Lecture 8 - Renal Failure

Question 1

Key roles of kidneys?

Answer 1

elimination of waste products, control of fluid balance, regulate acid-base balance, produce hormones

Question 2

GFR?

Answer 2

the rate at which blood is cleared of waste products

Question 3

Staging AKI?

Answer 3

Stage 1: <2x s[Creatinine] and <0.5ml/kg/hr for 6-12 hrs; 2: 2-2.9x s[Cre] and <0.5 for 12+ hrs; 3: 3x+ s[Crea] and <0.3 for 24+hr or anuria for 12+hr

Question 4

Types of AKI?

Answer 4

pre-renal, intra-renal, post

Question 5

At risk patients?

Answer 5

CKD, >75yr, heart failure, liver disease, CVD, diabetes, polypharmacy

Question 6

Medications to avoid?

Answer 6

nephrotoxic: NSAIDs, gentamicin, anti-hypertensives; renally excreted: hypoglycaemic agents

Question 7

General approach to prevent kidney disease?

Answer 7

identify risk groups, stop nephrotoxic agents, assess and optimise volume status (JVP), monitor creatinine and urine output

Question 8

Investigations?

Answer 8

strep. serology, autoimmunity check, viral serology, blood tests, urine analysis, imaging, renal biopsy

Question 9

Inulin clearance?

Answer 9

gold standard in measuring GFR, sugar filtered by glomerulus, isn’t reabsorbed no secreted into the tubule: GFR = (volume urine in time + urine inulin conc.)/conc. of inulin in blood

Question 10

Chemicals for isotope clearance?

Answer 10

51Cr-EDTA, 125I-IOT

Question 11

Creatinine clearance =?

Answer 11

(urine creatinine x urine volume)/(plasma creatinine x time period) - tends to overestimate GFR due to tubule secretion, serum values also affected by muscle mass

Question 12

Classification of CKD?

Answer 12

cause, GFR category, albuminuria category (CGA)

Question 13

CKD and GFR?

Answer 13

> 90, 60-90, 30-60, 15-30, <15 (CKD 1, 2, 3, 4, 5)

Question 14

Albuminaria addition to staging?

Answer 14

<30mg/mmol, 30-300mg/mmol, >300mg/mmol (A1, A2, A3)

Question 15

Sociodemographic risk factors?

Answer 15

old, male, Maori/Pacific, low income, obesity, smoking

Question 16

Most common causes of CKD?

Answer 16

diabetic nephropathy, glomerulonephritis (likne to IgA nephropathy), hypertensive nephrosclerosis, polycystic kidney disease

Question 17

Secondary factors contributing to End Stage Kidney Failure?

Answer 17

hypertension (systemic and intra-glomerular), glom. hypertrophy, Ca and P, dyslipidaemia, proteinuria, fibrosis, molecule toxicity

Question 18

Treating hypertension?

Answer 18

weight loss, salt restriction, exercise, moderation of alcohol, smoking cessation, multiple drug therapy -> 140/80 or better

Question 19

Drug therapies?

Answer 19

diuretics, renin:angiotensin, SNS

Question 20

Managing proteinuria?

Answer 20

weight loss, protein restriction, statins, aldosterone antagonists, ACE-inhibitors -> 125/70 or better

Question 21

Ca and P treatments?

Answer 21

limit P in diet, phosphate binders

Question 22

Acid-base balance?

Answer 22

CKD -> metabolic acidosis due to lack of non-organic acid excretion, treated with oral sodium bicarbonate

Question 23

Uraemia?

Answer 23

CKD 4 or 5, toxin build up in blood, no certain compound, neurological, haemotological, CVD, pulmonary, GI, metabolic and skin and psychological symptoms

Question 24

ESKD treatments>

Answer 24

dialysis (peritoneal and haemodialysis) and transplant (live or cadaveric)