SBI242 Week 3 - Chronic Diseases

What is Dementia?

A broad term describing a decline in cognitive function

How is memory defined?

Retention of information, skills, or thoughts

Name the two types of memory

Short-term and Long-term Memory

What are the components of long-term memory?

Episodic, semantic, and procedural memory

Where is short-term memory stored and how long does it last?

Stored in the prefrontal cortex, lasting 15-30 seconds

Where does long-term memory reside?

Distributed throughout various brain regions, including the hippocampus, temporal lobe, and other areas

What is Long-term Potentiation (LTP)?

A persistent strengthening of synaptic connections between neurons (increased number of EPSPs)

What is the property of plasticity?

Ability to alter the anatomy and function of the brain in response to changes in its activity patterns

What are the hallmark characteristics of Alzheimer's Disease?

Death of pyramidal cells, neuritic plaques, and neurofibrillary tangles, particularly in the hippocampus, temporoparietal, and frontal cortices

What are plaques in the context of Alzheimer's Disease?

Extracellular deposits of amyloid surrounded by glial processes, abnormal nerve endings, and dendrites

What are tangles in the context of Alzheimer's Disease?

Intraneuronal structures located in the cytoplasm and consisting of bundles of filaments made of highly phosphorylated tau protein

What neurotransmitter is associated with a deficit in Alzheimer's Disease?

Acetylcholine

What inflammatory response is elicited by plaques and tangles?

Activation of microglia and release of cytokines

List the common signs and symptoms of the early stage of Alzheimer's disease.

Memory loss, confusion, difficulty with problem-solving

List the common signs and symptoms of the moderate stage of Alzheimer's disease.

Hesitant, uncertain about making decisions/actions, forgetful. Memory loss becomes more apparent, has difficulty undertaking simple tasks. Unable to meet own needs, loses inhibitions, has periods of irritability, paranoia and anxiety. Prone to wandering, particularly at night, becomes lost in familiar surroundings.

List the common signs and symptoms of the advanced stage of Alzheimer's disease.

Near-total memory loss. Loss of the ability to communicate verbally or in writing. Becomes bedridden and incontinent of urine and faeces. Does not recognise loved ones. Becomes emaciated due to lack of eating

How does pharmacological management work for Alzheimer's disease?

Increasing levels of acetylcholine and cognitive function

Name the Pharmacological Management used for Alzheimer's disease.

Donepezil, Rivastigmine & Galantamine prevents excess entry of calcium ions into brain cells and Memantine to treat depressive symptoms

What is Acute Kidney Injury (AKI)?

A sudden, sharp decline in renal function, mostly reversible

What is Chronic Kidney Disease (CKD)?

Gradual decline in renal function over time, irreversible

What are examples of systemic diseases that may cause Chronic Kidney Disease?

Hypertension, autoimmune disorders, and diabetes mellitus

What are the categories of renal diseases that might progress to CKD?

Glomerular diseases, vascular diseases, and tubulointerstitial diseases

What are defining features of Acute Glomerulonephritis?

Large inflamed glomeruli with a decreased capillary lumen

What are common clinical manifestations of Acute Glomerulonephritis?

Hematuria, proteinuria, hypertension, and edema

What are defining features of Chronic Glomerulonephritis?

Glomerular scarring and eventual loss of functioning nephrons

What is the effect of increased glomerular membrane permeability and reduced glomerular membrane surface area on GFR in Glomerulonephritis?

Increased GFR due to increased permeability, but decreased GFR due to reduced surface area typically resulting in overall decrease in GFR

What are the clinical manifestations of glomerulonephritis?

Olliguria, Hematuria, proteinuria, hypertension, edema, and renal insufficiency

What is the result of Tubular Diseases?

Impaired reabsorption and secretion, leading to electrolyte imbalances and acid-base disturbances

What is Renal Tubular Acidosis?

A group of disorders characterized by impaired renal acidification, leading to metabolic acidosis

What is a Urinary Tract Infection (UTI)?

A bacterial or fungal infection affecting the kidneys, bladder, or urethra

What are the most common pathogens in UTIs?

Escherichia coli (E. coli), Staphylococcus saprophyticus, and Klebsiella pneumoniae

What are three steps in the pathogenesis of urinary tract infection?

Colonization, uroepithelium penetration, ascension

What is pyelonephritis?

Inflammation of the kidney's renal pelvis and parenchyma

What are the most common causes of Acute Pyelonephritis?

Ascending bacterial infection from the lower urinary tract, typically due to E. coli and Proteus mirabilis

What is Chronic Pyelonephritis?

Persistent or recurring episodes of acute pyelonephritis that leads to scarring and kidney damage

What should you investigate for in cases of recurrent UTIs?

Urinary tract abnormalities (e.g., stones, obstruction), underlying medical conditions (e.g., diabetes), and behavioral factors (e.g., hygiene, sexual activity)

What is the most common cause of upper urinary tract obstruction?

Renal Calculi

What are systemic diseases that cause CKD?

Diabetes mellitus, hypertension, systemic lupus erythematosus, and vasculitis

How does chronic kidney disease affect GFR and tubular function?

Decreased GFR and impaired tubular reabsorption and secretion

What does a Glomerular Filtration Rate (GFR) of > 90 mL/min/1.73 m² indicate?

Normal kidney function or Stage 1 CKD with evidence of kidney damage

What does a GFR of <15 indicate?

Kidney failure or Stage 5 Chronic Kidney Disease (CKD)

What substance's clearance is used to calculate GFR?

Creatinine

What factors is estimated glomerular filtration rate based on?

Serum creatinine, age, body size, gender, and race

How do the kidneys adapt to loss of nephron mass?

Hyperfiltration and hypertrophy of remaining nephrons

What are the mainstays of management for chronic kidney disease?

Blood pressure control, glycemic control, electrolyte monitoring, and lifestyle modifications

What is required to sustain life when end-stage kidney disease is established?

Renal replacement therapy (RRT) such as dialysis or kidney transplantation

A 60-year-old male is diagnosed with kidney disease. Which of the following lab values would be most consistent with this diagnosis?

Elevated plasma creatinine level

Azotaemia refers to:

Increased levels of nitrogenous waste in the blood

A 45-year-old female presents with hypertension, anorexia, nausea and vomiting, and anaemia. She is diagnosed with chronic kidney disease. Anaemia in this patient is caused by:

Inadequate production of erythropoietin

A 42-year-old female is diagnosed with chronic kidney disease. Treatment includes
restricting:

Proteins

Bone fractures are a risk factor in chronic renal failure because:

The kidneys fail to activate vitamin D

In a patient who develops chronic kidney disease because of chronic bilateral
pyelonephritis, there will be evidence of:

Recurrent urinary tract infections

In which area of the brain long-term memory is stored?

Hippocampus

In Alzheimer’s disease, the earliest sign could be a loss of memory. Which type of memory is affected first?

Semantic or episodic memory

Which neurotransmitter levels are reduced in parts of the brain affected by Alzheimer’s disease?

Acetylcholine

In severe Alzheimer’s disease, what is the main goal of management?

Patient safety

A 28 year-old female presents with fever, chills, and flank pain. She is diagnosed with pyelonephritis. Her infection is in the:

Renal pelvis

A 48 year-old male patient attends ED after missing 3 x dialysis sessions. Which of the following complications would you expect to see?

All are possible

True or False: CKD is reversible

False

What is a common cause of CKD?

Chronic glomerulonephritis

Which population group is most affected by CKD in Australia

Indigenous Australians

True of False: CKD affects all organ systems

True

What is the main indicator for kidney function?

GFR

Which disease can lead to CKD?

Lupus

True or False: UTIs can lead to CKD

True

What is a symptom of glomerulonephritis?

Olliguria

What is a sign of severe glomerulonephritis?

Proteinuria

Which equation estimates GFR?

Cockroft-Gault

What is a common treatment for CKD?

Vitamin D supplemenation

What is a complication of CKD?

Dyslipidaemia

Which of the following clusters of symptoms would make a clinician suspect a child has developed acute glomerulonephritis?

Gross haematuria, flank pain, and hypertension

The rate at which blood is filtered per minute is known as the:

Glomerular filtration rate (GFR)

How do you determine the minimum amount of urine that a person should pass in an hour?

0.5 mL/kg/hour

Each kidney contains approximately how many nephrons?

1 million

One of the main causes of prerenal acute kidney injury is:

Sepsis

What is a main cause of chronic kidney disease?

Hypertension

Why are NSAIDs contraindicated in patients with renal disfunction?

They inhibit prostaglandin synthesis, reducing renal blood flow