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Flashcards in Kidney Deck (31)
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1

How many adults in the UK have CKD?

8%

2

Costs of CKD to NHS

Dialysis
Transplantation
Antihypertensives
1º care consultations
Anaemia
Admissions to hospital
Excess MI, stroke

3

How much did CKD cost the NHS in 2009-10?

£1.45 billion

4

What is the commonest cause of renal impairment?

Diabetes

5

Functions of kidney lost in CKD-> symptoms

Waste excretion-> build up of toxins, uraemia
Acid base balance-> Metabolic acidosis, hyperkalaemia
Salt/water homeostasis-> Oliguria/polyuria, peripheral oedema
Blood pressure control-> hypertension
Gluconeogensesis, insulin metabolism-> T2DM
Secretion of erythropoetin-> Anaemia
Calcitriol production-> Vit D deficiency, hyperparathyroidism

6

How is CKD self perpetuating?

Sclerosis/fibrosis/atrophy
-> RAAS activation, aldosterone
-> Hypertension and mechanical vascular damage
-> Inflammation
-> Profibrotic cytokines
-> Glomerulosclerosis so less functional nephrons
-> Increased blood flow to remaining nephrons
-> Intraglomerular hypertension
-> Intraglomerular sclerosis

7

Name 2 pro fibrotic cytokines

TGF-B
Plasminogen activator inhibitor 1

8

Treatment of CKD

ACEi and ang-II receptor blockers in younger patients
Calcium channel blockers in older patients who already have renal disease so can't lower kidney perfusion by blocking RAAS

9

How is the diagnosis of CKD made?

2 eGFR estimations 3mg/mmol

10

Normal eGFR?

90 or more

11

Treatment of anaemia?

Parenteral iron
Epo injections
HIF stabilisers (hypoxic induced factor)

12

What is tumoural calcinosis?

Chunks of calcium caused by CKD mineral bone disorders

13

Why does hyperparathyroidism occur in CKD?

Less kidney mass, insufficient Vit D so calcium remains low
PTH remains unsupressed
= secondary hyperparathyroidism

14

What happens in worsening CKD?

Instead of hypocalcaemia due to less Vit D Ca2+ starts being resorbed from bone so hypercalcaemia occurs and hyperphosphataemia too

15

What is tertiary hyperparathyroidism?

Due to upregulation and hypertrophy of parathyroid glands in secondary hyperparathyroidism
Even if corrected, sometimes the glands remain hyperfunctioning

16

What happens with hyperparathyroidism?

Loss of bone mass, increased fractures
Hyperphophataemia
Vascular calcification (CVD, thrombosis, skin necrosis)

17

Treatment of hyperparathyroidism in CKD?

Vitamin D replacement
Dietary phosphate reduction
Phosphate binders (Ca salts)
Calcimimetics
Parathyroidectomy

18

How does CKD cause death?

Pulmonary oedema
Hypertension -> CVD
Nauseated and anorexic
Anaemia
Convulsions (ion imbalance)
Sudden cardiac death

19

What eGFR is end stage renal disease?

Less than 5mls/min

20

Types of treatment for end stage CKD?

Haemodialysis
Peritoneal dialysis
Renal transplantation

21

What is inserted into blood before the dialysis chamber?

Heparin to avoid coagulation

22

How does dialysis work?

Semi permeable membrane, countercurrent exchange

23

What are the drawbacks of haemodialysis?

Needs to be done each day
Recquires fashioning of AV fistula
Doesn't correct hormone imbalances or avoid CVD risk

24

What fluid is used for peritoneal dialysis?

Glucose solution that draws out nitrogenous waste

25

What are the 4 types of peritoneal dialysis?

NIPD (Night time intermittent)
CCPD (continuous cycling)
CAPD (continuous abulatory)
APD (automated)

26

What does a person need to be eligible for kidney transplantation?

Progressive irreversible kidney failure
No current infection
No current malignancy
Prrof of compliance with treatments
Life expectancy without transplant more than 5 years
BMI less than 40

27

3 options for renal tranplantation

Cadaveric brain stem death donor
Cadaveric cardiac death donor
Live donation

28

What is looked at for compatibility with kidney transplantation?

ABO
HLA
Not affected by same genetic disease
No diabetes/hypertension/malignancy

29

Can kidneys still be transplanted without ABO compatibility?

Yes, via plasma exchnage and immunoadsorption
Transplant in immunologically naive state

OR a paired sharing scheme could be used

30

Risk of rejection of kidney transplant with current methods?

Less than 10%