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Urinary > Week 11 > Flashcards

Week 11 Flashcards

(47 cards)

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1
Q

What is CKD

A

Irreversible, and sometimes progressive, loss of renal function over a period of months to years

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2
Q

Macroscopic appearance of kidneys in CKD

A

Shrunken
Irregular outline
Thin cortex

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3
Q

Histological appearance of kidneys in CKD

A

Tubule loss
Interstitial fibrosis
Glomerulosclerosis

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4
Q

Causes of CKD

A 
Majority of patients have a combination of:
Infection - pyelonephritis 
Genetics - Alports 
Immunological - glomerulonephritis
Obstruction 
Hypertension
Vascular disease
Systemic disease - diabetes, myeloma
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5
Q

Demographics of CKD

A

Elderly
Comorbidities
Ethnic minorities
Socially disadvantaged groups

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6
Q

How can CKD be classified

A

By:
GFR
Albumin creatinine ratio

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7
Q

Stages of CKD classified by GFR

A 
G1 - >90ml/min/1.73m2
G2 - 60-89
G3 - 30-59
G4 - 15-29
G5 - <15 or renal replacement therapy
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8
Q

Which G stages are symptomatic

A

G4-5

G3 can be symptomatic or asymptomatic

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9
Q

Which G stage require hospital admission

A

G3-5

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10
Q

Which G stages require other evidence of kidney damage and why

A

G1-2

GFR above 60 is inaccurate

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11
Q

Stages of CKD classified by ACR

A

A1 - <3
A2 - 3-30
A3 - >30

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12
Q

Investigations for CKD

A

Urine dipstick - proteinuria increases incidence of end stage renal disease
Measure serum creatinine to calculate eGFR

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13
Q

Why is serum creatinine a bad measure of GFR

A

Normal serum creatinine when GFR is 40

Dependent on renal function and muscle mass which is affected my sex, ethnicity and age

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14
Q

Limitations of eGFR

A

Only accurate in adults

Isn’t useful in AKI

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15
Q

Why don’t we measure GFR in clinical practice

A

Measuring clearance rates is expensive and takes a long time (need to measure 24 hour urine output)

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16
Q

Finding cause of CKD

A 
History
Examination - palpable kidneys
Autoantibody screen
Complement
Immunoglobulin
Anti neutrophil cytoplasmic antibodies
CRP 
Imaging - USS (hydronephrosis), CT (stones), MRI (renal artery stenosis)
If cause not obvious consider biopsy
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17
Q

How to prevent or delay progression of CKD

A 
Exercise
Stop smoking
Treat diabetes
Treat hypertension with ACEi/AT2 antagonists 
Lower lipids with statins/diet
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18
Q

Complications of CKD and how they are combated in treatment

A

Increased risk of cardiovascular death - lifestyle factors, ACEi, statins
Acidosis - give oral NHCO3 tablets
Anaemia - erythropoietin injections
Metabolic bone disease

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19
Q

Why do patients with CKD get anaemia

Study These Flashcards
A

Decreased erythropoietin production and decreased platelet function
Leads to decreased RBC survival and bleeding

20
Q

Why do patients with CKD develop metabolic bone disease

Study These Flashcards
A

Low GFR leads to increased phosphate and decreased calcitriol synthesis so hyperparathyroidism occurs

21
Q

What bone disorder is hyperparathyroidism associated with

Study These Flashcards
A

Osteitis fibrosa cystica (painful soft bones leading to deformity)

22
Q

What bone disorder is associated with low calcitriol

23
Q

What occurs to bone at different levels of vitamin D

Study These Flashcards
A

Deficiency - rickets or osteomalacia
Normal - mineralisation
High - osteoclast activity

24
Q

What other metabolic bone disorders occur in CKD patients

Study These Flashcards
A

Rugger jersey spine - sclerosis of end plates so middle of vertebral bodies look greyer
Erosion of terminal phalanges
Calciphylaxis - vascular calcification, thrombosis and skin necrosis

25
What is end stage renal disease
GFR <15ml/min | Death is likely with out renal replacement therapy
26
Symptoms of ESRD
``` Tiredness Difficulty sleeping and concentrating Symptoms of volume overload - oedema, gallop rhythm, raised JVP and high BP Nausea and pruritis due to accumulation of waste products Leg cramps Pruritis Low fertility Increased infections ```
27
Why do ESRD patients need dose alterations
Decreased drug elimination | Increased drug sensitivity - more side effects
28
When do patients need RRT
Renal function declines to a level that's no longer adequate to support health
29
Types of RRT
Haemodialysis Peritoneal dialysis Renal transplantation
30
What symptoms suggest dialysis is needed
``` Volume overload Acidosis Uraemic symptoms Pericarditis Hyperkalaemia ```
31
What needs to be done before haemodialysis begins
Create an arteriovenous fistula (connection between an artery and vein) so that venous pressure increases and the vein dilates and develops a muscular wall
32
Alternative to arteriovenous fistula
Tunnel line | Has a lower infection risk but increased risk of stenosis
33
What happens in haemodialysis
Venous blood passes through a pump to increase its pressure and an anticoagulant is added Dialyser contains highly purified H2O across a semipermeable membrane so waste products are removed from the blood Clean blood is returned to the venous system
34
Advantages of haemodialysis
Effective Don't need to use everyday Don't need to manage treatment themselves Erythropoietin given in haemodialysis fluid
35
Disadvantages of haemodialysis
Fluid and diet restrictions Tied to dialysis times Need 4 hours 3 times a week Need 19 tablets a day
36
Contraindications of haemodialysis
Failed vascular access Heart failure - can't tolerate removal of blood Coagulopathy - high chance of bleeding when the needle is used
37
Complications of haemodialysis
Infection Steal syndrome - arterial blood enters venous system so get ischaemia in fingers CVS instability Feel chronically unwell
38
What is peritoneal dialysis
Highly purified peritoneal dialysis fluid is put into the peritoneal cavity and the dialysis occurs at the peritoneal membrane Fluid containing waste products from the blood is drained away and disposed of
39
Advantages of peritoneal dialysis
``` Less food and diet restriction Self sufficient Easier to travel CVS stability Less (10) tablets per day ```
40
Disadvantages of peritoneal dialysis
Need 4/5 bag a day High risk of peritonitis Need to inject erythropoietin
41
Contraindications of peritoneal dialysis
Failure of peritoneal membrane e.g surgery, adhesions Unable to (dis)connect bags Obese or large muscle mass - can't get enough dialysis fluid
42
Complications of peritoneal dialysis
Peritonitis (about every 20 months) Leaks e.g into scrotum or diaphragm Herniae
43
Where do kidneys for transplants come from
Live donor Deceased after brain death Deceased after circulatory death
44
Where are kidneys transplanted to
Iliac fossa | Connected to iliac vessels and bladder
45
What are kidneys matched according to
Tissue match - blood type, HLA | Number of points - time on waiting list, age
46
Advantages of renal transplants
Less morbidity and mortality Cheaper Better QoL
47
Disadvantages of renal transplant
Life long immunosuppression (side effects, increased infection and malignancy) Perioperative risk

Urinary (6 decks)

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