08 What Happens When The Kidneys Stop Working

Question 1

What are the roles of kidneys

Answer 1

Homeostasis (acid base balance)
Hormonal regulation (erythropoietin, 1a hydroxylase)
Excretion of waste product
Glucose balance

Question 2

What are common symptoms of kidney failure

Answer 2

Metabolic acidosis
Hyperkalaemia 
Hyponatriuremia
Anaemia
Hypocalcaemia
Anorexia
Hypertension/hypotension

Question 3

What is the ECG finding when a patient suffers from hyperkalaemia?

Answer 3

Loss of P wave
Broadening of QRS
Slowing heart rate

Question 3

What are the implications of acidosis

Answer 3

Buffered by exchange of potassium for protons
Buffered by increasing CO2 loss
Exacerbates anorexia
Muscle catabolism

Question 5

What are the implications of hyperkalaemia

Answer 5

Arrhythmia
Disturbances of neural and muscular activity
Exacerbated by acidosis due to K/H exchanger on cells

Question 6

How does chronic renal failure lead to hyperparathyroidism

Answer 6

Chronic renal failure leads to retention of phosphate which will inhibit the release of calcitriol. This will cause hypocalcaemia and increase parathyroid hormone release

Question 7

How do you determine if the patient has chronic or acute kidney disease using ultrasound

Answer 7

Shrinkage: chronic
Normal: could be either.

Question 8

What is the predictor of end stage renal failure. And what is the major out come of the patient with “this predictor”

Answer 8

CKD

CVD

Question 9

What is the management of a patient with chronic renal disease presented in emergency department

Answer 9

Intravenous fluid
Intravenous sodium bicarbonate
Intravenous insulin (for potassium uptake by cells) with dextrose

Question 10

Why is creatinine a poor indicator of patient’s renal function clinically

Answer 10

Creatinine clearance is variable depending on the patient’s sex, age and muscle weight
Creatinine is also secreted slightly in the tubules

Question 11

How do we measure eGFR of a patient in a clinical setting

Answer 11

Modification of Diet in Renal Disease (MDRD)

CKD epidemiology collaboration (CKD-EPI)

Question 12

How is kidney disease classified

Answer 12

Determined by GFR and albuminuria

Question 13

What do decrease in GFR and increase in albuminuria associate with in terms of pathology

Answer 13

Increased risk of end stage renal disease, CVD and acute kidney injury