CPRS Case 10: Renal Failure Flashcards Preview

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Recognise physiology of normal kidney functions and pathophysiology in kidney failure

See lecture


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

See lecture


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

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

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


Approach to investigate patient’s with abnormal renal function

1. Urinalysis
- Protein
- Glucose

2. Blood test
- Electrolyte
- Urea and Creatinine
- Liver enzymes (ALT, Alkaline Phosphatase)
- Haemoglobin

3. Ultrasonogram
- Size of kidney


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

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
- Non-protein nitrogenous waste product
- K (calcium gluconate, beta agonist, insulin)
- H
- water
- Phosphate, sulphate (phosphate binder)
- phenols
- 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

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

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

Decreased albumin:
- loss in urine
- protein energy wasting

- reduced erythropoietin production
- chronic problem because hormonal changes take time


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

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


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

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


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

- A lot of money spent on dialysis and renal transplant
- Disturbance to everyday life


Ethical issues involved in renal replacement therapy

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