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Summary Renal Revision Posters
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Revision posters for Renal Diseases
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By: physician786 • 6 year ago
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Anatomy Endocrine Func1onKidneys = paired organs; L 11-14cm x W5-6cm x D3-4cm; each weighs 150g. Lie retroperitoneally, either Renin Angiotensin System
side of vertebral column at level of T12 - L3. Right kidney lies 1.5cm lower than leK (due to liver). Move Juxtaglomerular apparatus (JGA): specialised arteriolar smooth muscl
with respiraOon - downwards (3cm) with inspiraOon and upwards with expiraOon. Renal parenchyma: secrete renin, which converts angiotensin to angiotensin I. Renin relea
outer cortex and inner medulla. Nephron - funcOonal unit of kidney; nephron = glomerulus + PT + LoH + afferent arteriole; sympatheOc tone; chloride and osmoOc concentraO
distal tubule + collecOng duct and local PG release. ACE then converts Angiotensin I to Angiotensin I
Renal capsule and ureters innervated by T10-12 and L1 nerve roots. aldosterone release by the adrenal cortex and regulates intrarenal blo
Blood supply: renal arteries - branches of abdo aorta. MulOple renal artery branches within kidney: 3 triggers that cause JG cells to secrete renin: drop in BP; decrease in
interlobar As, arcuate As, interlobular As. Afferent glomerular arterioles arise from interlobular As, potassium levels. When Renin is secreted, it acOvates angiotensinoge
supplying the glomerular capillary bed, drains via efferent glomerular arterioles. These drain into Aas in angiotensinogen. ACE cleaves off last 2 Aas of angiotensinogen
peritubular capillary network, which drain into renal vein. Blood from juxtamedullary glomeruli passes blood stream - it specifically acOvates adrenal cortex to secrete aldost
via vasa recta in medulla. Venous blood ulOmately drains into IVC. LeK renal vein longer (therefore (adrenoandrogen, glucocorOcosteroids and mineralcorOcosteroids.)
used more commonly for live donor transplant nephrectomy). NB: glucocorOcosteroid release (corOsol) controlled by ACTH, mineral
RAAs. Aldosterone released from adrenal cortex (due to Ag-2) will affe
excreOon; Potassium in blood stream excreted into urine (to be elimin
Physiology level is too high (one of the 3 original triggers!). When K+ is too high,
GFR: Healthy individuals: GFR remains rel constant - infrarenal regulatory mechanism. Disease: GFR out. 2) Increase salt retenOon: Aldosterone causes kidneys to retain sa
falls when reduced intrarenal blood flow/ damage to or loss of glomeruli/ obstrucOon along renal levels. 3) Increase water retenOon: together with increased salt reten
tubule à reduced ability to eliminate waste products and inability to regulate body fluid volume and vessels. This is not like ADH. ADH causes you to retain ONLY water to
composiOon. Results clinically as: inc blood urea, inc plasma creaOnine, reduced GFR. salt and water- retaining isotonic fluid: expand blood volume, raises b
GFR measurement: inulin clearance/ creaOnine clearance. for the drop in BP.
Tubular Func1on and Tests: Tubular funcOon: selecOve reabsorpOon/ excreOon of water and Hyperaldosteronism: too much aldosterone. à renal hypertension du
electrolytes leads to hypervolemia, hypernaremia and hypokalemia. This is a prob
Proximal tubular tests (x5): Hypokalaemia (PT failure of K+ reabsorpOon; thiazide diureOcs; Hypoaldosteronism: aldosterone deficiency is fatal as fail to retain sa
hyperaldosteronism); Hypophosphataemia (PT abnormality; gut phosphorous binders; primary à hyponatremia, hypovalemia and hyperkalemia à depolarizaOon o
hyperparathyroidism); glycosuria in absence of hyperglycaemia; generalised aminoaciduria; proteins muscle cells and ulOmately fibrillaOon of the heart à death. By retain
derived from tubular cells (B2-microglobulin). drops and blood pressure drops = circulatory shock.
Distal tubular tests (x2): measure urinary concentraOng capacity in response to water deprivaOon, Endothelins
measure urinary acidificaOon. Endothelins (ET1, ET2, ET3) = potent vasoacOve pepOdes; influence ce
transport; don’t circulate - act locally. Intrarenal ET1 increases in acut
Erythropoie1n
Renal Imaging ErythropoieOn = glycoprotein produced principally by fibroblast-like c
Plain X-ray: plain radiograph of abdomen always taken prior to urography; idenOfy renal calcificaOon or erythropoeisis. Loss of renal substance - reduced EPO producOon: Nor
radiodense calculi in kidney, renal pelvis, line of ureters or bladder. Increased EPO producOon, polycythemia: polycysOc renal disease, ben
Excre1on Urography (aka Intravenous Urography IVU or Intravenous Pyelography IVP): role in renal Renal failure: biosyntheOc, recombinant human erythropoieOn
dg, esp in those with haematuria and stone disease; in part replaced by ultrasonography. Plain X-ray for Prostaglandins
urinary tract calcificaOon. PGs (PGE2, PGF2, PGD2, prostacyclin, thromboxane A2): unsaturated
Ultrasonography: Advantages over X-ray: avoid using radiaOon and IV contrast medium. Method of membrane phospholipids. Important in maintenance of renal blood fl
choice for: renal measurement; checking for pelvicalyceal dilaOon as indicaOon of chronic renal Kalikrein-Kinin System
obstrucOon (if suspect acute renal obstrucOon - IVU or unenhanced spiral CT); characterising renal Not understood fully; role in maintenance of renal blood flow, salt an
masses as cysOc/solid; diagnosing polycysOc kidney disease; detecOng infrarenal/perinephric fluid (pus/ VitD metabolism
blood); demonstraOng renal arterial perfusion/ detecOng renal vein thrombosis (using Doppler Vit D iniOally hydroxylated in liver, then again by 1-a-hydroxylase in ki
techniques). Used to measure bladder wall thickness/ check for bladder tumours and stones. Kidney disease: reduced 1-a-hydroxylase acOvity and reduced acOve v
Disadvantages: doesn’t show detailed pelvicalyceal anatomy or fully visualise the normal adult ureter; absorpOon in GIT and impaired bone mineralisaOon. This can result in
may miss small renal calculi; does not detect majority of ureteric calculi; operator-dependent. hyperparathyroidism (as parathyroid tries to compensate)
Computed Tomography (CT): second line imaging method of urinary tract; first line method for Protein and Polypep1de metabolism
suspected ureteric colic. Spiral technology enables collecOon of images from volume of Ossue rather Kidney = major site of catabolism of many small MW proteins and pol
than slice by slice. Used: characterise renal masses which are indeterminate at ultrasonography; stage calcitonin). Renal failure: catabolism of these substances is reduced an
renal tumours; detect lucent calculi (low-density; lucent on plain film); evaluate retroperitoneum for diabeOcs require less insulin if renal funcOon reduced).
tumours/retroperitoneal fibrosis and other causes of ureteric obstrucOon; assess severe renal trauma;
visualise renal arteries and veins; stage bladder and prostate tumours
Magne1c Resonance Imaging (MRI): second-line; used to characterise renal masses not characterised Urine
by CT; to stage renal, prostate and bladder cancer; demonstrate the renal arteries Appearance: Overt ‘bloody’ urine or very concentrated: dark/smoky.
Antegrade Pyelography: percutaneous puncture of pelvicalyceal system with a needle; injecOon of haemoglobinuria, drugs (Rifampicin), fluorescein, methylthioninium c
contrast medium - outlines pelvicalyceal system and ureter to find obstrucOon DiscolouraOon following standing for some Ome: porphyria, alkaptonu
Retrograde Pyelography: following cystography, catheter impacted in ureteral orifice/passed a short If frequency/dysuria, crystal-clear urine: absence of significant bacteri
distance up ureter and contrast medium injected. Mainly used to invesOgate lesions of ureter and Volume: Determined by diet/ fluid intake; 800-2500mL/24 hours. Vol
ureteral obstrucOon; commonly requires anaesthesia; may result in infecOon. protein and salt. Inc urine vol (&fluid intake): high-salt, high-protein in
Mictura1ng Cystourethrography: inv catheterisaOon and installaOon of contrast medium into bladder; physiological (hypotension/hypovolaemia) or due to intrinsic renal dis
used primarily in children with recurrent infecOons/ adults with disturbed bladder funcOon. NOT no urinary excreOon: urinary tract obstrucOon unOl proved otherwise
appropriate in females with recurrent UTIs: risk of vesicoureteric reflux and UTIs causing renal scarring persistent, large inc in UO; commonly associated with nocturia. Due to
and calyceal distorOon. of solute (hypergylcaemia/glycosuria)/ defecOve renal concentraOng a
Aortography/renal Arteriography: Gold standard method of renal artery imaging, but also now use MR Specific gravity and osmolality: Urine specific gravity: weight of disso
angiography and spiral CT angiography. Venography occasionally used to exclude renal V thrombosis. number of dissolved parOcles. Only req measurements of gravity/osm
Renal Scin1graphy: Dynamic studies: funcOon of kidney examined serially over period of Ome invesOgaOng polyuria/ inappropriate ADH secreOon. Urinary pH: Mea
Can be used to invesOgate renal A stenosis (which may cause HTN) or severe oliguria if renal perfusion acidosis.
is suspected to be altered. Unilateral renal stenosis: slowed and reduced uptake of tracer with delay in Chemical (S1x) tes1ng: RouOne screening of urine for blood, sugar, pr
reaching peak; use renographic assessment to decide if conservaOve surgery/nephrectomy. At end of those suspected with kidney disease
dynamic studies, invesOgate bladder emptying/ measure postmicturiOon residual vol. Measure GFR Blood: haematuria = macroscopic/microscopic; SOx tests very sensiOv
StaOc studies: inv imaging of tracer which is taken up and retained by renal tubule. sensiOve - posiOve tests in healthy individuals); Overt bleeding from u
Used to study: rel renal funcOon; kidney visualizaOon (i.e. to idenOfy ectopic kidneys or pseduotumours followed by clear urine; blood diffusely present throughout urinaOon:
of the kidneys); localisaOon of infecOon micturiOon: prostate/bladder base
Transcutaneous Renal Biopsy: carried out under US guidance. IndicaOons: nephroOc syndrome, Protein: proteinuria = common sign of renal disease; always req furth
unexplained renal failure with normal-sized kidneys, failure to recovered from assumed reversible ARF; proteinuria present on dipsOck tesOng which typically disappears a co
systemic disease with renal inv (sarcoidosis, amyloidosis), asymptomaOc proteinuria/haematuria dipsOck first thing in morning, posiOve subsequent dipsOcks (normally
C/I: uncooperaOve pt; single kidney; haemorrhagic disorders; gross obesity/oedema; uncontrolled HTN Microalbuminuria: albumin of normal size and weight; albumin excre
ComplicaOons: macroscopic haematuria (about 20%); pain in flank, someOmes referred to shoulder Op; 24hours); microalbuminuria detected by dipsOcks if >100mg/L (150mg
AV aneurysm formaOon (about 20%- almost always no clinical significance); profuse haematuria) excreOon = early indicator of diabeOc glomerular disease; can predict
demanding blood transfusion (1-3%) or b) demanding occlusion of bleeding vessel at angiography/ Glucose: posiOve test requires exclusion of DM.
nephrectomy (1 in 400); introducOon of infecOon; mortality (0.1%). Bacteriuria: tests detect nitrite (produced by reducOon of urinary nitr
(enzyme specific for neutrophils); posiOve tests - predict UTI.
Microscopy: Carried out whenever suspect renal disease. Req mid-str
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