Flashcards in Clinical Problems: Kidney Failure Deck (20)
What is the main definition of Kidney Failure?
A reduction in Glomerular Filtration rate.
(You may also get high K+, uraemia, high creatinine or oliguria, but not necessarily)
What do you wanna do when you get a patient
What do you want to know when history taking?
Has she been peeing (at night?)
Past diabetic history?
Dryness of skin>
JVP (1-2cm normal)
High vs low JVP?
High= fluid overload
Low= Less fluid volume (volume depleted)
What does it mean if creatinine is really high (normal ~ 70)
Represents diminished kidney function as the kidneys are unable to remove this waste product
Which blood test is most important for distinguishing between acute and chronic Renal failure?
The kidneys make erythropoietin (turns bone marrow cells into RBCs)
When renal failure occurs, obviously this stops happening BUT as RBC have a 120day lifespan, this can only be seen in bloodtests in CHRONIC kidney failure. (takes a while to become anaemic from this)
3 roles of the kidney
1) Remove fluid and electrolytes
2) Produce Erythropoietin
3) alpha hydroxylate vitamin D (Storage to active)
Acute Renal Failure
Acute deterioration of kidney function over a short period of time.
Usually associated with another illness (eg vomiting/diarrhoea leads to dehydration)
Pre-renal Acute Kidney failure
-Due to decreased perfusion of the kidneys
-Generally low BP (bleeding, sepsis, dehydration, HF)
Some progress to intrinisic renal damage (ATN)
Renal Acute Kidney Failure
-Mainly Acute Tubular Necrosis
-Mainly from pre-renal that wasn't treated in time
Rapidly Progressive Glomerulonephritis
-rapid acute renal failure
-cresecents in glomeruli on biopsy
- Red cells and casts in urine
Whats the best what to test for Post-renal Acute renal failure
Ultrasound as usually a blockage (stone etc) (hydronephrosis)
(also palpation of bladder)
High urea, creatinine, phosphate
What do they have?
Chronic kidney disease!
Signs/symptoms of fluid overload
EdemaDifficultly breathing lying down
crackles on auscultation
Strong rapid pulse
Signs of CKD
No acute presentation until function is REALLY bad!
-Fluid Overload (high BP, oedema, pulm oedema)
Apart from haem, what are some other tests helpful in confirming the diagnosis
Kidney Size <8cm (normal 10-11cm)
Presence of obstruction
Whats the best treatment for CKD
Treat the high BP!! (<130/80)
Best BP treatment are ACE inhibitors (but many people are also on Beta-blockers, diuretics etc)
Whats the most likely cause of CKD?
Diabetes (rates increasing!)