Renal/urinary risk factors and complications

Question 1

What are the risk factors for developing CKD?

Answer 1

Female gender

Old age (loss of kidney function)

All cardiovascular disease: HTN, atherosclerosis etc

Smoking

Question 2

What are the complications of chronic kidney disease?

Answer 2

Chronic kidney disease - mineral bone disease (hypocalcaemia and hyperparathyroidism)

Renal anaemia

Metabolic acidosis (reduced bicarbonate production)

Hyperkalemia

Question 3

What do ESRF CKD patients normally die from?

Answer 3

In short: haemodialysis causes haemodynamic stresses that accelerate development of heart failure and dilated cardiomyopathy.

Cardiovascular complications (not renal failure since they can have dialysis)

Most commonly - sudden cardiac death in haemodialysis patients
“Unexpected cardiac death within 1 hr of symptom onset, in a person without a prior condition that would appear fatal”

This is due to a milieu of metabolic/pathophysiological factors:
Myocardial fibrosis
Vascular calcification
Autonomic dysfunction

Question 4

What are the risk factors for chronic kidney disease?

Answer 4

Old age
Family hx of CKD
Reduced kidney mass - injury to one kidney
Low birth weight
Southeast Asian

Conditions:
DM
HTN
Autoimmune disease
Systemic sepsis
UTI
Renal stones
Urinary obstruction
Drug toxicity

Question 5

Why does anaemia occur in CKD?

Answer 5

Because of loss of EPO production!

Not because of haematuria!!!

Question 6

Why might heart failure occur in CKD?

Answer 6

Due to any of the pathological causes of CKD, but most likely due to hypertension and fluid overload due to: reduced glomerular filtration rate (less water out, and more salt left in) as the kidney function declines.

Increased preload and afterload making the heart work harder.

Question 7

Why does acidosis occur in renal failure?

Answer 7

Reduced acid secretion and excretion

Reduced bicarbonate production and reabsorption

Increased protein metabolism creating organic acids (sulphuric, nitric etc) - this is due to lots of reasons (general increased state of catabolism) but can also be due to diabetes: a major cause of renal failure

Question 8

Other than infection, what are the other major complication of immunosuppression in renal transplant patients?

Answer 8

1. Malignancy:
   Risk is related to number of years of immunosuppression and age.
2. Cardiovascular disease.
3. Drug interactions with immunosuppression drugs, via P450 enzyme - higher effective immunosuppression, causing increased risk of infection, including things like St. John’s wort.

Question 9

What are the complications of post-streptococcal glomerulonephritis?

Answer 9

Some children: have renal failure

25% adults: rapidly progressive glomerulonephritis

Question 10

What are the RFs for bladder cancer?

Answer 10

Age
Smoking
Exposure to dye chemicals
Exposure to rubber chemicals