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Year 3 Renal > Renal Failure > Flashcards

Renal Failure Flashcards

1
Q

What indicates hypovoleamia?

A

Cold hands
No visible JVP
Reduced capillary refill
Low BP

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2
Q

Why would a patient have a high respiratory rate with normal O2 and clear lungs on auscultation?

A

Respiratory compensation in response to metabolic acidosis

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3
Q

What is Kussmaul respiration?

A

Hyperventilation to breathe of CO2

O2 goes up

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4
Q

What is the state of the kidneys in CKD?

A

Small shrunken kidneys

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5
Q

What is interesting about salt and water balance?

A

Can cause kidney failure

Can be a symptom

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6
Q

What does kidney failure result in re salt and water?

A

REDUCE secretion of salt and water leading to:
Hypertension
Oedema
Pulmonary oedema

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7
Q

When might water loss be seen?

A

BUT Salt and water loss may be seen in tubulointerstitial disorders – damage to concentrating mechanism
& hypovolemia may be the cause of AKI.

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8
Q

What do you give to treat hyperkalaemia?

A

Bicarbonate
To reduce H+
So potassium can return to cell

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9
Q

What causes hyperkalaemia?

A

↓ Distal tubule potassium secretion

Acidosis

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10
Q

What are the symptoms of hyperkalaemia?

A

Cardiac arrhythmias
Neural and muscular activity
Vomiting

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11
Q

What do the symptoms of hyperkalemia depend on?

A

Chronicity

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12
Q

What are the ECG findings for arrhythmias caused by hyperkalaemia?

A 
Peaked T waves
P wave - broadens 
	- reduced amplitude -	- disappears
QRS widening
Heart block
Asystole
VT/VF
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13
Q

What does reduced erythropoietin cause?

A

Anaemia

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14
Q

What does reduced Vit D result in?

A

Reduced intestinal calcium absorption

Hypocalcaemia

Hyperparathyroidism

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15
Q

What is a major predictor of end stage renal failure?

A

CKD
BUT
Major outcome for a patient with CKD is cardiovascular disease
i.e. a patient with CKD is more likely to die from cardiovascular disease than end stage renal failure

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16
Q

How do you treat hypovolaemia?

A

Fluidshttps://www.brainscape.com/decks/11272691/cards/quick#

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17
Q

How do you treat hypervolaemia?

A

Diuretics if there is sustained urine ouput

Dialysis

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18
Q

How do you treat hyperkalaemia?

A

Drive into cells

  • sodium bicarbonate
  • insulin dextrose (caution)

Drive out of the body – diuretics/dialysis

Gut absorption – potassium binders, stay in gut, excreted via faeces

19
Q

What is the long term conservative management for kidney failure?

A
  • erythropoietin injections to correct anaemia
  • diuretics to correct salt water overload
  • phosphate binders
  • 1.25 vit d supplements
  • symptom management
20
Q

What is the ultimate aim in renal failure?

A

Transplantation if fit enough

21
Q

Why would you opt for conservative mangement?

A

Sometime dialysis would not be hugely beneficial

Dialysis is not very pleasant

22
Q

What home therapy is available?

A

Heamodialysis

Peritoneal dialysis/Assisted programmes

23
Q

What in centre therapy is available?

A

Haemodialysis

4 hours, 3 times a week

24
Q

How is a fistula created?

A

Connect artery to vein

Vein swells up - easy to get needles in to

25
Q

What should be avoided in kidney patients?

A

Taking blood or IV lines into the veins in the ante-cubital fossa

Avoiding transfusions in transplantable patients

26
Q

Why do you avoid transfusions?

A

Sensitisation can risk transplant success

27
Q

What are the features of using Creatinine to assess GFR?

A

Affected by muscle mass, age, race, sex etc.

Need to look at the patient when interpreting the result. TREND helpful.

28
Q

What are the features of using Creatinine clearance to assess GFR?

A

Difficult for elderly patients to collect an accurate sample

Overestimates GFR at low GFR (as a small amount of creatinine is also secreted into urine)

29
Q

What are the features of using radionuclide to assess GFR?

A

EDTA clearance etc
Reliable but expensive
Used for donated kidneys to check function prior to transplantation

30
Q

How does haemodilaysis work?

A

Blood flows into dialyzer
Countercurrent movement (blood and dialysate)
Via diffusion the blood is cleaned
Fresh dialysate is pumped in and used pumped out
Doctor can adjust property of dialysate solution according to the patients need

31
Q

How does peritoneal dialysis work?

A

Dialysate pumped into peritoneal cavity
Peritoneum acts as semi-permeable membrane
Diffusion occurs
Dialysiate pumped out via catheter

32
Q

What are the pros and cons of haemodialysis?

A

Dialysis centre visits (can be performed at home)

3-4.5 hours of treatment 3x a a week

33
Q

What are the pros and cons of peritoneal dialysis?

A

-

34
Q

What factors are considered in determining a candidate as a suitable live kidney donor?

A 
Patient fitness
Good kidney function
Psychological assessment
Blood type - but you can transplant against blood type
Tissues type (HLA, serum crossmatch)
Kidney size
No blood/protein in urine
Financial stability (of work for 4 weeks)
Age
Future pregnancy
Comorbidities
Family history of kidney disease
35
Q

What advice should be given to those post transplant?

A 
Low salt
Hygiene
No grapefruit
Manage BP
Use sunscreen
Be mindful of psychiatric disorders
Regular fluid intake
36
Q

Why is the old kidney left in situ?

A

Operative risk of removing is significant

37
Q

When would you remove the old kidney?

A

Concern in the native kidney e.g. cancer/TB

Polycystic kidneys - too bug

38
Q

What should be avoided after having a transplant?

A

Raw eggs/meat
Undercooked fish and unpasteurised chsses
Seville oranges/marmalade/grapfruit 0 can interact with immunosupressants
No live vaccines
No smoking
No NSAIDS/Herbal meds
No alcohol

39
Q

What should be avoided after having a transplant?

A

Raw eggs/meat
Undercooked fish and unpasteurised chsses
Seville oranges/marmalade/grapefruit - can interact with immunosupressants
No live vaccines
No smoking
No NSAIDS/Herbal meds
No alcohol

40
Q

What investigations are done for CKD?

A

Bloods - high creatinine, low eGFR

Urinalysis (haem/protein/albuminuria)

Renal US (kidney size)

41
Q

What is the conservative management for CKD?

A

Stop nephrotoxic drugs
Manage underlying cause
Diet - sodium/protein restriction
Smoking cessation

42
Q

What is the medical management for CKD?

A

ARB or ACEi
Loop diuretic e.g. fureosmide
Statin if hyperlipidaemia

43
Q

What is interventional management of CKD?

A

Renal replacement therapy

  • Haemodialysis
  • Peritoneal dialysis
  • Kidney transplant

Year 3 Renal (7 decks)

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