Urinary: Chronic Kidney Failure Flashcards Preview

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Flashcards in Urinary: Chronic Kidney Failure Deck (16)
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1
Q

What is chronic kidney disease?

A

The irreversible and progressive loss of renal function

The injury causes renal tissue to be replaced by extracellular matrix

2
Q

What are the causes of chronic kidney disease?

A
  • most commonly idiopathic
  • systemic disease eg diabetes
  • hypertension
  • obstruction and reflux nephrology
  • infection eg pyelonephritis
  • genetic
  • glomerulonephritis
  • athersclerotic vascular disease
3
Q

How does a kidney with CKD look different to a normal kidney?

A

Kidney is shrunken with an irregular outline

There is a decrease in cortical thickness

4
Q

Which pt groups is chronic kidney disease more common in?

A
  • elderly
  • multi morbid
  • ethnic minorities
  • socially disadvantaged
5
Q

How is chronic kidney disease staged?

A

Staged from 1-5 depending on GFR
GFRs above 60 are inaccurate so stage 1 and 2 need further diagnostic criteria

Given an ACR category depending on the urine albumin creatinine ratio

6
Q

How common is CKD?

A

7% of the population have stage 1 2 or 3 (out of 5) chronic kidney disease

7
Q

How can the rate of disease progression be slowed?

A

Small interventions such as treating BP and dealing with modifiable risk factors can change the need for dialysis in later life

8
Q

At what stage of GFR does mortality start to increase?

A

When GFR falls by 25% of the normal (so roughly 75ml/min)

9
Q

What bedside measurements should be monitored in pts with CKD?

A

Blood pressure
Urine dip stick - for protein or blood in the urine (proteinuria predicts the development of end stage renal disease so more likely to need dialysis and die of cardiovascular disease)

10
Q

How can proteinuria be treated?

A

Treat the BP and use ACEI

11
Q

What are the ways we can measure renal function?

A

Serum creatinine is used to estimate GFR

Can also measure GFR directly via inulin clearance or creatinine clearance but these are not clinically practical

12
Q

Why is it important to calculate eGFR from the serum creatinine values?

A

The relationship between serum creatinine and GFR is not linear therefore creatinine can be normal despite having a GFR as low as 40
This is because creatinine is not only determined by renal function but also muscle mass (age,sex,race)

13
Q

What examinations can be done to identify a cause of CKD?

A

USS to look for size and hydronephrosis (dilated pelvicalyceal system)
CTI, MRI
(if kidneys normal size and cause not obvious renal biopsy may be considered)

14
Q

What are the complications of CKD?

A
  • *Acidosis - treat with oral NaHCO3- tablets
  • *Anaemia - the kidneys usually make erythropoietin which controls RBC production, also there is decreased RBC survival and blood loss. Can now administer subcutaneous erythropoietin
  • *Metabolic bone disease - There is decreased GFR therefore decreased activation of Vit D, also increase in phosphate so decrease calcium, all lead to increased PTH
15
Q

What are some ways to help prevent or delay progression?

A

Lifestyle: obesity, smoking, lack of exercise
Treat diabetes and blood pressure
Give ACEI
Give statins

16
Q

What are the different types of renal replacement therapy?

A

Dialysis (haemo and peritoneal)

Renal transplantation

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