SBI242 Week 3 - Chronic Diseases

A broad term describing a decline in cognitive function

What is Dementia?

Retention of information, skills, or thoughts

How is memory defined?

Short-term and Long-term Memory

Name the two types of memory

Episodic, semantic, and procedural memory

What are the components of long-term memory?

Stored in the prefrontal cortex, lasting 15-30 seconds

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

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

Where does long-term memory reside?

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

What is Long-term Potentiation (LTP)?

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

What is the property of plasticity?

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

What are the hallmark characteristics of Alzheimer's Disease?

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

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

Acetylcholine

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

Activation of microglia and release of cytokines

What inflammatory response is elicited by plaques and tangles?

Memory loss, confusion, difficulty with problem-solving

List the common signs and symptoms of the early 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 moderate 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.

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

Increasing levels of acetylcholine and cognitive function

How does Pharmacological Management work for Alzheimer's diseas?

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

Name the Pharmacological Management used for Alzheimer's disease.

A sudden, sharp decline in renal function, mostly reversible

What is Acute Kidney Injury (AKI)?

Gradual decline in renal function over time, irreversible.

What is Chronic Kidney Disease (CKD)?

Hypertension, autoimmune disorders, and diabetes mellitus

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

Glomerular diseases, vascular diseases, and tubulointerstitial diseases

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

Large inflamed glomeruli with a decreased capillary lumen.

What are defining features of Acute Glomerulonephritis?

Hematuria, proteinuria, hypertension, and edema

What are common clinical manifestations of Acute Glomerulonephritis?

Glomerular scarring and eventual loss of functioning nephrons.

What are defining features of Chronic Glomerulonephritis?

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

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

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

What are the clinical manifestations of glomerulonephritis?

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

What is the result of Tubular Diseases?

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

What is Renal Tubular Acidosis?

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

What is a Urinary Tract Infection (UTI)?

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

What are the most common pathogens in UTIs?

Colonization, uroepithelium penetration, ascension

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

Inflammation of the kidney's renal pelvis and parenchyma, typically due to bacterial infection

What is pyelonephritis?

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

What are the most common causes of Acute Pyelonephritis?

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

What is Chronic Pyelonephritis?

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

What should you investigate for in cases of recurrent UTIs?

Renal Calculi

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

Diabetes mellitus, hypertension, systemic lupus erythematosus, and vasculitis

What are systemic diseases that cause CKD?

Decreased GFR and impaired tubular reabsorption and secretion

How does chronic kidney disease affect GFR and tubular function?

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

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

Kidney failure or Stage 5 Chronic Kidney Disease (CKD)

What does a GFR of <15 indicate?

Creatinine

What substance's clearance is used to calculate GFR?

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

What factors is estimated glomerular filtration rate based on?

Hyperfiltration and hypertrophy of remaining nephrons

How do the kidneys adapt to loss of nephron mass?

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

What are the mainstays of management for chronic kidney disease?

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

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

Elevated plasma creatinine level

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

Increased levels of nitrogenous waste in the blood

Azotaemia refers to:

Inadequate production of erythropoietin

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:

Proteins

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

The kidneys fail to activate vitamin D

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

Recurrent urinary tract infections

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

Hippocampus

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

Semantic or episodic memory

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

Acetylcholine

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

Patient safety

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

Renal pelvis

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

All are possible

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