Session 11 - Chronic Kidney Disease Flashcards Preview

Semester 3 - Urinary > Session 11 - Chronic Kidney Disease > Flashcards

Flashcards in Session 11 - Chronic Kidney Disease Deck (60):
1

Define chronic kidney failure

• The progressive and irreversible loss of renal function over a period of months to years

2

What is the underlying pathology of chronic kidney failure?

• Function renal tissue is replaced by extra-cellular matrix, which gives rise to glomerulosclerosis and tubular intersitial fibrosis

3

What does a diseased kidney do?

• Shrinks
• Fibrosis

4

What does chronic kidney failure result in?

• Progressive loss of both the excretory and hormone functions of the kidney
• Proteinuria and systemic hypertension develops

5

Give 8 causes of chronic kidney disease

I gave GOD HIV
• Immunologic
○ Glomerulonephritis
• Infection
○ Pyelonephritis
• Genetic
○ Polycystic Kidney Disease (PCK)
○ Alport’s Syndrome
• Obstruction and reflux nephropathy
• Hypertension
• Vascular
• Systemic Disease
○ Diabetes
○ Myeloma
• Cause unknown

6

What are the three most common causes of chronic kidney disease

• Diabetes mellitus
• Hypertension
• Glomerulonephritis

7

What do most patients with CKD have?

• Diabetes
• Hypertension
• Ischaemic Heart Disease

8

What is polycystic kidney disease?

• Multiple cysts appear on the kidney

9

What is Alport syndrome?

• Hereditary nephritis caused by an x-linked mutation
• Proliferating and sclerosing kidney disease

10

How is Chronic Kidney Disease classified?

• By amount of GFR fall and kidney disease

11

How many stages of chronic kidney disease are there?

5

12

What is stage 1 of chronic kidney disease? GFR, description, clinical diagnosis, %population

• >90 GFR
• Kidney damage with normal or increased GFR
• Need other evidence of kidney damage

3.3% population

13

What is stage 2 of chronic kidney disease? GFR, description, clinical diagnosis, %population

• 60-89% GFR
• Kidney damage with mild GFR fall
• Need other evidence of kidney dmage
• 3% population

14

What is stage 3 of chronic kidney disease? GFR, description, clinical diagnosis, %population

• 30-59% fall in GFR
• Moderate fall in GFR
• Symptoms +/-

6% population

15

What is stage 4 kidney disease?

• 15-29%
• Severe fall in GFR
• Symptoms ++
• 0.2% population

16

What is stage 5 kidney disease

• <10ml/min GFR
• 0.1% population

17

What is the incidence of CKD?

• 85% have diabetes, hypertension or ischaemic heart disease
• More common in the elderly, ethnic minorities and the socially disadvantaged

18

Why don't most patients with CKD end up needing dialysis?

High cardiovascular mortality at all stages of CKD

19

Give four systems affected by CKF

• CVS
• Haematological
• Musculoskeltal
• CNS

20

What does CKF cause in the CVS system?

• Atherosclerosis
• Cardiomyopathy
• Pericarditis

21

What does CKF cause in haemotologically

○ Decreased erythropoietin
○ Resistance to erythropoietin
○ Decreased RBC survival

Blood loss

22

Where is erythropoietin produced?

The interstitial fibroblasts in the kidney, in close assocaiation with peritublar capillaries.

23

What does CKF cause in the bone?

• Renal bone disease

24

Give two forms of renal bone disease

• Decreased GFR means less phosphate is excreted, increasing serum conc. Then forms complexes with free Ca2+, reducing effective serum conc. Stimulated PTH release, causing overactivity of osteoclasts - Osteitis Fibrosa Cystica
• Less Vitamin D hydroxylated to Calcitriol, causing hyperparathyroidism and osteomalacia

25

Where does hydroxylation of vitamin D occur?

• First step in the liver - prohormone calcifedol

Second step in the kidney

26

Give three CNS symptoms of CKD

• Neuropathy
• Seizures
• Coma

27

Give three general symptoms of CKD?

• Tiredness
• Breathlessness

Restless legs

28

How likely is a patient to require dialysis compared to their changes of having a CVS event?

• More likely to have CVS event than to require dialysis

29

What is a normal range of GFR?

• 80-120 ml/min

30

How can you compare current GFR of patient to normal GFR?

• % of normal GFR
• Use inulin clearance of 24hr creatinine clearance

31

What is inulin clearance?

• Extract inulin
• Infuse inulin into patient until steady plasma state
• Measure it's presence in the urine over a given rate

32

What is 51Cr EDTA?

• Measure radioactivity
• Expensive
• Radioactive

33

What is creatinine clearance?

• Patient collects urine over 24hrs
• Delivered to lab, blood sample taken

34

What is eGFR and what must be taken into account when finding it?

• Estimated GFR used to assess creatinine clearance
• Must take into account age, sex, gender and ethnicity

35

Why is creatinine clearance not a perfect marker of renal function?

• Someone with a GFR of 40% normal can still have a normal creatinine level
• Only accurate in adults and not useful in acute renal failure

36

What is creatinine?

• Muscles produce creatine, which is converted to creatinine in blood
• Levels determined by muscle mass and kidney function

37

Why is age taken into account when measuring creatinine?

• Lower muscle mass when old

38

Why is gender taken into account when measuring creatinine?

Females have lower muscle bulk

39

Why is ethnicity taken into account when measuring creatinine?

• Some ethnicitys have a higher muscle mass

40

Give three ways of imaging the kidney

• Ultrasound to look at size and hydronephrosis
• CT
• MRI

41

Give three ways of assessing cause of CFK

• Autoantibody screen
• Complement
• Immunoglobulin A
• CRP

42

What does treatment of CFK aim to do?

• Delay progression

43

Give five modifiable risk factors of CKF

• Lifestyle
○ Smoking
○ Obesity
○ Exercise
• Treat diabetes
• Blood pressure
• ACE inhibitor
• Statins

44

When is Renal Replacement Therapy indicated?
What are the two types?

• When native renal function declines to a level where it can no longer support health
• <10ml/min
• RRT is either dialysis or renal transplantation

45

Give five indications for dialysis

• Uraemic symptoms
• Acidosis
• Pericarditis
• Fluid overload
• Hyperkalaemia

46

What are two types of dialysis

• Haemodialysis
• Peritoneal dialysis

47

What is haemodialysis

• Requires the creation of an arteriovenous fistula
• Vascular access used to connect patient to dialysis machine, which contains highly purified water across a semi-permeable membrane, allowing for blood filtering

48

What is an arteriovenous fistulae?

- A connection between an artery and vein
• Difference in pressure means vein dilates and developes a muscular wall, which provides vascular access

49

Why is an AV fistula required?

• Increases strength of vein
• Increases blood flow through vein

50

What is used to keep blood flowing smoothly in dialysis

An anti-clotting agent

51

Give three advantages of haemodialysis

• Effective (survivors >25 years
• 4/7 days free from treatment
• Dialysis dose easily prescribed

52

Give five disadvantages of haemodialysis

• Fluid/diet restriction
• Limits holidays
• Access problems
• CVS instability
• High capital cost

53

What is peritoneal dialysis?

• Requires peritoneal membrane, blood flow and peritoneal dialysis fluid
• Peritoneal dialysis fluid placed in peritoneal cavity and dialysis occurs across the peritoneal membrane
• Fluid then drained away and disposed of

54

Give 5 advantages of peritoneal dialysis

• Low technology
• Home technique
• Easily learned
• Allows mobility
• CVS stability

55

Give 6 disadvantages of peritoneal dialysis

• Frequent exchanges
• No long term survivors yet
• Peritonitis
• Frequent treatment failure
• Limited dialysis dose range
• High revenue cost

56

Who is considered for a kidney transplant?

• All patients with progressive CKD or end-stage renal failure

57

Give four sources of kidney transplants

• Cadaver donors
• Non-heart beating donors
• Living related donors
• Altruistic donors
• Kids from the backstreet of Nepal you tempted into a backstreet with the promise of free money. Sarah.

58

Where is a kidney put when it is transplanted?

• Iliac fossa
• Allows it to be easily connected to iliac vessels and the bladder

59

Give five advantages of kidney transplantation

• Restores near normal renal function
• Allows mobility and rehabilitation
• Improved survival
• Good long term results

Cheaper than dialysi

60

Give five disadvantages of kidney transplantation

• Not all are suitable
• Limited donor supply
• Operative morbiditiy and mortality
• Life long immunosupression
• Still left with progressive CKD