Chronic Kidney Disease and Renal Failure

Question 1

What are the functions of the kidney?

Answer 1

Homeostatic
Excretory
Endocrine
Glucose

Question 2

What are the homeostatic functions?

Answer 2

Electrolyte balance
Acid-base balance
Volume homeostasis
Salt and water

Question 3

What are excretory functions?

Answer 3

Nitrogenous waste
Hormones
Peptides
Middle sized molecules

Question 4

What are the endocrine functions?

Answer 4

Erythropoietin
1 alpha-hydroxylase vitamin D

Question 5

What are the glucose metabolism functions?

Answer 5

Gluconeogenesis
Insulin clearance

Failure results in increase in cardiovascular risk

Question 6

What does the clinical presentation of kidney failure depend on?

Answer 6

Rate of deterioration
Cause of kidney failure

Question 7

What does chronic kidney disease cause to kidney size?

Answer 7

Shrunken kidney size

Question 8

In what cases of CKD, can kidney size be preserved?

Answer 8

Diabetes
Myeloma
Amyloid

Question 9

What does acute kidney disease cause to kidney size?

Answer 9

Preserved size

Question 10

Kidney failure tends to reduce secretion of salt and water leading to?

Answer 10

Hypertension
Oedema
Pulmonary oedema

Question 11

In CDK, in tubulointerstitial disorders, what may be seen?

Answer 11

Salt and water loss due to damage to concentrating mechanism

Question 12

In AKD if the cause was that you were vomiting or losing a lot of fluid, what could you be?

Answer 12

Hypovolemic

Question 13

Is there any relation between total sodium and serum sodium?

Answer 13

Hyponatremia is NOT equal to reduced total body sodium

Question 14

What is an odeoma?

Answer 14

Excess extracellular fluid and your total body sodium is increased. More water excess than salt

Question 15

Explain the acidosis in kidney failure?

Answer 15

Increase in H+ ions retention
Therefore swap with potassium (main intracellular ion) and it leaves the cell and leads to an increase
Can cause anorexia and muscle catabolism

Question 16

What causes hyperkalaemia?

Answer 16

The reduced ability to excrete potassium (reduced distal tubule potassium secretion)
The effect of acidosis

Question 17

How are sodium levels figured?

Answer 17

By the relative sodium and water levels rather than the actual sodium itself

Question 18

What are symptoms of of hyperkalaemia?

Answer 18

Cardiac arrhythmias
Neural and muscular activity
Vomiting

Question 19

What are the signs on an ECG for hyperkalaemia?

Answer 19

Peaked T waves
P wave - broadens, reduced amplitude, disappears
QRS widening
Heart block
Asystole
VT/VF

Question 20

In kidney failure, if you get reduced erythropoietin, what do you get?

Answer 20

Anaemia

Question 21

In kidney failure, if you have reduced 1-25 Vitamin D levels, what do you get?

Answer 21

Reduced intestinal calcium absorption
Hypocalcemia
Hyperparathyroidism

Question 22

How does kidney failure lead to hyperparathyroidism?

Answer 22

Question 23

What is a patient with CKD more likely to die from?

Answer 23

Cardiovascular disease than end stage renal failure

Question 24

What treatment when hypovolemic?

Answer 24

Give fluids

Question 25

What treatment when hypervolemic?

Answer 25

Trial of diuretics or dialysis

Question 26

With hyperkaliemia, what: Drives into cells? Drives out of the body? Gut absorption

Answer 26

Sodium bicarbonate / insulin dextrose (caution) Diuretics/dialysis Potassium binders

Question 27

Is AKI or CKD be reversed?

Answer 27

Acute can be as it was an event that led to damage but CKD is a continuous process so can't be reversed

Question 28

In terms of long-term management of Kidney failure, what conservative treatment can you give?

Answer 28

- erythropoietin injections to correct anaemia - diuretics to correct salt water overload - phosphate binders - 1.25 vit d supplements - symptom management

Question 29

In terms of long-term management of Kidney failure, what therapy is available

Answer 29

Home therapy - haemodialysis - peritoneal dialysis/assisted programmes In Centre therapy - haemodialysis, 4 hours 3 times a week

Question 30

What is the best treatment for Kidney failure and what needs to also be managed?

Answer 30

Transplantation Cardiovascular risks

Question 31

What is the kidney failure risk equation calculated from?

Answer 31

Age in years Sex CKD-EPI eGFR Urine albumin creatinine ratio (ACR)

Question 32

What is the use of the kidney failure risk equation?

Answer 32

Patient understanding of their CKD diagnosis especially in the context of multi-morbidity Identification of high risk CKD patients: targeted patient engagement/education aggressive risk factor management referral to secondary care

Question 33

When can the kidney failure risk equation be used?

Answer 33

Validated risk prediction tool for kidney replacement therapy in the next two or five years for adults with STABLE chronic kidney disease (CKD) Stages 3A to 5 . NOT to be used in patient with rapidly changing eGFR.

Question 34

Why should transfusions be avoided in transplantable patients with kidney disease?

Answer 34

As the transfusions sensitize them and could lead to transplant failure

Question 35

What are the traditional methods for checking for GFR? And what are the downsides?

Answer 35

Question 36

Which equation is recommended by NICE guidance to estimate GFR using serum creatinine?

Answer 36

CKD-EPI

Question 37

What change in GFR and ACR increases risk of kidney failure?

Answer 37

Decrease in GFR (up to G5) And increase in ACR (up to A3)