1. All things Renal Peer Support Zoulikha Zair

2. RAAS

3. Components of the RAAS Renin – Synthesised and stored in the JGA – Released in response to low BP and low NaCl in filtrate Angiotensin II – Vasoconstriction – increased PT Na + reabsorption (indirect via Aldo. in DT) – induces aldosterone production Aldosterone and Sodium Reabsorption – Aldosterone induces expression and activity of SGK (serum and glucocorticoid regulated kinase) – which causes translocation of ENaC to membrane and  expression – driving force is Na + /K + ATPase (activity also increased by aldosterone)

4. How is bp increased?

5. GFR and eGFR Glomerular filtration rate Linked to age, sex and body size – young male = 120ml/min/1.73m 2 – lower in females and decreases with age total volume filtered is ~180 l/day Regulated by constriction/dilatation of the afferent arteriole (AA) (if AA is dilated the GFR increases and hydrostatic pressure in the glomerulus  ) Estimated GFR the volume of blood plasma that isblood plasma cleared of creatinine per unit time Incorporates, age, sex and ethnicity Utilises MDRD = modification of diet in renal disease (µmol/L)

6. What is Acute Kidney Failure? A sudden (hours to weeks) decline in glomerular filtration rate marked by the accumulation of metabolic waste products with life threatening consequences.

7. Name three classifications of AKI Pre-renal - kidneys don’t receive adequate blood supply – Renal hypoperfusion – Local e.g. Renal artery stenosis, Drugs- ACE inhibitors, NSAIDs Intrinsic – Kidney tissue becomes damaged – Acute tubular injury e.g. ischaemia – Acute glomerulonephritis Post-renal – obstruction to urinary flow

9. What ic Chronic Kidney Disease? Progressive and irreversible loss of renal function over a period of years or months, resulting in the loss of both excretory and hormone functions of the kidney.

10. How is CKD Classified?

11. Diagnosis/Classification of CKD is based on eGFR plus evidence of other chronic kidney damage; – Persistent microalbuminaemia – Persistent proteinuria – Persistent haematuria after exclusion of other causes – Structural abnormalities of the kidneys shown by radiology – Biopsy proven glomerulonephritis