22. CKD lectures and videos Flashcards
what is CKD
• Kidney damage or GFR less than 60 for longer than 3 months due to any cause
what does ESRD mean
the patient is no longer able to live with their kidney function and need to be commenced on RRT
in someone with CKD what could urinalysis show
proteinuria, haematuria and glucosuria
what do the following abbreviations mean;
- AKI
- ARF
- ATN
- AIN
- RPRF
- ESRD/ESRF
- Acute kidney injury- AKI
- Acute renal failure- ARF
- Acute tubular necrosis- ATN
- Acute interstitial nephritis- AIN
- Rapidly progressive renal failure- RPRF
- End stage renal disease- ESRD/ESRF
what is azotaemia
elevation of nitrogenous metabolic waste in the blood due to failure of clearance by the kidneys
what is uraemia
clinical syndrome resulting from failing kidneys and progressive azotaemia
what systemic disease can cause Glomerulonephritis
vasculitis
what is normal gas. exchange dependant on
o Adequate alveolar ventilation
o Adequate pulmonary perfusion
o Minimal barrier to gaseous diffusion
which two organs work to maintain Ph
kidneys and lungs
if there issues excessive CO2 then there is renal compensation and what occurs
bicarbonate is retained by the kidneys
in chronic CO2 retention what is the most important thing to look at
the bicarbonate as it will be raised
in a DKA patient what kind of breathing might they have and how does this link to the compensation
kussmaul breathing, and they will have low bicarbonate so there is a compensation by blowing off CO2 in the lungs
what are the indications to start renal replacement therapy
• Fluid overload • Refractory hyperkalaemia • Uraemic symptoms o Nausea, vomiting, weight loss o Neurological symptoms o Uraemic pericarditis ( rarely seen in modern day practice)
what are the main types of diuretics
osmotic
loop
thiazide
potassium sparing
give an example of osmotic diuretics
mannitol, urea, glycerine ad isosorbide
give an example of loop diuretics
furosemide and bemetanide
give an example of a thiazide diuretic
hydrochlorothiazide, chlorothiazide
give an example of a potassium sparing diuretic
spironolactone (aldosterone inhibitor)
how do diuretics work in general
substances that help the body to get rid of sodium and water
they decrease BP due to decrease in plasma volume
where do osmotic diuretics exert their effect
• Limit the reabsorption of water in the tubule and increase osmolality in renal tubule
what is the issue with loop diuretics
can induce renin release due to plasma volume depletion
which type of diuretic can increase the the reabsorption of urea in proximal tubule which increases plasma uric acid which can lead to gout
thiazide
how do potassium sparing diuretics works
aldosterone secreted by adrenal glands (it’s a steroid so binds to receptor inside the cell)
o This causes more Na/K+ pumps to be made, therefore preventing excretions of potassium and also the reabsorption of sodium
what are the absolute and relative contraindications to haemo-dialysis
inability to achieve suitable vascular access
severe dementia severe heart failure bleeding disorder low BP severe active psychotic disorder
what are the absolute and relative contraindications to peritoneal dialysis
active IBD ischaemic bowel acute diverticulitis abdominal abscess pregnancy 3rd trimester
abdominal hernia stomas previous abdo surgery poor manual dexterity obesity severe. nephrotic range proteinuria severe obstructive airway disease
tell me about haemodialysis
can be done through an IV line in your neck or by making a fistula
usually done for 4 hours 3X a week
tell me about peritoneal dialysis
- pour dialysate solution into your peritoneum which diffuses waste products out of your body, and then drain this fluid out
- The exchange takes about 20-30 minutes
what are the two options for peritoneal dialysis
o Two ways to do it, continuous ambulatory peritoneal dialysis (CAPD) which is where you do it 4 times a days, or automated peritoneal dialysis (APD) which is where you plug yourself into the machine overnight and this runs for 7-10 hours. With APD you may get some fluid in the stomach during the day
what are the indications for having a renal transplant
o All patients with end stage renal failure (GRF less than 15) or those with CKD stage 4 (GFR 15-29) with progressive disease should als be assessed for renal transplantation
what are the absolute contraindications for renal transplant
untreated malignancy
active infection
untreated HIV infection or AIDS
ant condition with a life expectancy less than 2 years
malignant melanoma within the previous 5 years
what are the relative contraindications for renal transplant
co-morbidities eg diabetes age greater than 65 obesity HBC or HCV infection previous malignancy (depending on type)
what is the most common cause of mortality post-operatively within the first year of transplant
cardiovascular disease
most other long term complications that aren’t cardiovascular disease are often related to what
related to the use of immunosuppressive agents such as recurrent infections, diabetes or malignancy
