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Y2 BRS (Haroop) > 7.4 Chronic Kidney Disease & Renal Failure > Flashcards

7.4 Chronic Kidney Disease & Renal Failure Flashcards

1
Q

What is CKD?

A

Abnormalities of kidney structure or function, present for >3 months

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2
Q

What GFR parameter defines CKD?

A

GFR <60mL/minute

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3
Q

What are the symptoms of CKD? (4)

A

Albuminuria/proteinuria, haematuria, electrolyte abnormalities detected by imaging

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4
Q

What endocrine functions are performed by the kidneys?

A

Erythropoietin synthesis
1-alpha hydroxylase for vitamin D

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5
Q

What homeostatic functions are performed by the kidneys? (3)

A

Electrolyte balance
Acid-base balance
Volume homeostasis

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6
Q

What are the excretory functions of the kidneys? (5)

A

Nitrogenous waste
Middle sized molecules
Hormones
Peptides
Salt and water

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7
Q

What are the functions of the kidney regarding glucose metabolism?

A

Gluconeogenesis
Insulin clearance

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8
Q

Disruptions to the homeostatic balance of the kidneys can manifest as what? (4)

A

Hyperkalaemia
Reduced bicarbonate – decreases pH, manifests as metabolic acidosis
Increased phosphate
Salt and water imbalance

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9
Q

What are the endocrine imbalances that occur in kidney dysfunction?

A

Increased PTH
Anaemia – reduced EPO production
Hypocalcaemia – reduced calcitriol synthesis

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10
Q

Why is there parathyroid hyperplasia associated with kidney dysfunction?

A

Decreased renal 1-alpha hydroxylase leads to decreased calcitriol synthesis
This manifests as chronic hypocalcaemia, which causes raised PTH for increased bone resorption

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11
Q

Why does anaemia occur in kidney dysfunction?

A

Reduced erythropoeitin production

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12
Q

What do reduced 1-25 Vit D levels cause in kidney failure?

A

Reduced intestinal calcium absorption
Hypocalcaemia
Hyperparathyroidism

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13
Q

How does chronic renal failure contribute to the effects of reduced 1-25 Vit D?

A

Phosphate retention is seen in chronic renal failure
This contributes to low levels of 1-25 Vit D and hypocalcaemia, thus hyperparathryoidism

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14
Q

What are the symptoms associated with kidney failure and reduced secretion of sodium chloride?

A

Hypertension
Oedema
Pulmonary Oedema

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15
Q

Why is salt and water loss evident in tubulointestinal disorders?

A

Damage to the concentrating mechanism of urine – thus water reabsorption is decreased

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16
Q

Why is water and salt loss seen right after a kidney transplant?

A

There is damage to the tubules and they pee out a lot of water

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17
Q

Why does metabolic acidosis occur in kidney failure?

A

Reduced excretion of hydrogen ions from the distal convoluted tubule cells into the filtrate, manifests as acid retention

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18
Q

Why is salt and water loss seen after kidney obstruction is relieved?

A

The kidney can’t concentrate urine and you get kidney failure

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19
Q

What can cause AKI?

A

Hypovolaemia

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20
Q

What does hyponatremia mean and what does it not mean?

A

It does not mean reduced total body sodium
It’s to do with how much free water you have - you’ll have more in hyponatremia

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21
Q

How do we treat hyponatremia?

A

Remove the excess free water (instead of giving extra salt)

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22
Q

What does acidosis do to K+ ions in renal failure?

A

In response to acidosis (more H+ in blood), cells take up more H+ ions, which forces K+ out of cells, leading to hyperkalaemia

23
Q

What are the 2 causes of hyperkalaemia?

A

Acidosis
Reduced distal tubule potassium secretion

24
Q

What is used to treat hyperkalaemia in an acute setting?

A

Sodium bicarboante – neutralises the hydrogen ions, such that potassium can re-enter the cells

25
Q

What can acidosis cause?

A

Anorexia and muscle catabolism

26
Q

What are the symptoms of hyperkalaemia?

A

Cardiac arrhythmias
Disrupt neural and muscular activity
Vomiting

27
Q

What does symptom presentation depend on in hyperkalaemia?

A

Chronicity of the disease
If acute hyperkalaemia – symptoms will show
If chronic – body adapts, symptoms don’t show

28
Q

What features on an ECG suggest hyperkalaemia?

A

Peaked T waves
P-waves – broaden, reduced amplitude, disappear
QRS widening
Heart block
Asystole
Ventricular tachycardia/ventricular fibrillation

29
Q

What type of hyperparathyroidism is linked with chronic kidney failure?

A

Tertiary hyperparathyroidism

30
Q

Why is there an increased cardiovascular risk with chronic kidney disease?

A

Cardiac ventricular myocyte contraction is directly related to extracellular concentrations of calcium (arrythmias) + increased calcification risk

31
Q

What is the major predictor of end stage renal failure?

A

CKD

32
Q

What standard cardiovascular risk is there for kidney failure patients?

A

Hypertension
Diabetes
Lipid abnormalities

33
Q

What additional risks are there for kidney failure patients?

A

Inflammation
Oxidative stress
Mineral/bone metabolism disorder

34
Q

What is the major outcome for a patient with CKD, and what does this mean?

A

Major outcome is cardiovascular disease
Means CKD patients are more likely to die from cardiovascular disease than end stage renal failure

35
Q

What is the immediate treatment in a patient with hypovolaemia?

A

Give fluids

36
Q

What is the immediate treatment for a patient with hypervolaemia?

A

Fluid restriction, consider diuretics/dialysis

37
Q

What are the 3 main ways we manage hyperkalaemia?

A
  1. Drive potassium into cells
  2. Drive it out of body – diuretics/dialysis
  3. Reduce gut absorption – potassium binders
38
Q

What are the 2 ways we can manage hyperkalaemia by driving K+ into cells?

A
  • Sodium bicarbonate – H+ comes out of cell into blood to equalise this, and K+ goes back into the cell
  • Insulin dextrose
39
Q

Why do we need to be careful with insulin dextrose?

A

Fatalities associated with it due to hypoglycaemia
Only used when potassium >6.5 or when there are ECG changes

40
Q

What does conservative treatment for CKD include? (5)

A
  • Erythropoietin injections to correct anaemia
  • Diuretics to correct salt-water overload
  • Phosphate binders – for hyperphosphataemia, reduces itching
  • 1-25 Vitamin D supplements
  • Symptom managements – e.g. nausea
41
Q

What home therapy is available for CKD?

A
  • Haemodialysis
  • Peritoneal dialysis/assisted programmes

The peritoneum behaves as a semipermeable membrane and a dialysate is delivered with specific concentrations (hyperosmolar to generate drive, fluid into the peritoneal cavity)

42
Q

What in centre therapy is available for CKD?

A

Haemodialysis, 4 hours 3 times a week

43
Q

What is a fistula in terms of CKD?

A

A fistula is created by connecting an artery directly to the vein – vein swells for ease of access

44
Q

Where should taking blood be avoided in patients with renal failure?

A

Avoid taking blood from the veins of the anterior cubital fossa or cephalic vein at wrist level

45
Q

Which veins should be used when taking blood or IV lines for patients with renal failure?

A

Dorsal venous structures

46
Q

Why should transfusions be avoided in patients with renal failure?

A

Transfusions will sensitise anaemia (haemolytic anaemia, as foreign antigens are detected, and antibodies are formed)
This increases the risk of autoimmune mediated rejection of transplanted kidney

47
Q

Why is urea a poor indicator of GFR?

A

Confounded by diet, catabolic state, GI bleeding (bacterial breakdown of blood in gut), drugs, liver function etc

48
Q

What factors affect creatinine within patients with renal failure?

A

Affected by muscle mass, age, race and sex
So we need to look at the specific patient when using creatinine to assess kidney function

49
Q

What factors limit how useful creatinine clearance is for assessing kidney function? (2)

A

It overestimates GFR at a low GFR (as a small amount of creatinine is normally secreted into urine)
It’s also difficult for elderly patients to collect an accurate 24 hour urine sample

50
Q

When is inulin clearance used to assess kidney function?

A

Research purposes only, as it is laborious

51
Q

What is the most appropriate radionucleotide study in patients with renal failure?

A

EDTA

52
Q

What is the main factor in calculating estimated GFR (eGFR)?

A

Serum creatinine

53
Q

What is the difference between actual GFR and eGFR?

A

As kidneys get better and actual GFR goes up, the eGFR becomes less accurate
So in kidney disease patients with normal eGFR, we look at the creatinine trend

54
Q

What do we use to classify CKD? (3)

A

Proteinuria
Albumin:creatinine ratio
GFR

More protein means higher risk of end stage renal failure

Y2 BRS (Haroop) (62 decks)

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