1b// Chronic Kidney Disease and Renal Failure

Question 1

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

Answer 1

homeostatic function

excretory function

endocrine function

glucose metabolism

Question 2

What is the homeostatic function of the kidneys?

Answer 2

electrolyte balance

acid-base balance

volume homeostasis

Question 3

What is the excretory function of the kidneys?

Answer 3

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

Question 4

What is the endocrine function of the kidneys?

Answer 4

erythropoietin

1-alpha hydroxylase vitamin D

Question 5

What is the glucose metabolism role of the kidneys?

Answer 5

gluconeogenesis

insulin clearance

Question 6

What happens to homeostatic function when there is kidney failure?

Answer 6

Question 7

What happens to excretory function when there is kidney failure?

Answer 7

Question 8

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

Answer 8

Question 9

What happens to endocrine function when there is kidney failure?

Answer 9

Question 10

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

Answer 10

“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%

Question 11

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

Answer 11

hypovolemic

Question 12

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

Answer 12

acidotic bc they cant make bicarbonate

metabolic acidosis
respiratory compensation

Question 13

What is kussmaul respiration?

Answer 13

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

Question 14

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

Answer 14

high urea
high creatinine
low sodium
high potassium
low haemoglobin

Question 15

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

Answer 15

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

met acidosis w/ resp comp

Question 16

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

Answer 16

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

Question 17

How may someone with acute kidney failure present?

Answer 17

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

Question 18

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

Answer 18

normo

Question 19

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

Answer 19

urea up
creatinine up
sodium normal
potassium normal
haemoglobin normal

Question 20

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

Answer 20

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

mild metabolic acidosis w/ resp comp

Question 21

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

Answer 21

normal sized with no obstruction

Question 22

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

Answer 22

reduced

hypertension
oedema
pulmonary oedema

*so usually CKD leads to hypovolaemia

Question 23

Where else can salt and water loss be seen?

Answer 23

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

Question 24

Does hyponatremia always mean reduced total body sodium?

Answer 24

NO

Question 25

What is the acid balance of CO2 and H2O?

Answer 25

Question 26

What does the increased H+ mean for the kidneys?

Answer 26

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

Question 27

What does the hyperkalemia lead to?

Answer 27

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

Question 28

What are the causes and symptoms of hyperkalaemia?

Answer 28

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

Question 29

What does hyperkalemia do to ECGs?

Answer 29

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

Question 30

What does reduced erythropoietin lead to in kidney failure?

Answer 30

anaemia

Question 31

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

Answer 31

Reduced intestinal calcium absorption Hypocalcaemia Hyperparathyroidism

Question 32

How does chronic renal failure lead to hyperparathyroidism?

Answer 32

Question 33

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

Answer 33

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.

Question 34

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

Answer 34

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

Question 35

What is the initial management of kidney failure?

Answer 35

Question 36

What are the types of dialysis?

Answer 36

haemodialysis peritoneal dialysis

Question 37

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

Answer 37

conservative treatment home therapy or in centre therapy transplantation

Question 38

What is the long term conservative treatment for kidney failure?

Answer 38

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

Question 39

What are the home and in centre therapy options?

Answer 39

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

Question 40

What is KFRE?

Answer 40

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

Question 41

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

Answer 41

transfusions bc it leads to sensitisation and then transplant failure

Question 42

What are the traditional methods of assessing for GFR?

Answer 42

urea creatinine radionuclide studies creatinine clearance inulin clearance

Question 43

Is urea a good way of measuring GFR?

Answer 43

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

Question 44

Is creatinine a good way of measuring GFR?

Answer 44

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

Question 45

Is radionuclide studies a good way of measuring GFR?

Answer 45

EDTA clearance etc. reliable but expensive

Question 46

Is creatinine clearance a good way of measuring GFR?

Answer 46

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)

Question 47

Is inulin clearance a good way of measuring GFR?

Answer 47

Laborious - used for research purposes only

Question 48

Does this make sense?

Answer 48

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

Question 49

GFR NICE guidance classification.

Answer 49

more albumin= more risk??