22. CKD lectures and videos

Question 1

what is CKD

Answer 1

• Kidney damage or GFR less than 60 for longer than 3 months due to any cause

Question 2

what does ESRD mean

Answer 2

the patient is no longer able to live with their kidney function and need to be commenced on RRT

Question 3

in someone with CKD what could urinalysis show

Answer 3

proteinuria, haematuria and glucosuria

Question 4

what do the following abbreviations mean;

• AKI
• ARF
• ATN
• AIN
• RPRF
• ESRD/ESRF

Answer 4

• Acute kidney injury- AKI
• Acute renal failure- ARF
• Acute tubular necrosis- ATN
• Acute interstitial nephritis- AIN
• Rapidly progressive renal failure- RPRF
• End stage renal disease- ESRD/ESRF

Question 5

what is azotaemia

Answer 5

elevation of nitrogenous metabolic waste in the blood due to failure of clearance by the kidneys

Question 6

what is uraemia

Answer 6

clinical syndrome resulting from failing kidneys and progressive azotaemia

Question 7

what systemic disease can cause Glomerulonephritis

Answer 7

vasculitis

Question 8

what is normal gas. exchange dependant on

Answer 8

o Adequate alveolar ventilation
o Adequate pulmonary perfusion
o Minimal barrier to gaseous diffusion

Question 9

which two organs work to maintain Ph

Answer 9

kidneys and lungs

Question 10

if there issues excessive CO2 then there is renal compensation and what occurs

Answer 10

bicarbonate is retained by the kidneys

Question 11

in chronic CO2 retention what is the most important thing to look at

Answer 11

the bicarbonate as it will be raised

Question 12

in a DKA patient what kind of breathing might they have and how does this link to the compensation

Answer 12

kussmaul breathing, and they will have low bicarbonate so there is a compensation by blowing off CO2 in the lungs

Question 13

what are the indications to start renal replacement therapy

Answer 13

•	Fluid overload 
•	Refractory hyperkalaemia 
•	Uraemic symptoms
o	Nausea, vomiting, weight loss
o	Neurological symptoms 
o	Uraemic pericarditis ( rarely seen in modern day practice)

Question 14

what are the main types of diuretics

Answer 14

osmotic
loop
thiazide
potassium sparing

Question 15

give an example of osmotic diuretics

Answer 15

mannitol, urea, glycerine ad isosorbide

Question 16

give an example of loop diuretics

Answer 16

furosemide and bemetanide

Question 17

give an example of a thiazide diuretic

Answer 17

hydrochlorothiazide, chlorothiazide

Question 18

give an example of a potassium sparing diuretic

Answer 18

spironolactone (aldosterone inhibitor)

Question 19

how do diuretics work in general

Answer 19

substances that help the body to get rid of sodium and water
they decrease BP due to decrease in plasma volume

Question 20

where do osmotic diuretics exert their effect

Answer 20

• Limit the reabsorption of water in the tubule and increase osmolality in renal tubule

Question 21

what is the issue with loop diuretics

Answer 21

can induce renin release due to plasma volume depletion

Question 22

which type of diuretic can increase the the reabsorption of urea in proximal tubule which increases plasma uric acid which can lead to gout

Answer 22

thiazide

Question 23

how do potassium sparing diuretics works

Answer 23

aldosterone secreted by adrenal glands (it’s a steroid so binds to receptor inside the cell)
o This causes more Na/K+ pumps to be made, therefore preventing excretions of potassium and also the reabsorption of sodium

Question 24

what are the absolute and relative contraindications to haemo-dialysis

Answer 24

inability to achieve suitable vascular access

severe dementia 
severe heart failure 
bleeding disorder 
low BP
severe active psychotic disorder

Question 25

what are the absolute and relative contraindications to peritoneal dialysis

Answer 25

``` active IBD ischaemic bowel acute diverticulitis abdominal abscess pregnancy 3rd trimester ``` ``` abdominal hernia stomas previous abdo surgery poor manual dexterity obesity severe. nephrotic range proteinuria severe obstructive airway disease ```

Question 26

tell me about haemodialysis

Answer 26

can be done through an IV line in your neck or by making a fistula usually done for 4 hours 3X a week

Question 27

tell me about peritoneal dialysis

Answer 27

- pour dialysate solution into your peritoneum which diffuses waste products out of your body, and then drain this fluid out - The exchange takes about 20-30 minutes

Question 28

what are the two options for peritoneal dialysis

Answer 28

o Two ways to do it, continuous ambulatory peritoneal dialysis (CAPD) which is where you do it 4 times a days, or automated peritoneal dialysis (APD) which is where you plug yourself into the machine overnight and this runs for 7-10 hours. With APD you may get some fluid in the stomach during the day

Question 29

what are the indications for having a renal transplant

Answer 29

o All patients with end stage renal failure (GRF less than 15) or those with CKD stage 4 (GFR 15-29) with progressive disease should als be assessed for renal transplantation

Question 30

what are the absolute contraindications for renal transplant

Answer 30

untreated malignancy active infection untreated HIV infection or AIDS ant condition with a life expectancy less than 2 years malignant melanoma within the previous 5 years

Question 31

what are the relative contraindications for renal transplant

Answer 31

``` co-morbidities eg diabetes age greater than 65 obesity HBC or HCV infection previous malignancy (depending on type) ```

Question 32

what is the most common cause of mortality post-operatively within the first year of transplant

Answer 32

cardiovascular disease

Question 33

most other long term complications that aren't cardiovascular disease are often related to what

Answer 33

related to the use of immunosuppressive agents such as recurrent infections, diabetes or malignancy