Renal Flashcards
(34 cards)
What is chronic kidney disease?
Irreversible and progressive loss of kidney function
Occurs over months - years
Results in a scarred, non-functional kidney
What are some causes of CKD?
Diabetes mellitus - most common
Hypertension
Glomerulonephritis
Obstruction
Systemic diseases
How is CKD assessed?
Measuring kidney function - eGFR
Urine dipstick - proteinuria, haematuria
Renal USS - size and evidence of obstruction
How should CKD be managed?
Lifestyle modification - lose weight, stop smoking, healthy diet
Tight blood glucose control
Control of HTN:
Keep within 120-139mmHg systolic
Give an ACE-I or ARB
Cardiovascular risk:
Give atorvastatin
What is the effect of CKD on water and salt handling by the kidneys?
Reduced GFR => lose ability to maximally dilute and concentrate urine
Small glomerular filtrate but same solute load => increases osmolarity => osmotic diuresis
What are some complications of CKD?
Hyperkalaemia Metabolic acidosis Anaemia Mineral bone disease Altered drug metabolism
How does CKD cause anaemia?
Decreased EPO
Short RBC life span
Absolute iron deficiency - malnutrition, poor absorption
High hepcidin, inflam and infection => iron deficiency and impaired bone marrow response to EPO
How does CKD cause mineral bone disease?
Impaired renal function => decreased Vit D => less Ca2+ absorption from GI tract => low plasma [Ca2+] => PTH release => inc bone reabsorption
Causes secondary hyperparathyroidism
Calcium and phosphate accumulate => calcification of arteries, skin and joints
What class of drugs should be avoided in CKD and why?
NSAIDs
Inhibition of prostaglandin mediated vasodilation of afferent arteriole
Results in vasoconstriction of afferent arteriole => reduced renal perfusion => reduced GFR
What is end stage renal failure?
When death is likely without renal replacement therapy
eGFR <15 ml/min
What are some symptoms of end stage renal failure?
Overwhelming fatigue Difficulty sleeping Difficulty concentrating Peripheral and pulmonary oedema Nausea and vomiting
When is renal replacement therapy indicated?
eGFR 8-10 ml/min
What are some examples of renal replacement therapy?
Haemodialysis
Peritoneal dialysis
Transplant
What is haemodialysis?
A method of removing waste products and excess fluid from the blood using a dialysis machine
Requires a fistula - connection between cephalic vein and brachial artery
Done 3 times a week for 4 hrs each time, can be done at night
What are some advantages of haemodialysis?
Less responsibility for pt
Can have days off
What are some disadvantages of haemodialysis?
Travel and waiting time
Tied to dialysis items
Big restrictions on food and fluid intake
What are some complications of dialysis?
Infections
Thrombosis
Venous stenosis
Problems w/ AVF
What is peritoneal dialysis?
Uses the peritoneum as a membrane to exchange substances
Fill abdomen w/ fluid containing dextrose
Requires surgery to fit a catheter
What are some advantages to peritoneal dialysis?
Allows independence
Generally less food and fluid restriction
Fairly easy to travel
What are some disadvantages to peritoneal dialysis?
Frequent daily changes on catheter bags
Responsibility is on pt
What are some complications of peritoneal dialysis?
Peritonitis
Hernias - fluid within abdo cavity puts strain on muscles
Weight gain - absorption of sugars from dialysis fluid
Leakage of fluid
What is acute kidney injury?
Abrupt decline in GFR, taking place over days to weeks
Significant increase in plasma creatinine and oliguria
What are three general causes of AKI?
Pre-renal
Renal
Post-renal
How do pre-renal conditions cause AKI?
Decreased blood flow => reduced GFR
No cell damage => kidney works to maintain BP => RAAS and ADH
Responds to fluid resuscitation
