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3 REN > 10 CKD > Flashcards

10 CKD Flashcards

1
Q

Why is serum creatinine not used to measure kidney function?

A

because it does not respond to small changes in kidney function

doesn’t offer a good comparison between people

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2
Q

Why is eGFR used to measure kidney function?

A

It is the best measure in stable kidney function

Can be used to compare between people

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3
Q

What is CKD?

A

Chronic kidney disease

either
eGFR < 60ml/minute/1.73m2
or
kidney damage…

must be present for at least 3 months

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4
Q

What is the eGFR range for stage 1?

A

kidney damage with normal GFR

at least 90

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5
Q

What is the eGFR range for stage 2?

A

mild kidney damage

60-89

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6
Q

What is the eGFR range for stage 3?

A

moderate kidney damage

30-59

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7
Q

What is the eGFR range for stage 4?

A

severe damage

15-29

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8
Q

What is the eGFR range for stage 5?

A

kidney failure

less than 15

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9
Q

How might stage 5 CKD be treated?

A

haemodialysis
peritoneal dialysis
transplant

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10
Q

What are the groups of causes of CKD?

A 
Systemic diseases
immune mediated diseases
infectious diseases
genetic diseases
arterial diseases
obstruction
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11
Q

What sorts of systemic diseases might cause CKD?

A

diabetes

hypertension

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12
Q

What sorts of immune mediated diseases might cause CKD?

A

membranous nephropathy

IgA nephropathy

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13
Q

What sorts of infectious diseases might cause CKD?

A

HIV
HBV
HCV
TB

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14
Q

What sorts of genetic diseases might cause CKD?

A

Polycystic kidneys

cystinosis

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15
Q

what sort of arterial diseases might cause CKD/?

A

atherosclerosis

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16
Q

What sorts of obstructions might cause CKD?

A

tumours
stones
fibrosis

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17
Q

What would you see down the microscope in chronic glomerulonephritis?

A

scleroses glomeruli

atrophied tubules

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18
Q

What proportion of those with diabetes experience renal disease?

A

40%

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19
Q

What is the pathology of nephropathy?

A

BM thickens
mesangial expansion
glomerulosclerosis

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20
Q

What facilitates mesangial expansion?

A

hyperglycaemia stimulates increased matrix production by mesangial cells
stimulation of TGF-beta release

21
Q

What facilitates glomerulosclerosis?

A

intraglomerular hypertension or ischaemic damage

22
Q

What might cause vascular disease?

A 
renal artery stenosis
stones
benign prostate
tumours
fibrosis
23
Q

How can CKD lead to a failure of fluid homeostasis?

A

inability to concentrate urine (early)

and then, an inability to excrete water load (dilution hyponatraemia, oedema hypertension)

24
Q

How might we treat fluid overload?

A

diuretic
decrease fluid intake
less salt

if all else fails dialysis or transplant

25
Q

How does nephropathy cause hypertension?

A

inability to excrete salt and water

26
Q

What can sodium inbalance lead to?

A

confusion, fits, coma

27
Q

How can interference with Potassium excretion cause very low GFR?

A

acidosis with volume contraction

diabetic nephropathy

28
Q

What effect does hyperkalaemia have on ECGs?

What might this cause?

A

tall T waves
Long QRS interval
long PR interval

Cardiac arrest

29
Q

What treatment is there for hyperkalaemia and hypernatraemia?

A

eat fewer bananas and crisps

30
Q

What is the basis of the carbonic acid buffer system?

A

a failure to secrete acid pushes the PoE to the right, meaning more CO2 has to be removed by the lungs to balance pH

31
Q

What are the symptoms of metabolic acidosis?

A

breathlessness
chest pain
confusion
bone pain (demineralisation)

32
Q

How would you treat metabolic acidosis?

A

sodium bicarbonate

otherwise dialysis/transplant

33
Q

What effect does renal failure have on calcium homeostasis?

A

less GI calcium absorption
hyperparathyroidism
hyperphosphataemia
ectopic clacification

34
Q

How might you treat the effects of renal failure on calcium homeostasis?

A

active form of Vit D (we can’t activate it)
calcium supplements
phosphate restriction
phosphate binders

if fails parathyroidectomy

35
Q

How would you treat renal anaemia?

A

recombinant Epo

36
Q

What are the mechanisms of renal hypertension?

A 
sodium retention
volume expansion
RAS activation
Sympathetic NS activity
endothelial dysfunction

causes over-production of renin, not under-production

37
Q

How would you treat renal hypertension?

A

less sodium and water
take BP tablets
diuretic
RAS blockade

38
Q

What happens in a failure of excretory function?

A

creatinine rise (only after significant damage)
retention of nitrogenous waste
retention of urate
retention of phosphate

39
Q

How would you treat Uraemia?

A

dialysis or transplant

you could restrict protein intake although this cause malnourishment

40
Q

What might happen if the kidney fails to excrete insulin?

A

hypoglycaemia

41
Q

What might happen if the kidney fails to excrete opiates?

A

narcosis

42
Q

What might happen if the kidney fails to excrete antibiotics?

A

encephalopathy

43
Q

What might happen if the kidney fails to excrete sedatives?

A

respiratory arrest

44
Q

What might happen if the kidney fails to excrete digoxin?

A

cardiac arrhythmia

45
Q

How would you treat drug toxicity in renal disease?

A

lower the dose!

46
Q

Why does CKD progress?

A

uncontrolled underlying disease
hypertension
proteinuria
smoking

47
Q

How do you limit the progression of CKD?

A

treat underlying disease
stop smoking
ACEi / ARB block renin angiotensin system to stop protein leaking

48
Q

What are the characteristics of hyperparathyroidism?

A

browns tumour

rugger jersey vertebrae

3 REN (21 decks)

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