CPRS Case 10: Renal Failure Flashcards Preview

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Flashcards in CPRS Case 10: Renal Failure Deck (9)
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1
Q

Recognise physiology of normal kidney functions and pathophysiology in kidney failure

A

See lecture

2
Q

Mechanism of fluid / electrolyte / acid-base homeostasis and excretion of metabolic waste by the kidneys

A

See lecture

3
Q

Difference between acute and chronic renal failure, and conditions that can lead to either

A

Acute:

  • quick onset
  • reversible
  • pre-renal: Ischaemia
  • intra-renal: GN, tubular necrosis
  • post-renal: UTI

Chronic:

  • gradual onset
  • irreversible loss of nephrons
  • Chronic glomerulonephritis
  • hypertension
  • DM
  • long term medication (NSAIDs)
4
Q

Approach to investigate patient’s with abnormal renal function

A
  1. Urinalysis
    - Protein
    - RBC
    - Glucose
  2. Blood test
    - Electrolyte
    - Urea and Creatinine
    - Liver enzymes (ALT, Alkaline Phosphatase)
    - Haemoglobin
  3. Ultrasonogram
    - Size of kidney
5
Q

***Common biochemical / haematological investigation results of patients with renal diseases

A

Chronic renal failure:

  • Generalised oedema (salt and water retention)
  • Metabolic acidosis (cannot excrete acidic products)
  • Azotaemia / uraemia (cannot excrete metabolic end products of proteins)
  • High concentration of other substances (phenols, phosphates, potassium)
***Kidney failure
Increase:
- Non-protein nitrogenous waste product
- K (calcium gluconate, beta agonist, insulin)
- H
- water
- Phosphate, sulphate (phosphate binder)
- phenols
Decrease:
- Na
- HCO3 (cannot synthesize)
- RBC (blood transfusion may worsen fluid overload)
- albumin
- Ca (arrhythmia, neuromuscular disease)

Water retention:

  • reduced kidney function to excrete water and salt
  • decrease in Na concentration (dilution effect)
  • increased secretion of renin and angiotensin
  • decrease in albumin

Increased potassium and phosphate:
- due to decreased GFR

Acidosis:

  • acid accumulate in body fluid
  • buffering power is used up —> Low bicarbonate level

Azotaemia:

  • Increased urea, uric acid, creatinine
  • concentration rise in proportion to degree of reduction —> assess CKD severity

Decreased albumin:

  • loss in urine
  • protein energy wasting

Anaemia:

  • reduced erythropoietin production
  • chronic problem because hormonal changes take time
6
Q

Psycho-social implications of chronic renal failure and of patients with chronic disease in general

A
  1. Intense emotions to illness
  2. Change of behaviour
  3. Disruption to work, school (unemployment)
  4. Disruption to family life (change in family role)
7
Q

Factors that determine health seeking behaviour and psychological reactions of patients towards chronic diseases

A

Factors that determine health seeking behaviour

  • Gender
  • Social support (migration)
  • Financial
  • Illness cognition (how common, how familiar with the symptoms)
  • Illness danger (predictability of outcome, amount of threat)

Psychological reaction towards chronic diseases

  • Fear
  • Anxiety
  • Depression

Default follow-up

  • Financial consideration
  • Dissatisfaction
  • Patient’s belief
  • Improvement in symptoms
8
Q

Impact of health economics involved in management of patients with chronic renal failure, and of patients with chronic diseases in general

A
  • A lot of money spent on dialysis and renal transplant

- Disturbance to everyday life

9
Q

Ethical issues involved in renal replacement therapy

A
  1. Organ trade
  2. Familial pressure towards living-related transplantation
  3. Appropriate allocation of available organ
  4. Ways to increase organ donation