8. What happens when the kidneys stop working? Flashcards

1
Q

What 4 things happen when the kidneys stop working?

A

Loss of excretory function (accumulation of waste)
Loss of homeostatic function (electrolyte balance, acid-base control, volume)
Loss of endocrine function (erythropoietin, 1-alpha-hydroxylase Vit D)
Abnormality of glucose homeostasis (Decreased gluconeogenesis)

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2
Q

What causes the symptoms of lethargy and anorexia?

A
Accumulation of nitrogenous waste products 
Acidosis 
Hyponatremia 
Volume depletion 
Anaemia
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3
Q

What could cause salt and water imbalance? (“Salt retentainers”)

A

Inability to excrete salt and water, leads to a tendency to retain Na+ (Causes Hypertension, Oedema and Pulmonary oedema)

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4
Q

What could cause salt and water imbalance? (“Salt losers”)

A

Tubulointerstitial disorders in which the conc. mechanisms have been damaged
Inability to decrease Na+ excretion (i.e. increase Na+ reabsorption) when Na+ depleted.
Causes osmotic diuresis (as high conc. small MW waste substances, e.g., urea)

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5
Q

What does an inappropriately high loss of salt result in?

A

Volume depletion

Low BP

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6
Q

Signs and symptoms of renal failure

A
“Very unwell”
Pale, Hands cold 
Capillary refill decreased
Poor skin turgor
Low pulse rate 
Low BP
Tachypnoeic
Clear lungs on auscultation
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7
Q

What in a blood test may indicate renal failure?

A

High plasma creatinine and urea

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8
Q

Ultrasound findings in renal failure

A

Small, shrunken kidneys

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9
Q

What is acidosis caused by?

A

Decreased excretion of H+ ions and retention of acid bases

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10
Q

Why does acidosis tend to aggravate hyperkalaemia?

A

Excess H+ is buffered by taking it into cells in exchange for K+
So extracellular K+ concentration increases

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11
Q

How can serum and total body sodium levels vary?

A

Can have low Na+ in blood, but excess total body Na+ if oedematous
Can have high Na+ in blood, but low total body Na+
Conc. not always aligned to total body levels

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12
Q

What respiratory compensation mechanism is seen in response to metabolic acidosis?

A

Increasing CO2 loss through the lungs

Air hunger, rapid breathing

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13
Q

What is a serious consequence of hyperkalaemia?

A

Can cause CARDIAC ARRHYTHMIAS

initial loss of p waves, bradycardia, arrest

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14
Q

What can hyperkalaemia effect?

A

Neural and muscular activity

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15
Q

What effect does renal failure have on the production of erythropoietin? What is the result of this?

A

Decreases erythropoietin production

Results in anaemia

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16
Q

What effect does renal failure have on 1-25 Vitamin D levels? What is the result of this?

A

Decreases levels of 1-25 Vitamin D

Results in hypocalcaemia (short term) and hyperparathyroidism (long term)

17
Q

A major predictor of end stage renal failure is chronic kidney disease, but what is a major outcome for patients with chronic kidney disease?

A

Cardiovascular Disease

18
Q

What potential mechanisms cause CVD in patients with CKD?

A

Hypertension
Secondary cardia effects
Endothelial effects
Lipid abnormalities

19
Q

State 5 similarities between acute and chronic kidney disease.

A
Anaemia 
Acidosis 
Tendency to hyperkalaemia
Tendency to hyponatreamia 
Volume usually overloaded (Oedema)
20
Q

State 2 differences between acute and chronic kidney disease.

A

Acute: renal size unchanged + previously normal creatinine

Chronic = renal size DECREASED, previously ABNORMAL creatinine, chronic uraemia symptoms

21
Q

When might a patient with chronic kidney disease have normal sized kidneys?

A

Polycystic kidney disease
Diabetes
Myeloma
Amyloid

22
Q

What is the initial management plan for someone suffering from kidney disease?

A

IV saline to correct fluid loss
IV sodium bicarbonate to correct acidosis
IV insulin and dextrose to lower plasma K+ (increase uptake of K+ into cells)

23
Q

What are the methods of estimating GFR?

A
Urea (poor indicator: confounded by diet, drugs, liver function)
Creatinine (affected by muscle mass, age, race, sex) 
Creatinine Clearance (difficult in elderly patients to collect an accurate sample) 
Inulin Clearance (laborious) 
Radionuclide Studies (EDTA clearance, expensive)
24
Q

Estimated GFR (EGFR) equation

A

Equation accounts for creatinine, age and ethnicity

Still need to look at patient