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BRS UROLOGY & RENAL > 1b// Chronic Kidney Disease and Renal Failure > Flashcards

1b// Chronic Kidney Disease and Renal Failure Flashcards

1
Q

What are the 4 categories of the functions of the kidney?

A

homeostatic function

excretory function

endocrine function

glucose metabolism

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2
Q

What is the homeostatic function of the kidneys?

A

electrolyte balance

acid-base balance

volume homeostasis

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3
Q

What is the excretory function of the kidneys?

A

Nitrogenous waste
Hormones
Gluconeogenesis
Insulin clearance
Peptides
Middle sized molecules
Salt and water

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4
Q

What is the endocrine function of the kidneys?

A

erythropoietin

1-alpha hydroxylase vitamin D

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5
Q

What is the glucose metabolism role of the kidneys?

A

gluconeogenesis

insulin clearance

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6
Q

What happens to homeostatic function when there is kidney failure?

A
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7
Q

What happens to excretory function when there is kidney failure?

A
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8
Q

What happens to glucose metabolism function when there is kidney failure?

A
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9
Q

What happens to endocrine function when there is kidney failure?

A
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10
Q

How would a patient present if they had chronic kidney disease?

A

“Very unwell”
Pale
Hands cold
Capillary refill decreased Poor skin turgor
Pulse rate 50/minute
Blood pressure - 67/35 mm Hg JVP not visible
Tachypnoeic
Clear lungs on auscultation Oxygen sats 100%

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11
Q

Would a patient with chronic kidney disease be hyper, hypo or euvolemic?

A

hypovolemic

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12
Q

Why would a patient with chronic kidney disease be tachypneic with normal oxygen sats and clear lungs on auscultation?

A

acidotic bc they cant make bicarbonate

metabolic acidosis
respiratory compensation

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13
Q

What is kussmaul respiration?

A

Kussmaul respirations are fast, deep breaths that occur in response to metabolic acidosis.

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14
Q

What happens to urea, creatinine, sodium, potassium and haemoglobin in a patient with chronic kidney disease?

A

high urea
high creatinine
low sodium
high potassium
low haemoglobin

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15
Q

What happens to pH, pCO2, pO2, bicarbonate, base excess in a patient with chronic kidney disease?

A

low pH
low pCO2
high O2 (from hyperventilation)
low bicarbonate
low base excess

met acidosis w/ resp comp

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16
Q

What would be the summary of clinical findings for a patient with chronic kidney disease?

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.

This is complicated by:
hyperkalaemia
hyponatraemia
metabolic acidosis
anaemia

ULTRASOUND - 2 small shrunken kidneys

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17
Q

How may someone with acute kidney failure present?

A

54 year old previously fit and well, admitted with a 2 day history of nausea and vomiting and 1 day history of reduced urinary output after eating some wild mushrooms.

Alert and orientated Temp 36.4 degrees C HR 79
RR 16
BP 143/81
Normal skin turgor

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18
Q

Is this patient hypo, hyper or normovolemic?

54 year old previously fit and well, admitted with a 2 day history of nausea and vomiting and 1 day history of reduced urinary output after eating some wild mushrooms.

Alert and orientated Temp 36.4 degrees C HR 79
RR 16
BP 143/81
Normal skin turgor

A

normo

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19
Q

What happens to urea, creatinine, sodium, potassium and haemoglobin in a patient with acute kidney disease?

A

urea up
creatinine up
sodium normal
potassium normal
haemoglobin normal

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20
Q

What happens to pH, pCO2, pO2, bicarbonate, base excess in a patient with acute kidney disease?

A

normal pH (up?)
down CO2
up O2
low bicarbonate

mild metabolic acidosis w/ resp comp

21
Q

What would the ultrasound KUB look like for acute kidney failure?

A

normal sized with no obstruction

22
Q

What normally happens to salt and water secretion during kidney failure? And what does it lead to?

A

reduced

hypertension
oedema
pulmonary oedema

*so usually CKD leads to hypovolaemia

23
Q

Where else can salt and water loss be seen?

A

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

24
Q

Does hyponatremia always mean reduced total body sodium?

A

NO

25
Q

What is the acid balance of CO2 and H2O?

A
26
Q

What does the increased H+ mean for the kidneys?

A

reduced excretion of H+ ions
retention of acid bases

leads to hyperkalemia
K+ leaves the cells

27
Q

What does the hyperkalemia lead to?

A

anorexia and muscle catabolism?

the picture suggests but nothing on google backs so idk…

28
Q

What are the causes and symptoms of hyperkalaemia?

A

decreased DCT potassium secretion
Acidosis

cardiac arrhythmias
neural and muscular activity
vomiting

29
Q

What does hyperkalemia do to ECGs?

A

Peaked T waves

P wave…
- broadens
- reduced amplitude
- disappears

QRS widening

Heart block

Asystole

VT/VF

30
Q

What does reduced erythropoietin lead to in kidney failure?

A

anaemia

31
Q

What does Reduced 1-25 Vit D levels lead to in kidney failure?

A

Reduced intestinal calcium absorption

Hypocalcaemia

Hyperparathyroidism

32
Q

How does chronic renal failure lead to hyperparathyroidism?

A
33
Q

What is a major predictor of end stage renal failure and what is the major outcome for a patient with CKD?

A

major predictor of end stage renal failure is CKD
BUT
Major outcome for a patient with CKD is cardiovascular disease

i.e. a patient with CKD is more likely to die from cardiovascular disease than end stage renal failure.

34
Q

What are the cardiovascular risks of kidney failure? (6)

A

Standard cardiovascular risk…
- Hypertension
- Diabetes
- Lipid abnormalities

Additional risks…
- Inflammation
- Oxidative stress
- Mineral/bone metabolism disorder

35
Q

What is the initial management of kidney failure?

A
36
Q

What are the types of dialysis?

A

haemodialysis

peritoneal dialysis

37
Q

What are the types of treatments for long-term treatment of kidney failure?

A

conservative treatment

home therapy or in centre therapy

transplantation

38
Q

What is the long term conservative treatment for kidney failure?

A
  • erythropoietin injections to correct anaemia
  • diuretics to correct salt water overload
  • phosphate binders
  • 1.25 vit d supplements
  • symptom management
39
Q

What are the home and in centre therapy options?

A

home…
- haemodialysis
- peritoneal dialysis/assisted programmes

centre…
- haemodialysis, 4 hours 3 times a week

40
Q

What is KFRE?

A

Kidney failure risk equation (KFRE):

Validated risk prediction tool for kidney replacement therapy in the next two or five years for adults with STABLE chronic kidney disease (CKD) Stages 3A to 5 . NOT to be used in patient with rapidly changing eGFR.

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

Use:
Patient understanding of their CKD diagnosis especially in the context of multi-morbidity Identification of high risk CKD patients:
targeted patient engagement/education
aggressive risk factor management
referral to secondary care

41
Q

What should you avoid in transplantable patients with kidney disease and why?

A

transfusions

bc it leads to sensitisation and then transplant failure

42
Q

What are the traditional methods of assessing for GFR?

A

urea
creatinine
radionuclide studies
creatinine clearance
inulin clearance

43
Q

Is urea a good way of measuring GFR?

A

poor indicator
confounded by diet, catabolic state, GI bleeding (bacterial breakdown of blood in gut), drugs, liver function

44
Q

Is creatinine a good way of measuring GFR?

A

Affected by muscle mass, age, race, sex etc.

Need to look at the patient when interpreting the result. TREND helpful.

45
Q

Is radionuclide studies a good way of measuring GFR?

A

EDTA clearance etc.
reliable but expensive

46
Q

Is creatinine clearance a good way of measuring GFR?

A

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)

47
Q

Is inulin clearance a good way of measuring GFR?

A

Laborious - used for research purposes only

48
Q

Does this make sense?

A

most likely no (idk what it means)

*ok I watched the video apprently its j to show there are multiple equations to measure GFR and you have to look at the trend of patients

49
Q

GFR NICE guidance classification.

A

more albumin= more risk??

BRS UROLOGY & RENAL (10 decks)

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