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Flashcards in Renal Disease/Treatments Deck (35):
1

What process does dialysis involve?

diffuse across semi permeable membrane

2

What does dialysis allow for the infusion of?

bicarbonate

3

What does dialysis remove toxin wise?

urea, potassium, sodium

4

What restrictions are placed on patients during dialysis?

fluid, salt, potassium and phosphate intake
phosphate binders taken with meals

5

What is the gold standard of dialysis access?

fistula

6

What else could be used as well as fistula?

tunneled venous catheter - but higher risk of infection

7

What is intradialytc hypotension and why is it a problem?

removing large volumes of water 3 times a week instead of continously is bad - can lead to low BP

8

What is peritoneal dialysis?

diffusion across peritoneal membrane

9

What is osmosis of water out driven by during PD?

high glucose concentration

10

What are the two types of PD?

CAPD (continous)
APD (automated)

11

What problems may arise with PD?

infection
Hernias (increased abdo pressure)
membrane failure due to fluid overload

12

What should you do if membrane failure occurs in PD?

switch to HD

13

What are metabolic complications of dialysis?

photphate retention
low vit D
hypocalcaemia
High PTH
anaemia
sodium/water retention

14

What can dialysis do to cardiovascular disease?

accelarate it

15

What GFR should cause you to start dialysis?

<5

16

What urea should start dialysis?

>45

17

When else should you start dialysis?

resistant hyperkalaemia
unresponsive acidosis
based on symptoms

18

Why do you need to gradually build up HD treatment?

disequilibrium syndrome may occur
leads to cerebral oedema/ seizures

19

What is the commonest cause of end stage renal failure?

diabetes

20

What is the second commonest cause of end stage renal failure?

chronic Glomerulonephritis

21

What is an important treatable cause of Acute Renal Failure.

Acute glomerulunephritis

22

Define glomerulonephritis.

Immune-mediated disease of the kidneys affecting the glomeruli
(with secondary tubulointerstitial damage)

23

In GN what leads to haematuria and/or proteinuria?

disruption of size and charge barrier

24

In GN, damage to what leads to a proliferative lesion and red cells in urine?

endothelial or mesangial cells

25

In GN, damage to what leads to a non-proliferative lesion and protein in urine?

podocytes

26

How is GN diagnosed?

CLINICAL PRESENTATION
BLOOD TESTS
EXAMINATION of URINE
Urinalysis - haematuria, proteinuria
Urine microsopy - RBC (dysmorphic), RBC & granular casts, lipiduria
Urine Protein: Creatinine Ratio / 24 hour urine - quantify proteinuria
KIDNEY BIOPSY

27

What is involved in nephrItic syndrome?

Acute Renal Failure
Oliguria
Oedema/ Fluid retention
Hypertension
Active urinary sediment
RBC’s, RBC & Granular Casts

Indicative of a proliferative process

28

What is involved in nephrOtic syndrome?

Proteinuria  3 g/day (mostly albumin, also globulins)
Hypoalbuminaemia (<30)
Oedema
Hypercholesterolaemia
Usually normal renal function

Indicative of a non proliferative process

29

How is GN classed in terms of primary and secondary?

Primary (Idiopathic): THE MAJORITY
Secondary: caused by eg. infections or drugs associated - malignancies or part of systemic disease eg. ANCA - associated systemic vasculitis, lupus, Goodpastures, HSP

30

In what other ways can GN be classed?

Proliferative or non-proliferative
Focal/Diffuse (50% glomeruli affected?)
Global/Segmental (all or part glomerulus affected)
Crescentic (presence of crescents - epithelial cell extracapillary proliferation eg. RPGN in vasculitis)

31

What is the commonest cause of nephrotic syndrome in children?

Minimal Change Nephropathy

32

What is the commonest cause of nephrotic syndrome in adults (35%)?

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

33

What is the commonest GN in the world?

IgA Nephropathy

34

What type of rapidly progressive glomerulonephritis is ANCA positive?

Systemic Vasculitis
Wegener’s granulomatosis
(Granulomatosis with polyangiitis)
Microscopic polyangiitis

35

What type of rapidly progressive glomerulonephritis is ANCA negative?

Goodpasture’s disease-Anti-GBM
Henoch Scholein Purpura HSP/IgA
Systemic Lupus Erythematosus