1b// Chronic Kidney Disease and Renal Failure Flashcards by rachael a

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

homeostatic function

excretory function

endocrine function

glucose metabolism

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What is the homeostatic function of the kidneys?

electrolyte balance

acid-base balance

volume homeostasis

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What is the excretory function of the kidneys?

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

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What is the endocrine function of the kidneys?

erythropoietin

1-alpha hydroxylase vitamin D

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What is the glucose metabolism role of the kidneys?

gluconeogenesis

insulin clearance

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What happens to homeostatic function when there is kidney failure?

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What happens to excretory function when there is kidney failure?

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

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What happens to endocrine function when there is kidney failure?

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

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

hypovolemic

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

acidotic bc they cant make bicarbonate

metabolic acidosis
respiratory compensation

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What is kussmaul respiration?

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

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

high urea
high creatinine
low sodium
high potassium
low haemoglobin

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

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

met acidosis w/ resp comp

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

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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How may someone with acute kidney failure present?

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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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

normo

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

urea up
creatinine up
sodium normal
potassium normal
haemoglobin normal

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

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

mild metabolic acidosis w/ resp comp

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

normal sized with no obstruction

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

reduced

hypertension
oedema
pulmonary oedema

*so usually CKD leads to hypovolaemia

Where else can salt and water loss be seen?

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

Does hyponatremia always mean reduced total body sodium?

What is the acid balance of CO2 and H2O?

What does the increased H+ mean for the kidneys?

reduced excretion of H+ ions retention of acid bases leads to hyperkalemia K+ leaves the cells

What does the hyperkalemia lead to?

anorexia and muscle catabolism? the picture suggests but nothing on google backs so idk...

What are the causes and symptoms of hyperkalaemia?

decreased DCT potassium secretion Acidosis cardiac arrhythmias neural and muscular activity vomiting

What does hyperkalemia do to ECGs?

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

What does reduced erythropoietin lead to in kidney failure?

anaemia

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

Reduced intestinal calcium absorption Hypocalcaemia Hyperparathyroidism

How does chronic renal failure lead to hyperparathyroidism?

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

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.

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

Standard cardiovascular risk... - Hypertension - Diabetes - Lipid abnormalities Additional risks... - Inflammation - Oxidative stress - Mineral/bone metabolism disorder

What is the initial management of kidney failure?

What are the types of dialysis?

haemodialysis peritoneal dialysis

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

conservative treatment home therapy or in centre therapy transplantation

What is the long term conservative treatment for kidney failure?

- erythropoietin injections to correct anaemia - diuretics to correct salt water overload - phosphate binders - 1.25 vit d supplements - symptom management

What are the home and in centre therapy options?

home... - haemodialysis - peritoneal dialysis/assisted programmes centre... - haemodialysis, 4 hours 3 times a week

What is KFRE?

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

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

transfusions bc it leads to sensitisation and then transplant failure

What are the traditional methods of assessing for GFR?

urea creatinine radionuclide studies creatinine clearance inulin clearance

Is urea a good way of measuring GFR?

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

Is creatinine a good way of measuring GFR?

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

Is radionuclide studies a good way of measuring GFR?

EDTA clearance etc. reliable but expensive

Is creatinine clearance a good way of measuring GFR?

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)

Is inulin clearance a good way of measuring GFR?

Laborious - used for research purposes only

Does this make sense?

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

GFR NICE guidance classification.

more albumin= more risk??