Uraemia and uraemic toxins Flashcards Preview

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Flashcards in Uraemia and uraemic toxins Deck (24):
1

What is uraemia?

Clinical sydrome with various symptoms that arises as a result of progressive kindey failure

2

What are the characteristics of uraemia?

Build up of uraemic toxins

Solutes become retained as a result of declining kidney function

Symptoms are non specific - loss of apetite, nausea, vomiting

3

Is it known which uraemic toxins are the source of which symtoms?

No

4

How does the build up of the uraemic toxins lead to kidney damage?

Molecules cause inflammation

5

What are ways to classify uraemic toxins?

Size

They way they are carried around by the body

6

What are examples of uraemic toxins?

Urea - small, water soluble

Phenols - small, lipid soluble or protein bound

Beta 2 microglobulin - large molecule

7

Which molecule was originally thought of as the cause of uraemia?

Urea

8

What are some features of urea?

Osmotically active - rapid changes in concentration leads to water movement

Used to monitor effectiveness of dialysis - urea clearance

Very non-toxic molecule

9

How is it proven that urea does not play a major role in uremia?

Increased removal of urea does not have a major impact in renal failure

Addition of urae to dialyste does not induce symptoms of uraemia

10

What is the source of many uraemic toxins?

Related to nitrogen breakdown

11

What happens to carbohydrates and proteins not digested in the upper GI?

The colon salvages the energy from the undigested carbohydrates and nitrogen from the undigested proteins

12

What happens to proteins along the GI tract?

Digested into peptides in the gut

Peptides are acted upon in the large intestine by bacteria

Nitrogenous wastes products are formed

13

What is P-cresyl sulphate and Indoxyl sulphate?

Amino acids are broken down into PCS and IS by gut bacteria

14

Why are PCS and IS not easily removed by dialysis?

They are protein bound

15

What is the effect of PCS and IS in the kidneys?

Pro-inflammatory effects on various cells

Endothelial cells, epithelial cells and leukocytes

16

Where do PCS and IS become protein bound?

In the kidneys

17

What happens when PCS and IS become protein bound?

They recirculate and worsen kidney failure

18

What is AST-120?

Oral sorbent

Prevents absorption of IS and PCS from the gut

Rather than PCS and IS recirculating, they are egested via the faeces

19

What is another name for PCS and IS?

Indole compounds

20

What is the build up of uraemic toxins linked to?

CVD and poor survival

21

What are ways to remove protein-bound substances?

Adsorption

Oral compounds that bind them in the gut

22

What is an ADEPT device?

Adsorbent device that promotes toxin removal during haemodialysis

Fits in line with current dialysers

Removes protein bound uraemic toxins by non-specific adsorption from blood

23

What is the ADEPT device made of?

Carbon-based monolith

Made by synthetic resin

24

What are PCS and IS examples of?

Protein-bound uraemic toxins