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Flashcards in Urinary 13 - CKI Deck (32):
1

Describe CKI:

Irreversible loss of renal function over months/years, where damaged renal tissue is replaced by extracellular matrix

2

List the main causes of CKI:

- Immunologic (glomerulonephritis)
- Infection
- Genetic (polycystic kidney disease, Alport etc.)
- Obstruction (stones, enlarged prostate)
- Hypertension
- Vascular
- Systemic disease (DM, Myeloma)
- Unknown

3

List the risk factors for CKI:

- Increasing age
- Ethnic minorities
- Multi-morbid
- Socially disadvantaged
- Female > Male
- Nephrotoxins
- Decreased kidney perfusion
- Hyperlipidaemia
- Hyperphosphataemia

4

Give 5 nephrotoxins:

1) Myoglobin
2) Urate
3) Drugs
4) Poisons
5) Bilirubin

5

How is CKI classified?

According to GFR and ACR (Albumen:Creatinine ratio)

6

List the symptoms of CKI:

- Pruritus
- Fatigue
- Breathlessness
- Restless legs
- Sleep reversal
- Aches + Pains
- Nausea + Vomiting
- Chest pain
- Seizures

7

What are the 3 main complications of CKI?

1) Acidosis
2) Anaemia
3) Mineral/Bone disorders

8

How does CKI lead to anaemia?

CKI is the loss of renal function = decreased GFR
When GFR < 30 = decreased erythropoetin production
= Decreased RBC production = blood loss`

9

What is renal osteodystrophy?

Pathological bone changes due to abnormal levels of calcium and phosphate in blood, due to increased PTH in CKI

10

How does CKI affect serum phosphate, calcium, calcitriol and PTH?

- Increases serum phosphate
= Decreases serum calcium

- Decreases calcitriol
= Increases PTH

Changes due to decreased GFR

11

What is a pathological bone change associated with CKI, seen in the spine?

'Rugger jersey spine'
Sclerosis of end plates, giving sclerotic-lucent-sclerotic pattern
Due to hyperparathyroidism

12

What is Calciphylaxis?

Vascular calcification and skin necrosis associated with CKD

13

Why are CKI patients susceptible to Osteomalacia?

CKI = decreased GFR = decreased Calcitriol
= decreased calcification level per bone unit
= softening of bone

14

What are the symptoms of Osteomalacia?

- Bone pain
- Back ache
- Muscle weakness
- Fractures (commonly femoral neck, spine, ribs, pubic ramus)

15

What USS finding is common in CKI?

Small shrunken kidneys

16

What are the 2 types of dialysis available?

1) Haemodialysis
2) Peritoneal dialysis

17

What are the advantages of haemodialysis?

- Little responsibility for patient
- Days off
- Proven effectiveness

18

What are the disadvantages of haemodialysis?

- Hospital-based = ^^ cost
- Time consuming (travel/waiting time)
- Fluid + Diet restrictions
- CVS access problems = Fistula creation - ugly
- 19 pills/day

19

What type of fistula is usually created to aid access for haemodialysis?

Radiocephalic

20

What are the main complications of haemodialysis?

- Infection
- Thrombosis
- Venous stenosis
- CVS instability

21

Define dialysis:

Diffusion of solutes across a semi-permeable membrane.
- Allows removal of waste products and water from the blood

22

Name the 2 types of peritoneal dialysis:

1) Continuous Ambulatory PD
2) Automated PD

23

What is the main difference between Continuous Ambulatory PD, and Automated PD:

CAPD = dialysis throughout the day (4/5 bags per day)
APD = dialysis throughout night

24

What are the advantages of Peritoneal dialysis?

- Self-sufficient
- Independent
- Home technique
- Easy-to-learn
- Allows mobility
- CVS stability
- Less fluid/food restriction (compared to haemodialysis)

25

What are the disadvantages of peritoneal dialysis?

- Frequent daily exchanges
- Responsibility of patient
- Peritonitis likely
- ^^ cost
- Body image problem
- 10 pills + injection per day

26

What is the most common complication of peritoneal dialysis (occurs ~ 1/20 months)?

Peritonitis

27

If patient with ESRD has had a hernia in the past, which type of dialysis should they have, and why?

Haemodialysis
Hernia weakens abdo wall, so peritoneal dialysis fluid would leak out of peritoneal cavity.

28

What is the gold standard treatment of ESRD?

Kidney transplant

29

What are the 3 types of kidney donation, in order of expected lifespan from longest to shortest:

1) Live donor (longest lifespan)
2) Deceased after brain death
3) Deceased after circulatory death

30

Kidney donations are matched to a patient according to what 4 factors?

- ABO blood type
- HLA (or MHC)
- Age
- Time on waiting list

31

What is the average waiting time for a kidney transplant?

~ 3 yrs

32

What are the disadvantages of a kidney transplant?

- Operative, Infection & Malignancy risk
- Requires immunosuppressive drugs
Side effects = tremor, hypertension, diabetes, headaches, nausea, diarrhoea, weight gain