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Year 1 Body Systems > Renal > Flashcards

Flashcards in Renal Deck (216)
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121

What are the 6 symptoms associated with renal osteodystrophy in CKD and why do they occur?

Lack of calcium and phosphate problems
1) Osteomalacia
2) Muscle weakness
3) Bone pain
4) Hyperparathyroidism
5) Osteosclerosis
6) Adynamic bone disease

122

Why might you get oedema in CKD?

Heart failure is a CV symptom of CKD and you also get salt and water retention as a renal symptoms of CKD so these 2 together contribute to oedema

123

What are the 2 symptoms you may see in the skin in CKD and why?

Odd pigmentation
Puritis - phosphate deposited in the skin causes itching - poorly functioning kidneys dont remove phosphate well

124

What are the 2 symptoms associated with platelet abnormalities in CKD and why do they occur?

High urea (not excreted by the poorly functioning kidneys) interferes with platelet function
Get epistaxis (nose bleeds)
and bruising

125

What are the 3 CNS symptoms in CKD and what are they due to?

Uraemia and hyponatraemia
Confusion
Coma
Fits

126

Why does anaemia occur in CKD?

In response to hypoxia kidneys normally secrete erythropoietin which leads to the formation of RBCs
Poorly functioning kidney doesnt do this

127

What are the 4 CV symptoms in CKD and why do they occur?

1) Uraemic pericarditis
2) Hypertension (RAAS system knocked off?)
3) Peripheral vascular disease
4) Heart failure

128

Why might you get bone pain in CKD?

Bone disease - resorption of calcium from bone due to poor calcium absorption due to lack of active vitamin D from the kidneys

129

What are the 3 renal symptoms in CKD?

1) Nocturia
2) Polyuria
3) Salt and water retention

130

What are the 4 features of nephritic syndrome?

1) Haematuria
2) Proteinuria (non nephrotic)
3) Hypertension
4) AKI

131

Why would you do urinalysis investigations in CKD?

To look for blood or protein suggestive of glomerular disease

132

What 4 substances would you look for in the blood in suspected CKD?

1) Elevated urea
2) Elevated creatinine
3) Hypocalcaemia (indicative of CKD as opposed to AKI)
4) Hyperphosphataemia (again indicative of CKD as opposed to AKI)

133

Why would you perform immunology in CKD?

Myeloma screen
Look for immunoglobulins, do serum electrophoresis and look for Bence Jones protein)

134

What radiology would you perform in CKD?

Renal ultrasound scan to rule out obstruction

135

What is the BP target for CKD patients (compared to healthy patients) and why?

CKD - 130/80 mmHg
Healthy - 140/90mmHg
High BP over time will damage the kidneys
Kidney disease also leads to hypertension
CKD patients are a high risk group for CV disease and mortality

136

In CKD how is hyperkalaemia treated?

Reduced dietary intake

137

How is acidosis treated in CKD?

Sodium Bicarbonate tablets

138

How is metabollic bone disease treated in CKD (2 things)?

1) Phosphate binders - prevent it being absorbed in the gut allowing it to be excreted
2) Vit D tablets (containing active Vit D)

139

How is anaemia in CKD treated?

Subcutaneous Recombinant erythropoeitin
Ferrous sulphate

140

What are the 2 options for patients with ESKD?

1) Renal replacement therapy
2) Conservative therpay

141

What 4 things are included in renal replacement therapy?

1) Haemodialysis
2) Peritoneal dialysis
3) Haemofiltration
4) Renal transplantation

142

What is the national GFR for commencing dialysis?

8ml/min/1.73m2

143

How does peritoneal dialysis work?

Peritoneum is used as a semipermeable membrane
Tube placed directly into the peritoneal cavity and dialysis fluid is run into the peritoneal cavity
Uraemic toxins pass into the peritoneal fluid down a concentration gradient and water is dragged by osmosis into the peritoneal cavity (most dialysis fluids contain glucose to create this osmotic gradient)

144

What is the main benefit of peritoneal dialysis?

Can do it at home

145

What are the 2 possible complications of peritoneal dialysis?

Peritonitis
Sclerosing peritonitis

146

What are the 4 contraindications for peritoneal dialysis?

1) Presence of a hernia
2) Abdominal hernias
3) Severe arthritis - unable to perform technique
4) Previous surgery with adhesions

147

How does haemodialysis work?

Blood pumped through an artificial kidney (layers of semipermeable membrane known as a dialyser) with dialysis fluid flowing in the opposite direction
Uraemic toxins pass across the membrane by diffusion and water can be removed from the blood

148

Haemodialysis requires a blood flow of at least 200 ml per minute through the dialyser what are the 2 possible forms of vascular access?

1) An arterovenous fistula
2) Large bore double lumen cannula (can be used in an emergency

149

What are the benefits of haemodialysis?

Is hospital based for elderly patients

150

What are the possible complications of haemodialysis?

1) Hypotension
2) Infections of vascular access
3) Time consuming