1b// Chronic Kidney Disease and Renal Failure Flashcards
What are the 4 categories of the functions of the kidney?
homeostatic function
excretory function
endocrine function
glucose metabolism
What is the homeostatic function of the kidneys?
electrolyte balance
acid-base balance
volume homeostasis
What is the excretory function of the kidneys?
Nitrogenous waste
Hormones
Gluconeogenesis
Insulin clearance
Peptides
Middle sized molecules
Salt and water
What is the endocrine function of the kidneys?
erythropoietin
1-alpha hydroxylase vitamin D
What is the glucose metabolism role of the kidneys?
gluconeogenesis
insulin clearance
What happens to homeostatic function when there is kidney failure?
What happens to excretory function when there is kidney failure?
What happens to glucose metabolism function when there is kidney failure?
What happens to endocrine function when there is kidney failure?
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%
Would a patient with chronic kidney disease be hyper, hypo or euvolemic?
hypovolemic
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
What is kussmaul respiration?
Kussmaul respirations are fast, deep breaths that occur in response to metabolic acidosis.
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
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
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
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
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
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
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?
NO
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??
