💧Urology💧- CKD & Renal Failure

Question 1

What are the homeostatic functions of the kidneys?

Answer 1

Electrolyte balance
Acid-base balance
Volume homeostasis

Question 2

What are the excretory functions of the kidneys?

Answer 2

Nitrogenous waste
Hormones
Peptides
Salt and water

Question 3

What are the endocrine functions of the kidney?

Answer 3

Erythropoietin
1- alpha-hydroxylase - Vitamin D

Question 4

What are the glucose metabolism functions of the kidney?

Answer 4

Gluconeogenesis
Insulin clearance

Question 5

What homeostatic functions will be impaired in kidney failure?

Answer 5

Question 6

What excretory functions will be impaired in kidney failure?

Answer 6

*Decreased insulin requirement due to decreased clearance

Question 7

What endocrine functions will be impaired in kidney failure?

Answer 7

Increased PTH - secondary hyperparathyroidism
Increased PTH as no vitamin D means low calcium - PTH cant raise calcium by itself

Question 8

What is the overall main health risk due to kidney failure?

Answer 8

Increased cardiovascular risk

Question 9

How was acute kidney injury occurred according to this image?

Answer 9

Vesicoureteral reflux
Retrograde flow of bladder urine into the ureters - lack of competent valve system in ureters
Can lead to pyelonephritis and scarring
Tubulointerstitial disease - salt and water loss

Question 10

Why might a patient with CKD be tachypnoeic?

Answer 10

Decreased bicarbonate excretion and H+ elimination in kidneys - metabolic acidosis
Increased resp rate to get rid of CO2 and lower pH - compensatory mechanism
Known as Kussmaul respiration

Question 11

Describe the bloods in a patient with kidney failure

Answer 11

*haemoglobin will be normal in acute, and low in chronic
*sodium will also be low in this case

Question 12

Describe the ABG of a patient with CKD

Answer 12

Raised O2 and lowered CO2 - ?due to respiratory compensation

Question 13

What conditions caused by renal failure can complicate management/diagnosis?

Answer 13

Hyperkalaemia
Hyponatraemia
Metabolic acidosis
Anaemia

Question 14

Outline the key takeaways in kidney failure as acute kidney injury

Answer 14

Metabolic acidosis due to less bicarbonate secretion and H+ elimination
Tachypnoeic compensatory response
Salt and water loss - hypovolemia and dehydration

Question 15

What investigations would you do in suspected CKD?

Answer 15

Kidney ultrasound

Question 16

What would be the consequences of CKD induced hyperkalaemia?

Answer 16

ECG changes
Arrhythmias
Can be fatal if ventricular

Question 17

What are the ECG changes seen in hyperkalaemia?

Answer 17

Peaked T waves
P wave - broadens, reduced amplitude, can disappear
QRS widening
Heart block
Asystole
VT/VF

Question 18

What levels would you expect to find in AKI?

Answer 18

Increased Urea
Increased creatinine
Sodium - ↓ if volume overload or dilutional hyponatremia (fluid retention) - normal or ↑ if hypovolemic (prerenal AKI)
Increased Potassium
Normal haemoglobin
Acidic pH
pCO2 lower (respiratory compensation)
Decreased Bicarbonate

Question 19

What would an ultrasound show in AKI?

Answer 19

Normal sized kidneys with no obstruction

Question 20

What does kidney failure tend to do to salt and water?

Answer 20

Reduce secretion of salt and water
Leads to hypertension, oedema, pulmonary oedema

Question 21

When can salt and water loss be seen in kidney failure?

Answer 21

Salt and water loss may be seen in tubulointerstitial disorders – damage to concentrating mechanism
& hypovolemia may be the cause of AKI

Question 22

What does metabolic acidosis lead to?

Answer 22

Anorexia
Muscle catabolism

Question 23

What are the causes of hyperkalaemia in kidney failure?

Answer 23

Decreased distal tubule potassium
Acidosis

Question 24

What are the symptoms of chronic hyperkalaemia?

Answer 24

Cardiac arrythmias
Neural and muscular activity decrease
Vomiting

Question 25

How does acidosis cause hyperkalaemia?

Answer 25

H+ concentration high extracellularly H+ moves into cell, exchanged for potassium Mass influx of potassium from cells into blood

Question 26

What effect does kidney failure have on blood oxygen?

Answer 26

Reduced erythropoietin - anaemia

Question 27

What effect does kidney failure have on calcium regulation?

Answer 27

Reduced 1-alpha hydroxylas - less vitamin D Hypocalcaemia Hyperparathyroidism

Question 28

What is the major outcome for patients with CKD?

Answer 28

CKD acts as major predictor for end stage renal failure BUT Major outcome is CVD (i.e. a patient with CKD is more likely to die from cardiovascular disease than end stage renal failure)

Question 29

What is the initial treatment for kidney failure?

Answer 29

Question 30

What are the long term management options for kidney failure?

Answer 30

Question 31

What does the Kidney failure risk equation use?

Answer 31

Age in years Sex CKD-EPI eGFR Urine albumin creatinine ratio (ACR)

Question 32

When should the kidney failure risk equation not be used?

Answer 32

In patient with rapidly changing eGFR

Question 33

Why should transfusion be avoided in patients with transplantable kidney disease?

Answer 33

Transfusions lead to immune sensitisation This can lead to transplant failure

Question 34

What are the various ways of assessing GFR?

Answer 34

Urea Creatinine Radionuclide studies Creatinine clearance Inulin clearance

Question 35

Outline using urea as a way of assessing GFR

Answer 35

Poor indicator Confounded by diet, catabolic state, GI bleeding (bacterial breakdown of blood in gut), drugs, liver function etc.

Question 36

Outline using creatinine as a way of assessing GFR

Answer 36

Affected by muscle mass, age, race, sex etc. Need to look at the patient when interpreting the result. TREND helpful.

Question 37

Outline using radionuclide studies as a way of assessing GFR

Answer 37

EDTA clearance etc Reliable but expensive

Question 38

Outline using creatinine clearance as a way of assessing GFR

Answer 38

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)

Question 39

Outline using inulin clearance as a way of assessing GFR

Answer 39

Laborious - used for research purposes only

Question 40

What is estimated GFR effectively equal to?

Answer 40

Serum creatinine concentration