Lid edema

Calcium deposits on lid/conj

Corneal changes

Aniridia

Uveitis

ONH edema

Drusen around macula

Retinal changes

ARMD

Dry Eye

1. Remove wastes from blood

2. Remove foreign substances

3. Regulate blood composition  (water, ions, buffers etc.)

1. Absorb water and solutes from the renal tubules

2. Provide blood supply to the renal tissue

Fenestrated Endothelium

Incomplete basement membrane

Modified epithelial cells -->podocytes

Phagocytic function

Contractile capabilities

Constriction of the afferent arteriole

Release of Renin from Juxtaglomerular cells

Size of substance (ie. size of fenestrations)

Charge of substance

Configuration of substance

1. The Concentration of molecules

2. The rate of flow of the filtrate

The higher the concentration of the substance in the filtrate, the more there is for transporters to pick up, therefore the more gets absorbed.

Higher concentration=higher absorption

Faster flow reduces the time the transporters have to pick up molecules,

Faster flow=lower absorption

In the proximal tubule

66% of sodium

80% Cl and Water

50% Potassium

Explain the movement of these ions in the distal tubule:

1. Sodium/Chloride

2. Potassium

3. Calcium 

Sodium/Chloride are actively transported OUT of the tubules

Potassium is actively transported INTO the tubules (excreted) in exchange for sodium

Calcium is reabsorbed due to PTH action

Explain the movement of these substances in the collecting ducts"

1. Sodium

2. Potassium

3. Urea

1.Sodium actively reabsorbed

2. Potassium excreted by exchange with sodium

3. Urea passively reabsorbed

Aldosterone increases the activity of the sodium/potassium exchange

ADH allows water to be reabsorbed in the collecting ducts

1. Decreased blood volume

2. Increased blood osmolarity

Baroreceptors

Osmoreceptors

Na+

Mannitol

Glucose 

Endothelins

Nitric oxide gas molecules

Prostaglandins

They can cause either vasoconstriction or vasodilation, depending on agents and receptors.

However they tend to cause vasoconstriction

-More water excretion

-Helps macula densa cells provide feedback

Prevent Vasoconstriction (increasing blood flow)

Impair water reabsorption

1. Block vasopressin in collecting ducts

2. Prevent sodium reabsorption

3. Prevent potassium excretion

Renin converts angiotensinogen to angiotensin I

ACE (Angiotensin Converting Enzyme) converts Angiotensin I to Angiotensin II

1. Vasoconstrictor

2. Release of aldosterone from Adrenal Cortex

3. Increased release of Vasopressin

1. Renin release

2. Erythropoietin release

3. Calcitrol release

Converts Vitamin D to its active form (D3)

1. Regenerationof bicarbonate

2. Excretion of hydrogen ions when pH is too low

3. Excretion of bicarbonate ions when pH is too high

1. Glomerular Filtration Rate

2. Creatinine Clearance Rate

3. Serum Creatinine Levels

4. Urea (BUN) levels

5. Urinalysis

6. Serum lab tests (potassium, phosphate, Calcium, pH, bicarbonate)

7. NGAL test

Normal is 100 mL/min

<60 mL/min is indicative of disease

Calcium

pH

Bicarbonate

Cytoscopy

Ultrasound

CAT scan 

Intravenous pyelogram  (X-ray visualization)

Diabetes 

Hypertension

T/F

Kidney disease is easily caught early on before too much damage has been caused

False

Signs and symptoms only tend to appear when 80-90% of kidney function has been lost

High blood pressure

Swelling of legs

Pulmonary edema

1. Calcium sulfate and phosphate precipitate in the sweat

2. Itching

3. Yellow Discoloration

4. Odoriferous

Increased risk of Cardiovascular Death

Increased risk of stroke

Increased Endothelin

Decreased Nitric Oxide

Decreased Prostaglandin

Overall causing vasoconstriction

Headaches 

Nausea/Vomiting

Visual scotoma-sees spots

High Diastolic BP >120 mmHg

Optic Nerve Head edema

Vascular damage causes increased permability and fibrosis of the small vessels. 

The fibrosis results in narrowing of the vessels, causing ischemia.

The kidney will respond to decreased blood flow by secreting renin.

The Renin causes further vasoconstriction, worsening the problem. 

Medications-Hypersensitivity

Medications- Toxicity

NSAIDs

Radiographic contrast agents

1. Pre-existing renal insufficiency

2. Dehydration

Nephrotic syndrome

Nephritic syndrome

Membranoproliferative glomerulonephritis

Tubular Interstitial Nephropathy

Pyelonephritis

Acute Tubular Necrosis

Proteinuria

Edema

Hypoalbuminemia

Hyperlipiduria

hyperlipidemia

HTN

Diabetes

Systemic Lupus Erythematosus

NSAIDs

Membranoproliferative glomerulonephritis

1. ACE inhibitors/ ARBs -decrease GFR, improve membrane charge and size selectivity

2. Diuretics

3. Fluid/sodium restriction

4. Corticosteroids

5. Immunosuppressants

6. Prophylactic treatment of thromboembolism

Acute inflammation of the glomeruli

(Not initiated by injury like nephrotic syndrome)

Oliguria

Hematuria

Proteinuria

HTN/fluid retention

Previous streptococcus infection

Systemic Lupus Erythematosus

Subacute bacterial endocardititis

Idiopathic

Salt restriction

Diuretics/Anti-hypertensives

T/F

Majority of patients with Acute Nephritic Syndrome progress to Chronic renal failure

Membranoproliferative glomerulonephritis

-refer pt to kidney doc

Bilateral Central Clustered Drusen 

Sub Retinal Neovascular Membrane

Macular detachment

Central Serous Retinopathy

Retinal Atrophy

Fever

Weight loss

Fatigue

Fever

Dysuria

Flank/back pain

Pyuria

Fatigue

General poor feeling

Frequent Urinary Tract Infections

Progressively destroys the kidneys

Proteinuria

Microalbuminuria

Glomerular capillary basement membranes thicken

Renal Atherosclerosis

Increased susceptibility to infection -->pyelonephritis

An X-linked recessive disease that is caused by an enzyme defect that disrupts glycosphingolipid metabolism

Enzyme= alpha-galactosidase A

It causes glycolipids to accumulate within blood vessels and organs and impair function.

Corneal Whorl or Verticillata is an ocular sign of what condition?

What else can cause this?

Fabry's disease 

Can also be caused by Amiodarone and Acetaminophen

Burning sensation in the hands

Raised rash on buttocks, groin and thighs

Decreased sweat

Corneal Whorl/Verticillata (#1 sign)

Conj. vessel tortuosity

Retinal venous dilation/hemorrhage

Cataracts

Renal failure

Cardiovascular disease

Cerebrovascular disease

GI dysfunction

Measure alpha-GAL enzyme activity

Evaluate X chromosome (look for mutation)

Replace the enzyme that is not produced naturally-

-Agalsidase beta -->IV, every 2 weeks

Dehydration

Medications

Gout

Name 4 treatments of a kidney stone

1. Let it pass spontaneously, with pain meds (90%)

2. Antibiotics

3. Shockwave lithotripsy

4. Surgery if stone is large

What accounts for 80-90% of malignant tumours of the kidney?

What is the 2nd most common cause?

Renal Cell Carcinoma

2nd is Wilm's tumor

Hematuria

Dull flank pain

Palpable flank mass

Hematuria

Dull flank pain

Palpable flank mass

Long-standing fever

Elevated ESR

Other Cancer signs like weight loss/fatigue

Radiotherapy

Nephrectomy

Chemotherapy

Diuretics

Beta blockers

ACE inhibitors

Angiotensin II Receptor Blockers

Calcium channel blockers

Renin Inhibitors

ACE inhibitors

Angiotensin II Receptor Blockers

Renin Inhibitors

What is the mechanism of diuretics?

1. Thiazide

2. Loop

3. Potassium Sparing

4. Carbonic Anhydrase inhibitors

5. Osmotic diuretics

Carbonic Anhydrase inhibitors - eg. Acetazolamide

Osmotic Diuretics

Fill in the blank

Diuretics that act on the ........... portion  of the nephron are less effective than those that act on the .................. portion of the nephron

Mechanism: Na reabsorption inhibition at distal tubule

Diuretic type?

Mechanism: prevent Na, potassium and chloride reabsorption at ascending loop

Diuretic type?

Pharm flashback:

What sort of supplements should be taken by a patient on a loop diuretic?

Hemodialysis

Peritoneal Dialysis

Renal Transplant

Anemia

Ionic dysfunction

Heart dysfunction

Pulmonary edema

Infection

1. Requires less time

2. Less dietary restrictions

3. More consistent filtration

4. Residual kidney function retained longer

5. More cost efficient

1. More complex activities on the part of the patient

2. Risk of peritonitis

Corticosteroids

Calcineurin inhibitor

Anti-metabolite/Kinase inhibitor

Cataracts

Increased IOP

Disc edema

Donor kidney is placed in pelvic region

It may get most of the blood supply that was originally going to the native kidney. 

Native kidney experiences lower GFR and therefore secretes Renin

Immunosuppresive disorders

Graft rejection

Secondary hypertension

Infections

Malignancy 

Kidney transplant recipients

Aminoglycosides

Tetracyclines (except doxycycline)

In terms or prescribing:

Patient has HALF the normal kidney function so you should.................... the dosing interval