Flashcards in Renal Deck (216)
What are the 6 symptoms associated with renal osteodystrophy in CKD and why do they occur?
Lack of calcium and phosphate problems
2) Muscle weakness
3) Bone pain
6) Adynamic bone disease
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
What are the 2 symptoms you may see in the skin in CKD and why?
Puritis - phosphate deposited in the skin causes itching - poorly functioning kidneys dont remove phosphate well
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)
What are the 3 CNS symptoms in CKD and what are they due to?
Uraemia and hyponatraemia
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
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
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
What are the 3 renal symptoms in CKD?
3) Salt and water retention
What are the 4 features of nephritic syndrome?
2) Proteinuria (non nephrotic)
Why would you do urinalysis investigations in CKD?
To look for blood or protein suggestive of glomerular disease
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)
Why would you perform immunology in CKD?
Look for immunoglobulins, do serum electrophoresis and look for Bence Jones protein)
What radiology would you perform in CKD?
Renal ultrasound scan to rule out obstruction
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
In CKD how is hyperkalaemia treated?
Reduced dietary intake
How is acidosis treated in CKD?
Sodium Bicarbonate tablets
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)
How is anaemia in CKD treated?
Subcutaneous Recombinant erythropoeitin
What are the 2 options for patients with ESKD?
1) Renal replacement therapy
2) Conservative therpay
What 4 things are included in renal replacement therapy?
2) Peritoneal dialysis
4) Renal transplantation
What is the national GFR for commencing dialysis?
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)
What is the main benefit of peritoneal dialysis?
Can do it at home
What are the 2 possible complications of peritoneal dialysis?
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
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
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
What are the benefits of haemodialysis?
Is hospital based for elderly patients