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11. Urinary > 11. Chronic Kidney Disease > Flashcards

11. Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney failure?

A

Progressive and irreversible loss of renal function over a period or months to years.

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2
Q

What are the histological features of renal tissue in chronic kidney failure?

A

Functional tissue is replaced by extra-cellular matrix causing glomerulosclerosis and tubular interstitial fibrosis.

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3
Q

What are the causes of chronic kidney disease?

A

Immunological, infection, genetics, obstruction and reflux nephropathy, hypertension, vascular, systemic disease, unknown.

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4
Q

What immunological cause can lead to chronic kidney disease?

A

Glomerulonephritis.

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5
Q

What infection can lead to chronic kidney disease?

A

Pyelonephritis.

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6
Q

What genetic causes can lead to chronic kidney disease?

A

Polycystic kidney disease, Alport’s syndrome.

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7
Q

Which systemic disease can lead to chronic kidney disease?

A

Diabetes or myeloma.

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8
Q

How can the stages of chronic kidney disease be classified according to GFR?

A
  1. > 90
  2. 60-89
  3. 30-59
  4. 15-29
  5. <15 or RRT
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9
Q

Briefly describe the five stages of chronic kidney disease.

A
  1. Kidney damage with normal or increased GFR.
  2. Kidney damage with mild GFR fall.
  3. Moderate fall in GFR, may or may not have symptoms.
  4. Severe fall in GFR, have some symptoms.
  5. Established renal failure, lots of symptoms.
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10
Q

How are 85% of patients with chronic kidney disease identified?

A

By looking on registries for diabetes, hypertension, and ischaemic heart disease.

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11
Q

In what populations is chronic kidney disease more common?

A

In elderly, ethnic minorities, and socially disadvantaged.

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12
Q

How does chronic kidney failure affect cardiovascular health?

A

Leads to atherosclerosis, cardiomyopathy, pericarditis.

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13
Q

How does chronic kidney failure affect the haematopoietic system?

A

Causes anaemia from decreased synthesis or resistance to erythropoietin.

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14
Q

How does chronic kidney failure affect bone health?

A

Causes renal bone disease. The decreased GFR means that less phosphate is excreted so its serum concentration is raised, it forms complexes with free calcium reducing free concentration. This stimulates parathyroid hormone release so there is overactivity of osteoclasts - osteitis fibrosa cystica. Also damage to kidneys means less vitamin D is activated by hydroxylation so hyperparathyroidism and osteomalacia. Finally there is non-bone calcification.

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15
Q

How does chronic kidney failure affect the CNS?

A

Neuropathy, seizures, coma.

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16
Q

What are the general symptoms of chronic kidney failure?

A

Tiredness, breathlessness, restless leg, sleep reversal, seizure, aches and pains, nausea and vomiting, itching, chest pain.

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17
Q

Are patients more likely to need dialysis or die from a CVS event if they have chronic kidney disease.

A

Die from a cardiovascular event.

18
Q

How can GFR be measured?

A

By inulin clearance or 24 hour creatinine clearance.

19
Q

What is an estimated GFR?

A

GFR measured using creatinine that has been modified to take into account age, sex, gender, and ethnicity.

20
Q

What are the limitations in using creatinine as a marker for renal function?

A

GFR can fall to 40% of normal before having abnormal creatinine. It is only accurate in adults. It only defines chronic kidney disease, not acute.

21
Q

How can the cause of chronic kidney disease be assessed?

A

Auto-antibody screen, complement, immunoglobulin, ANCA, CRP, SPEP/UPEP, imaging of the kidneys.

22
Q

How can the kidneys be imaged?

A

Ultrasounds for size and hydronephrosis, CT, or MRI.

23
Q

What are the modifiable risks for preventing progression of CKD?

A

Lifestyle changing like stopping smoking, losing weight so not obese, exercise. Treat diabetes, blood pressure if needed. ACE inhibitors or angiotensin receptor blockers. Lipid lowering drugs.

24
Q

When is renal replacement therapy given in CKD?

A

When the renal function declines to a level when it is no longer adequate to support health, GFR >10ml/min.

25
Q

What are the renal replacement therapy options?

A

Dialysis of renal transplantation.

26
Q

What are the indications for the initiation of dialysis?

A

Uraemic symptoms, acidosis, pericarditis, fluid overlad, and hyperkalaemia.

27
Q

What are the two type of dialysis?

A

Haemodialysis, and peritoneal dialysis.

28
Q

What needs to be created in haemodialysis?

A

An arteriovenous fistula - connection between an artery and vein.

29
Q

What is the method behind creating an arteriovenous fistula in haemodialysis?

A

The difference in pressure means blood moves into the vein so it dilates and develops a muscular wall to provide vascular access.

30
Q

How is haemodialysis performed?

A

Using the vascular access from the arteriovenous fistula, the patient is connected to a dialysis machine with highly purified water across a semi-permeable membrane to filter their blood.

31
Q

Why are anti-coagulatns given with haemodialysis?

A

To stop the blood clotting while in the machine.

32
Q

Wat are the components required in peritoneal dialysis?

A

Peritoneal membrane, blood flow, and peritoneal dialysis fluid.

33
Q

How is peritoneal dialysis performed?

A

Peritoneal dialysis fluid is put into the peritoneal cavity, and the dialysis occurs across the peritoneal membrane. The fluid is then drained away and disposed of.

34
Q

What are the advantages of haemodialysis?

A

Effective (survivors >25 years), 4 days a week free from treatment, dialysis dose easily prescribed.

35
Q

What are the disadvantages of haemodialysis?

A

Fluid/diet restrictions, limits holidays, access problems, CVS instability, high capital cost.

36
Q

What are the advantages of peritoneal dialysis?

A

Low technology, home technique, easily learned, allows mobility, CVS stability.

37
Q

What are the disadvantages of peritoneal dialysis?

A

Frequent exchanges (4 a day), no long term survivors yet, frequent treatment failures, peritonitis, limited dialysis dose range, high revenue costs.

38
Q

Who should be considered for renal transplantation?

A

All patients with progressive CKD or end-stage renal failure.

39
Q

What are the possible sources of kidneys for transplantation?

A

Cadaver donors, non-heart beating donors, living related donors/friends, altruistic donors.

40
Q

Where are kidneys placed in transplantation?

A

Not in the normal anatomical location, but to the iliac fossa to easily be connected to iliac vessels and the bladder.

41
Q

What are the advantages to renal transplantation?

A

Restores near normal renal function, allows mobility and rehabilitation, improved survival, good long term results, cheaper than dialysis.

42
Q

What are the disadvantages to renal transplantation?

A

Not all are suitable, limited donor supply, operative morbidity and mortality, life long immunosuppression, still left with chronic kidney disease.

11. Urinary (12 decks)

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