months

      • Decreased GFR

      • Most common manifestation of damage is persistent albuminuria

      • Failure of

        • Glomerular filtration

        • Tubular handling of solute

        • Erythropoietin production

        • Activation of vitamin D

        • Blood pressure regulation

  • Classification

    • Numbered 1-5 (5=most severe)

    • Works on GFR function

    • 1= kidney damage with normal or increased GFR

    • 5=Established renal failure, GFR <15

  • Symptoms and signs

    • Symptoms

      • Often asymptomatic

      • Vague (nausea, loss of appetite, itching etc.)

      • Fluid overload (swelling, SOB)

      • Anaemia (tired, SOB, angina)

      • Urinary symptoms (nocturia, frequency)

      • Symptoms related to underlying disease

    • Clinical signs

      • Often non-specific

      • Skin (pallor, pruritus marks, rashes)

      • CV (high BP, raised JVP, 3rd heart sound, pericardial rub, peripheral oedema)

      • Respiratory (Tachypnoea, crepitations)

      • Abdominal (ascites, scars)

  • Causes

    • PRE-RENAL

      • Usually to do with blood supply

      • Decreased CO

      • Renovascular occlusion (renal artery stenosis, aortic aneurysm/dissection)

      • Impaired renal autoregulation (NSAIDs, cyclosporin, ACEis)

    • INTRA-RENAL

      • Glomerular damage

        • Glomerulonephritis (lots of types; blood & protein in urine)

        • Vasculitis (inflammation and destruction of BVs)

        • Diabetes

      • Tubular damage

        • Reflux nephropathy (valves do not work; childhood)

        • Drug induced (analgesics, others, herb medicines)

  • Detection

    • Urine

      • Urinalysis

        • Blood (Haematuria)

        • Protein

        • Nitrates/leucocytes

      • Proteinuria quantification

    • Blood

      • Urea

      • Creatinine

    • Estimating GFR

      • Inulin clearance (rarely used)

      • Isotope clearance rate from plasma (uncommon)

      • Creatine clearance rate

  • Effects

    • Decreased GFR

      • Increased “waste products in blood”

      • Anorexia (too much...

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