Renal Failure Flashcards

Question

Renal failure

Answer 1

Result of Acute Kidney Injury (AKI) or Chronic kidney disease (CKD) (called End-Stage Renal Disease (ESRD) when the cause is CKD)

Answer 2

Symptoms of Uraemia (elevated blood urea + fluid, electrolyte and hormone imbalances): nausea, vomiting, lethargy Disorders of Micturition (urination): decreased frequency, nocturia, urine retention Disorders of Urine volume: polyuria, oliguria, anuria Alterations in urine composition (haematuria, proteinuria, bacteriuria, leukocyturia, calculi) Oedema: (hypoalbuminaemia, salt and water retention) Pain, Fatigue, Confusion Anaemia

Answer 3

•Impaired blood flow to the kidneys: severe dehydration, blood or fluid loss, heart attack, infection, sepsis, liver failure, anaphylaxis, renal artery stenosis, hyperperfusion, etc. • Damage to the kidneys: toxins, drugs, infections, autoimmune diseases, glomerulonephritis, muscle tissue breakdown (rhabdomyolysis), etc. •Urinary obstructions: kidney stones, prostate, bladder, cervical or colon cancer, etc.

Answer 4

Acute(temporary): • Myocardial infarction • Cardiac arrest (→impaired kidney oxygenation) • Rhabdomyolysis • Decreased perfusion of the kidneys (e.g. blood loss or shock) • Obstruction along the urinary tract • Haemolytic uremic syndrome (E. coli infection) • Toxins • Glomerulonephritis Chronic kidney disease(permanent damage): • Diabetic nephropathy • Hypertension • Lupus (autoimmune disease) • Prolonged urinary tract obstruction • Alport syndrome (genetic) • Nephrotic syndrome • Polycystic kidney disease (genetic) • Cystinosis (genetic) • Interstitial nephritis or pyelonephritis

Answer 5

3 types(prerenal=affecting blood supply,intrarenal=intrinsic kidney disease,postrenal(affecting lower urinary tract )

Answer 6

-Decreased blood flow to the kidneys -dehydration -hypotension -haemorrhage -sepsis -low cardiac output -burns -Postoperative fluid and blood losses

Answer 7

-urinary tract obstruction -bilateral obstructing kidney stones -prostatic enlargement -urinary tract neoplasms -neurogenic bladder -retropritoneal fibrosis involving both ureters

Answer 8

-intrinsic damage to the kidneys -diseases:glomerular,micro vascular ,systemic lupus etc -neprhotoxins:plant toxins,x ray contrast Media,NSAIDs -intrarenal obstruction eg bence jones protein

Answer 9

Stage 1: Creatinine concentration :≥ 26 μmol/L increase within 48 h Or 1.5-1.9-fold increase from baseline within 7 days Urine output:< 0.5 ml/kg/h for > 6 h Stage 2: Creatinine concentration: 2-3 fold increase from baseline within 7 days Urine output: < 0.5 ml/kg/h for > 12 h Stage 3: Creatinine concentration: ≥ 354 μmol/L Or ≥ 3-fold increase form baseline within 7 days Urine output: < 0.3 ml/kg/h for > 24 h or anuria for 12 h Biochemical changes In plasma : Increased: potassium urea creatinine phosphate magnesium hydrogen ion urate Decreased: Sodium Bicarbonate Calcium

Answer 10

• depends on the cause and stage of AKI • May require renal replacement therapy (dialysis)

Answer 11

CKD: Abnormal kidney structure or function, present for more than 3 months, with a gradual loss of kidney function over months and years 5 stages: 1=kidney damage with normal kidney function 2=kidney damage with mild loss of kidney function 3a=mild to moderate loss of kidney function 3b=moderate to severe loss of kidney function 4=severe loss of kidney function 5=kidney failure

Answer 12

Early CKD stages (1-3): mostly asymptomatic Later CKD stages: • weight loss and poor appetite • swollen ankles, feet or hands – as a result of water retention (oedema) • shortness of breath • tiredness • blood in the urine • an increased need to pee – particularly at night • difficulty sleeping (insomnia) • itchy skin • muscle cramps • feeling sick • headaches • erectile dysfunction in men

Answer 13

• Massive proteinuria—at least 3.5 g/day→frothy urine • Hypoalbuminemia (albumin < 3.5 mg/dL) • Generalized edema (e.g. peri-orbital, lower limb, ascites) • Shortness of breath (with associated chest signs of pleural effusion – e.g. stony dullness in lung bases) • Hyperlipidemia, hyperlipiduria (↑lipids in the urine –e.g. HDL)

Answer 14

• Causes: e.g. glomerulonephritis (inflammation of the glomeruli) • Mild to moderate proteinuria— less than 3.5g/L/day • Generalized edema • Low urine output • Associated with hypertension • Hematuria (presence of red blood cells in the urine) • RBC casts – symptom of glomerular damage • Uraemic symptoms (e.g. reduced appetite, fatigue, pruritus, nausea) • Poorer prognosis than nephrotic syndrome

Answer 15

Aim: ➢ Reduce rate of disease progression to stage 5 CKD (renal failure) ➢ Alleviate symptoms in stage 4 and 5 Management: • Blood glucose control (if diabetes is a leading factor for CKD) • Diuretics to promote sodium excretion • Anti-hypertensive drugs (e.g. targeting the Renin-Angiotensin system: ACEIs and ARBs) • Bicarbonate to control metabolic acidosis • Appropriatenutrition • Treatment of anaemia in the later CKD stages • Renal replacement therapy (dialysis of kidney transplantation) at stage 5 CKD

Answer 16

RF (Stage 5 CKD) begins when >90% of nephrons lost, corresponding to eGFR <15 ml/min/1.73m2 for more than 3 months Treatment: dialysis or transplantation