CKD & renal failure Flashcards
(25 cards)
What are the 4 functions of the kidneys?
Excretion
Homeostasis
Endocrine
Glucose metabolism
What are the homeostatic functions of the kidneys? (3)
Electrolyte balance
Acid-base balance
Volume homeostasis
What is excreted by the kidneys? (5)
What can be seen in renal failure?
Nitrogenous waste
Middle molecules
Salt and water
Peptides
Hormones
High urea and creatinine, low insulin requirement
What endocrine functions do the kidneys perform?
What can be seen in renal failure?
Erythropoietin
1-alpha-hydroxylase (Vitamin D)
Low calcium, high PTH, anaemia
What functions do the kidneys do in glucose metabolism?
Gluconeogenesis
Insulin clearance
What is the most common presentation of a patient with kidney failure?
What are the exceptions?
Hypertension
Oedema
(Pulmonary oedema)
Acute: vomiting can lead to hypovolaemia
Chronic: tubulointerstitial causes instead of glomerular, can lose salt & water
What is oedema caused by?
Excess extracellular fluid
Excess water and salt
More water excess than salt
What are the two ways that hyperkalaemia occurs in kidney failure?
- decreased K+ secretion in distal tubule
- decreased H+ secretion, acidosis leading to H+ and K+ swapping, K+ becomes extracellular
What are the symptoms of hyperkalaemia?
Cardiac arrythmias
Neural and muscular activity
Vomiting
What are some ECG changes that can be seen in hyperkalaemia?
Peaking T waves
Loss of P waves
Widened QRS
Heart block
Asystole
V tach/fib
How does CKD affect PTH levels?
What condition is this?
- Phosphate retention & decreased 1-alpha-hydroxylation (decreased 1,25 Vit D)
- Hypocalcaemia
- Increased PTH
Secondary hyperparathyroidism, can progress to tertiary
What is the initial management for kidney failure?
- Fluid balance - give IV fluids or diuretics
- Reduce K+
What are the 3 ways to reduce hyperkalaemia?
- Drive into cells - sodium bicarbonate, dextrose
- Drive out of body - diuretics/dialysis
- Reduced gut absorption - potassium binders
What are some long-term management options for kidney failure?
Transplant
Dialysis
Conservative treatment
What are some conservative treatments for kidney failure? (4)
Erythropoietin injections
Diuretics
Phosphate binders
1,25 Vit D supplements
What is the kidney failure risk equation used for? What patients are applicable?
What information is needed from the patient?
Risk prediction tool for kidney replacement therapy in the next 2 or 5 years
Patients with stable CKD, stages 3A to 5, with stable eGFR
Age, sex, eGFR, urine albumin-creatinine ratio
Methods of assessing GFR
Urea
Serum creatinine
Radionuclide studies (EDTA)
Creatinine clearance
Inulin clearance
What can affect serum urea levels?
Diet
Catabolic state
GI bleeding
Drugs
Liver function
What can affect serum creatinine levels?
Muscle mass
Age
Sex (higher in males)
Race
Why is creatinine clearance not used anymore to assess GFR?
Difficult for elderly patients to collect accurate samples
Overestimates GFR at low GFR
What factors should be considered when selecting a live kidney donor? (8)
Age
Mental health
2 healthy kidneys
FHx of kidney disease
Kidney match to patient (HLA, serum, blood type)
Comorbidities
Future pregnancy
Financial stability
What conditions are post-kidney-transplant patients more at risk for?
What can be done to counteract them?
Psychiatric disorders - being mindful & seek help
Cancer - sunscreen, regularly check skin & breasts
Cardiovascular disorders - active lifestyle, measure BP
Diabetes - active lifestyle, low sugar diet
Dietary considerations for post-kidney-transplant patients
What immunosuppressant is often used?
Regular fluid intake
Low salt and sugar diet
Avoid raw eggs, meat, fish and unpasteurised cheese
Avoid foods that interact with immunosuppressant e.g. Seville oranges, grapefruit
Tacrolimus
Drugs/medication considerations for post-transplant patients
Avoid NSAIDs
Stop smoking & alcohol & recreational drugs
Avoid live vaccines
Keep taking immunosuppressants
Keep getting flu jabs
