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Year 2 Uro > Renal Failure > Flashcards

Renal Failure Flashcards

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1
Q

What are the homeostatic functions of the kidney?

A

Electrolyte balance
Acid-base balance
Volume homeostasis

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2
Q

What are the endocrine functions of the kidney?

A

Erythropoietin

1 alpha hydroxylase

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3
Q

What are the excretory functions of the kidney?

A 
Nitrogenous waste
Hormones
Peptides
Middle sized molecules”
Salt and water
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4
Q

How is the kidney involved in glucose metabolism?

A

Gluconeogenesis

Insulin clearance

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5
Q

What happens when the homeostatic function is compromised?

A 
Increase potassium
Decreased bicarb
Decreased pH
Increased phosphate
Salt and water imbalance
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6
Q

What happens when the excretory function is compromised?

A

Increased urea
Increased creatinine
Decreased insulin requirement

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7
Q

What happens when the endocrine function is compromised?

A

Decreased calcium
Anaemia
Increased PTH - tertiary hyperparathyroidism possible

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8
Q

Overall what does Kidney failure increase risk of?

A

Cardiovascular problems

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9
Q

What is the clinical presentation related to?

A

Rate of deterioration

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10
Q

What is the most important thing to asses with renal failure?

A

Blood volume

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11
Q

What indicates hypovoleamia?

A

Cold hands
No visible JVP
Reduced capillary refill
Low BP

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12
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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13
Q

What is Kussmaul respiration?

A

Hyperventilation to breathe of CO2

O2 goes up

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14
Q

What is the state of the kidneys in CKD?

A

Small shrunken kidneys

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15
Q

What is interesting about salt and water balance?

A

Can cause kidney failure

Can be a symptom

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16
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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17
Q

When might water loss be seen?

A

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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18
Q

What do you give to treat hyperkalaemia?

A

Bicarbonate
To reduce H+
So potassium can return to cell

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19
Q

What causes hyperkalaemia?

A

↓ Distal tubule potassium secretion

Acidosis

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20
Q

What are the symptoms of hyperkalaemia?

A

Cardiac arrhythmias
Neural and muscular activity
Vomiting

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21
Q

What do the symptoms of hyperkalemia depend on?

A

Chronicity

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22
Q

What are the ECG findings for arrhythmias caused by hyperkalaemia?

A 
tented T waves
P wave - broadens - - reduced amplitude -	- disappears
QRS widening
Heart block
Asystole
VT/VF
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23
Q

What does reduced erythropoietin cause?

A

Anaemia

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24
Q

What does reduced Vit D result in?

A

Reduced intestinal calcium absorption

Hypocalcaemia

Hyperparathyroidism

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25
What do the effects on metabolism result in?
Increased risk of CVD
26
What is a major predictor of end stage renal failure?
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
27
What are standard cardiovascular risks?
Hypertension Diabetes Lipid abnormalities
28
What are the additional cardiovascular risks in renal faliure?
Inflammation Oxidative stress Mineral/bone metabolism disorder
29
How do you treat hypovolaemia?
Fluids
30
How do you treat hypervolaemia?
Diuretics if there is sustained urine ouput Dialysis
31
How do you treat hyperkalaemia?
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
32
What is the long term conservative management for kidney failure?
- erythropoietin injections to correct anaemia - diuretics to correct salt water overload - phosphate binders - 1.25 vit d supplements - symptom management
33
What is the ultimate aim in renal failure?
Transplantation if fit enough
34
Why would you opt for conservative mangement for renal failure?
Sometime dialysis would not be hugely beneficial Dialysis is not very pleasant
35
What home therapy is available?
Heamodialysis | Peritoneal dialysis/Assisted programmes
36
What in centre therapy is available?
Haemodialysis | 4 hours, 3 times a week
37
How is a fistula created?
Connect artery to vein | Vein swells up - easy to get needles in to
38
What should be avoided in kidney patients?
Taking blood or IV lines into the veins in the ante-cubital fossa Avoiding transfusions in transplantable patients
39
Why do you avoid transfusions?
Sensitisation can risk transplant success
40
What are the features of using Urea to assess GFR?
Poor indicator | Confounded by diet, catabolic state, GI bleeding (bacterial breakdown of blood in gut), drugs, liver function etc.
41
What are the features of using Creatinine to assess GFR?
Affected by muscle mass, age, race, sex etc. | Need to look at the patient when interpreting the result. TREND helpful.
42
What are the features of using Creatinine clearance to assess GFR?
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)
43
What are the features of using Inulin clearance to assess GFR?
Laborious - used for research purposes only | best way to calculate GFR
44
What are the features of using radionuclide to assess GFR?
EDTA clearance etc Reliable but expensive Used for donated kidneys to check function prior to transplantation
45
What is the GFR equation? MDRD
GFR (mL/min/1.73m2) = 175 x (SCr)-1.154 x (Age)-0.203 x (0.742 if female) x (1.212 if Afr American)
46
What is the GFR equation? (CKD-EPI)
GFR = 141 x min (SCr/K,1)-α x max (SCr/K,1)-1.209 x 0.993Age x 1.018 [if female] x 1.159 [if black]
47
What are the different methods of dialysis?
Haemodialysis
48
How does haemodilaysis work?
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
49
How does peritoneal dialysis work?
Dialysate pumped into peritoneal cavity Peritoneum acts as semi-permeable membrane Diffusion occurs Dialysiate pumped out via catheter
50
What are the pros and cons of haemodialysis?
Dialysis centre visits (can be performed at home) | 3-4.5 hours of treatment 3x a a week
51
What are the pros and cons of peritoneal dialysis?
-
52
What factors are considered in determining a candidate as a suitable live kidney donor?
``` 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 ```
53
What advice should be given to those post transplant?
``` Low salt Hygiene No grapefruit Manage BP Use sunscreen Be mindful of psychiatric disorders Regular fluid intake ```
54
Why is the old kidney left in situ?
Operative risk of removing is significant
55
When would you remove the old kidney?
Concern in the native kidney e.g. cancer/TB Polycystic kidneys - too bug
56
What should be avoided after having a transplant?
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
57
What should be avoided after having a transplant?
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
58
AKI vs CKD history
acute vs chronic | history of acute illness e.g gastroenteritis vs history of impaired renal function
59
AKI vs CKD on examination
AKI - acutely ill, SOB, arrythmia, fatigue, nausea, may be hypotensive/acidotic/fluid overload CKD - signs of anaemia, cachexia, grey skin, weak
60
AKI vs CKD bloods
AKI - rapidly increasing creatinine, normal calcium, normal-low Hb CKD - slowly trending increase creatinine, low calcium (untreated), normocytic anaemia
61
ultrasound AKI vs CKD
AKI - normal | CKD -scarring, smaller kidneys
62
GFR using renal plasma flow
renal plasma flow x filtration fraction
63
GFR using filtration coefficient
net ultrafiltration pressure x filtration coefficient
64
renal clearance calculation
rate of urine production x concentration of urine / concentration of substance in plasma in mL/min
65
what are all the functions of the kidneys A WET BED
``` Acid base balance Water balance Electrolyte balance Toxin removal Blood pressure control Erythropoietin vitamin D metabolism ```

Year 2 Uro (5 decks)

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