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BRS 12 Urology and renal > 1b Chronic Kidney Disease and Renal Failure > Flashcards

1b Chronic Kidney Disease and Renal Failure Flashcards

1
Q

What are the important aspects of homeostatic function of the kidney?

A

Electrolyte balance
Acid base balance
Volume homeostasis

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2
Q

What are the important aspects of excretory function of the kidneys?

A

nitrogenous waste
hormones
peptides
middle sized molecules
salt and water

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3
Q

What is the endocrine function of the kidneys?

A

EPO production and 1-alpha hydroxylase vitamin D

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4
Q

What are the important aspects of glucose metabolism in the kidneys?

A

Gluconeogenesis and insulin clearance

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5
Q

What type of anaemia does loss of EPO production result in?

A

Normocytic and normochromic

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6
Q

What happens to potassium levels in a patient with kidney failure?

A

increase

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7
Q

What happens to bicarbonate levels in a patient with CKD?

A

decrease

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8
Q

What happens to phosphate levels in a patient with CKD?

A

increase

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9
Q

What happens to the pH of the blood in a patient with CKD?

A

lowers

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10
Q

What does a reduction in 1 alpha hydroxylase vitamin D lead to?

A

reduce calcium and increased parathyroid hormone,

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11
Q

What happens to urea and creatinine in a CKD patient?

A

Both increased

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12
Q

What is the key condition which patients with CKD will die from due to an increased risk?

A

Cardiovascular risk

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13
Q

What are some clinical signs of CKD?

A
  • high creatinine
  • feeling weak, too weak to move
  • pale
  • hand cold and decreased capillary refill
  • hypotensive
  • tachypnoeic despite 100% O2 sats and clear lungs
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14
Q

What is the volume assessment of a CKD patient?

A

volume depleted, hypovolemic = dry volume status

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15
Q

What type of breathing might CKD patients present with?

A

Kussmaul respiration

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16
Q

Why does the respiratory rate increase for patients with CKD despite clear lungs and 100% O2 sats?

A

excess hydrogen ions which is converted into carbon dioxide - this stimulates breathing to remove the excess H+ = results in KUSSMAUL breathin

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17
Q

What is Kussmaul respiration a key sign of?

A

Acidosis

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18
Q

What is the common acid base status of a patient with CKD?

A

metabolic acidosis with respiratory compensation

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19
Q

Why does respiratory compensation occur in CKD?

A

Low pH = acidosis, bicarbonate low so metabolic acidosis, Carbon dioxide also low so has been some respiratory compensation = breathing out carbon dioxide to try and reduce CO2

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20
Q

What happens to the size of the kidneys in CKD?

A

Shrinking of the kidneys - on an ultrasound

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21
Q

What happens to the kidney size on AKI?

A

Preserved

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22
Q

What symptoms might someone experience with CKD?

A

Symptoms of extreme lethargy, weakness and anorexia.
Clinically volume depleted resulting in severe hypotension.
Elevated plasma urea and creatinine make diagnosis of renal failure.

23
Q

What is the acid base status in AKI?

A

Mild metabolic acidosis with respiratory compensation

24
Q

Kidney failure tends to REDUCE secretion of salt and water leading to:

A

Hypertension
Oedema
Pulmonary oedema

Due to water and salt retention

25
Q

In which situation might salt and water loss be seen?

A

tubulointerstitial disorders due to the concentrating mechanism

results in hypovolemia = due to loss of fluid through vomiting

26
Q

What is meant by oedema?

A

Oedema = excess extracellular fluid

27
Q

What is the main extracellular ion?

A

sodium

28
Q

Describe the acidosis mechanism in kidney failure?

A

reduce excretion of H+ ions, results in increased H+ ions

They enter into the cells and as a result the H+ ions swap for potassium, which leave the cells

This results in a rise of potassium

29
Q

What symptoms does acidosis due to kidney failure result in?

A

Anorexia
Muscle Catabolism

30
Q

What are the causes of hyperkalaemia due to kidney failure?

A

↓ Distal tubule potassium secretion
Acidosis

31
Q

What are the symptoms which result from hyperkalaemia due to kidney failure?

A

Cardiac arrhythmias
Neural and muscular activity
Vomiting

32
Q

What are the ECG changes which are seen due to hyperkalaemia?

A

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

33
Q

What does reduced EPO as a result of kidney failure lead to?

A

Anaemia

34
Q

What does reduced vitamin D as a result of kidney failure lead to?

A

Reduced intestinal calcium absorption
Hypocalaemia
Hyperparathyroidism

35
Q

Why does CKD lead to phosphate retention?

A

Kidneys not working-> GFR drops -> less phosphate excreted

36
Q

What impact does phosphate retention have?

A

Calcium levels go down (also as a result of low levels of vitamin D), which leads to hyperparathyroidism

37
Q

Describe the effect of vitamin D on PTH?

A

Vitamin D suppresses PTH production so low vit D will increase PTH production

38
Q

Which type of hyperparathyroidism occurs?

A

Secondary, which can eventually change into tertiary

39
Q

What is the major outcome for a patient with CKD?

A

Cardiovascular disease

40
Q

What are the three components of a standard cardiovascular risk?

A

Hypertension
Diabetes
Lipid Problems

41
Q

What are the additional CVD risks due to CKD?

A

Inflammation
Oxidative stress
Mineral / Bone metabolism disorders

42
Q

What medication is used to drive K+ back into cells?

A

Sodium bicarbonate

43
Q

How is the fluid balance restored?

A

If hypo = give IV fluids
If Hyper = use dialysis

44
Q

What are the treatments for hyperkalaemia

A

Sodium bicarbonate to drive K+ into the cells

Diuretics to drive K+ into the cells

gut absorption - use potassium binders to bind the excess potassium in the gut

45
Q

what are the conservative treatment methods for long term management?

A
  • erythropoietin injections to correct anaemia
    • diuretics to correct salt-water overload
    • phosphate binders to reduce phosphate to prevent bone disease
    • 1.25 vit d supplements
    • symptom management
46
Q

What is the best treatment for CKD?

A

Kidney transplant

47
Q

What is the equation used to work out the chance of the patient reaching end stage renal failure in the next five years?

A

Kidney Failure Risk Equation

48
Q

Which patients is the KFRE not used in?

A

patients with a rapidly changing eGFR

49
Q

Why should transfusions be avoided?

A

transfusion -> sensitisation -> transplant failure

50
Q

Why is UREA a poor method of measuring GFR?

A

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

51
Q

what are the problems associated with using creatinine clearance?

A

Overestimates GFR at low GFR (as a small amount of creatinine is also secreted into urine)

Difficult for elderly patients to collect an accurate sample

52
Q

why is creatinine not effective of assess GFR?

A

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

53
Q

What happens to GFR and ACR as risk of CKD increases?

A

GFR goes down
ACR increases

54
Q

What are the home therapies for kidney failure?

A

Haemodialysis
peritoneal dialysis

BRS 12 Urology and renal (11 decks)

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