CKD and Renal Failure Flashcards
What are the 4 main functions of the kidney?
Homeostasis
Endocrine
Excretory
Glucose metabolism
What are the endocrine functions of the kidney?
Erythropoietin synthesis
Have 1 alpha hydroxylase for the synthesis of vitamin D
What are the homeostatic functions of the kidney?
Electrolyte balance
Acid-base balance
Volume homeostasis
What are the excretory functions of the kidney?
Nitrogenous waste Hormones Peptides Middle sized molecules Salt Water
What are the functions of the kidney in relation to glucose metabolism?
Carry out some gluconeogenesis
Insulin clearance
What does loss of kidney homeostatic function lead to in terms of potassium, bicarbonate, pH, phosphate, salt and water?
High potassium Low bicarbonate Low pH (patients become acidotic when H+ cannot be removed) High phosphate Salt and water imbalance
What does loss of kidney endocrine function lead to?
Low calcium
Anaemia
High PTH
What does loss of kidney excretory function lead to?
High urea
High creatinine
Low insulin requirement
Why is insulin requirement low in those with kidney failure?
Kidneys get rid of insulin normally. In kidney failure clearance is decreased so less requirement
What is the main systemic risk that increases in kidney failure?
Cardiovascular risk
When assessing a patient with kidney failure what question is it really important to adress?
What their fluid status is- are they hypovolemic, hypervolemic or euvolemic? hypovolemic = low fluid volume
In hypovolemic kidney failure what will happen to levels of urea, creatinine, potassium, sodium, haemoglobin?
High urea High creatinine High potassium Sodium levels vary (depending on hydration) Low haemoglobin
What is important to remember in hyponatremia?
Hyponatraemia does not mean there is low total sodium in the body, it may just mean there is extra fluid
This is why assessing volume status is so important
Why might kidney failure patients not have anemia?
If they present early on eg due to toxin from food causing kidney failure then there may not be effects in the bone marrow
Why might patients with kidney failure not have high potassium levels?
If they have diarrhoea or are vomiting they may be getting rid of the excess potassium
In kidney failure what happens to secretion of salt and water? What are the effects of this?
It falls, this causes hypertension, oedema, pulmonary oedema
What imbalance does acidosis contribute to?
Hyperkalaemia
Why is bicarbonate given to patients with kidney failure?
Mainly to treat hyperkalemia, but also to resolve the acidosis
What is the main issue with having a hyperkalemia?
It leads to cardiac arrhythmia which can eventually be deadly
What is seen on the ECG of someone with chronic kidney disease when they have arrhythmia?
First sign is peaking of T waves P waves: - broaden - reduced amplitude -disappears QRS complex widens Heart block, asystole, VT/VF may occur
Aside from arrhythmia what effects does hyperkalemia have?
Neural and muscular activity is disrupted
Vomiting
Why does anaemia arise in kidney failure?
Reduced erythropoietin
What are CKD patients most likely to die of?
Cardiovascular disease, not end stage renal failure
What does reduced vitamin D cause in patients with kidney disease?
Reduced calcium absorption
Hypocalcaemia
Hyperparathyroidism
