Define CKD. What is injured tissue replaced by?
• Irreversible and sometimes progressive loss of renal function over a period of months to years
• Injured renal tissue replaced by ECM
Give 3 causes of CKD
• Immunologic – e.g. glomerulonephritis
• Genetic – e.g. Alport’s
• Obstruction and reflux nephropathy
• Hypertension – damages the small blood vessels in the kidney
• System diseases – e.g. diabetes, myeloma
What measurement is used to measure renal function? How must it be corrected for certain groups?
eGFR Corrected for black patients due to higher muscle mass
How would you assess CKD?
• Image kidneys – can use ultrasound, CT or MRI. Look at size and hydronephrosis (distention of renal pelvis and calyces)
Give the renal disease classification for kidney failure and define how many ml/min that is
G5 (kidney failure) - <15 ml/min
Give the renal disease classification kidney failure in albumin:creatinine ratio
Why would kidney damage likely result in anaemia?
• Kidney makes erythropoietin. Resistance to erythropoietin occurs due to uraemia (build up of urea in blood)
• Erythropoietin necessary for RBC production. Therefore leads to decreased RBC survival and possible catastrophe during blood loss.
Explain how osteomalacia comes as a result reduced renal blood flow
1) Decreased GFR from CKD
2) Results in decreased Active vitamin D due to renal impairment
3) Results in osteomalacia due to lack of calcium absorption because of lack of vitamin D
4) Lack of calcium in blood results in increased PTH which leaches calcium from bones, resulting in osteitis fibrosa cystica (weakened bones which are replaced with fibrous tissue and formation of cyst like brown tumours in and around bones)
Explain how osteitis fibrosa cystica comes as a result of reduced renal blood flow
a) Decreased GFR from CKD
b) Phosphate is usually in excess in diet, therefore decrease GFR = increase in serum phosphate
c) Increase in phosphate results in decreased calcium due to homeostasis between them
d) Low calcium triggers increased PTH and leads to osteitis fibrosa cystica.
How can CKD result in CVD? How would you manage CVD?
• CKD results in heart disease risk factors e.g. hyperlipidaemia.
• Treat with ACEi and statins
• Monitor and control blood pressure
• ARBs (angiotensin II receptor blockers) for proteinuria
What are the advantages and diadvantages of haemodialysis?
Adv – less responsibility and days off
Disadv – have to travel to clinic, tied to dialysis times, and big restriction on fluid/food intake
What contraindications would you have for haemodialysis?
o Failed vascular access
o Heart failure
What complications are associated with haemodialysis?
o Lines – infection, thrombosis
o CVS – instability
o Chronically unwell feeling o Arteriovenous fistula (AVF) – thrombosis, bleeding, steal syndrome (ischaemia caused by AVF)
Expain how peritoneal dialysis works
• Fluid placed in peritoneum and left for an amount of time
• The peritoneum acts as a semipermeable membrane through which waste products cross into the peritoneal space
• Low efficiency but done all day every day
Give the advantages and disadvantages of peritoneal dialysis
o Less fluid and food restrictions
o Easy to travel with
o Renal function better preserved initially
o Frequent daily exchanges
o Your own responsibility
What contraindications are associated with peritoneal dialysis?
o Failure of peritoneal membrane
o Previous abdo surgery, hernias, stoma
o Obese or large muscle mass
What complications are associated with peritoneal dialysis?
o Development of herniae