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TAS Nephrology > Chronic Kidney Disease ✅ > Flashcards

Chronic Kidney Disease ✅ Flashcards

1
Q

How can CKD present in children?

A
  • Faltering growth
  • Increased tiredness
  • Pallor
  • Oliguria
  • Oedema
  • Hypertension
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2
Q

What can the causes of CKD be divided into?

A
  • Congenital
  • Hereditary/metabolic
  • Glomerulonephritis
  • Others
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3
Q

What are the congenital causes of CKD?

A
  • Urinary tract malformations
  • Obstructive nephropathy
  • Renal dysplasia/hypoplasia
  • Reflux nephropathy
  • Congenital anomaly of kidney and urinary tract (CAKUT)
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4
Q

What are the hereditary/metabolic causes of CKD?

A
  • Nephronopthisis
  • Cystinosis
  • Oxalosis
  • Alport syndrome
  • Polycystic kidney disease
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5
Q

What are the glomerulonephritic causes of CKD?

A
  • Focal segmental glomerulosclerosis
  • Membranoproliferative glomerulonephritis
  • Congenital nephrotic syndrome
  • IgA nephropathy
  • Goodpasture disease
  • Haemolytic uraemic syndrome
  • Henoch-Schonlein purpura
  • Systemic lupus erythematosus
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6
Q

Give 2 types of congenital nephrotic syndrome?

A
  • Finnish type

- Diffuse mesangial sclerosis

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7
Q

What is IgA nephropathy also known as?

A

Berger’s disease

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8
Q

What is Goodpasture disease also known as?

A

Antiglomerular basement membrane disease

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9
Q

What are the other causes of CKD?

A

Bilateral Wilm’s tumour

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10
Q

What are investigations aimed at in CKD?

A
  • Identifying underlying cause
  • Differentiating from AKI
  • Identifying complications
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11
Q

What features suggest chronic kidney disease?

A
  • Presence of non-haemolytic anaemia
  • Small or dysplastic kidneys on ultrasound
  • X-ray evidence of rickets
  • End-organ damage from hypertension
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12
Q

What is the overall aim of management in CKD?

A
  • Treat any underling disorder and associated conditions

- Support kidney function

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13
Q

What is the limitation of the treatment of CKD?

A

It is often not possible to reverse the renal damage

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14
Q

What is the result of it often not being possible to reverse renal damage in CKD?

A

The focus is on preventing further damage

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15
Q

How is further renal damage prevented in CKD?

A
  • Maintaining nutrition and growth
  • Controlling hypertension
  • Reducing proteinuria
  • Treating anaemia
  • Treating fluid, electrolyte, and acid-base imbalance
  • Relieving any obstruction
  • Controlling renal osteodystrophy
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16
Q

How can renal osteodystrophy be controlled?

A

Keeping calcium, phosphate, alkaline phosphate, and parathyroid hormone in normal range for age

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17
Q

How severe is renal failure?

A

Varies, from mild renal impairment to severe irreversible end-stage kidney disease

18
Q

What is required in severe irreversible end-stage kidney disease?

A

Renal replacement therapy

19
Q

What is the difficulty of defining when someone needs RRT?

A

The indications for RRT are complex, and depends on a holistic view of the child rather than specific biochemical values

20
Q

When is RRT generally started?

A

When the child becomes symptomatic from renal failure, or when blood biochemistry approaches hazardous levels despite therapy and dietary restrictions

21
Q

What symptoms of renal failure might indicate a need for RRT?

A
  • Tiredness
  • Anorexia
  • Vomiting
22
Q

What is the ultimate aim of therapy in severe irreversible renal failure?

A

Pre-emptive renal transplantation

23
Q

Why is the ultimate aim of therapy in severe irreversible renal failure pre-emptive renal transplantation?

A
  • Places far less restriction on normal life

- Associated with lower morbidity and mortality

24
Q

What is meant by pre-emptive renal transplantation?

A

Transplantation before dialysis

25
Q

Give an example of when a child may not be suitable for pre-emptive transplantation?

A

Those requiring bilateral native nephrectomies for focal and segmental glomerulosclerosis

26
Q

How is dialysis modality chosen?

A

Individualised to the child and family

27
Q

What are the disadvantages of haemodialysis?

A
  • Access issues

- Fluid restriction

28
Q

What are the problems with accessing haemodialysis?

A

Haemodialysis for children is based in a few specialist centres, and travel to and from the centre for a 3-5 hour session 3 times a week can be problematic

29
Q

Is home haemodialysis available?

A

Yes, but only in a few paediatric centres throughout the world

30
Q

How does fluid restriction in haemodialysis compare to in peritoneal dialysis?

A

Fluid restriction is normally more severe when on haemodialysis

31
Q

What are the practical advantages of haemodialysis?

A
  • Family relieved of some of the stresses and responsibilities of peritoneal dialysis
  • Child retains some independence
32
Q

When is home peritoneal dialysis performed?

A

Usually overnight

33
Q

What is the advantage of peritoneal dialysis occurring at home overnight?

A

It enables normal school attendance

34
Q

What is the disadvantage of home peritoneal dialysis?

A

Huge burden on caregivers, and child very dependent on them on a regular basis

35
Q

What are the advantages of peritoneal dialysis?

A
  • Avoidance of fluid fluid and electrolyte shifts

- Less severe fluid and dietary restrictions

36
Q

Who is peritoneal dialysis particularly suited to?

A

Younger patients

37
Q

What is the preferred treatment for end-stage renal disease?

A

Renal transplantation

38
Q

What is the advantage of renal transplantation?

A

Offers nearest to normal lifestyle

39
Q

What is the 5 year survival following successful renal transplantation?

A

Over 95%

40
Q

What kind of renal transplant has the highest survival rates?

A

Living donor kidneys

41
Q

What is required long-term in renal transplantation patients?

A

Immunosuppression medications

TAS Nephrology (16 decks)

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