29: Renal Failure Flashcards
What are the five key roles of the kidney?
- Eliminate waste products
- Regulate fluid balance
- Regulate acid-base balance
- Produce hormones
- Regulate electrolytes
What is normal GFR?
120ml/min
What are the two markers of acute kidney injury? How many stages are there?
- Serum creatinine & Urine output
- Three stages
What are the risk factors for AKI
- Concurrent illness
- CKD
- Age > 75 years
- Diabetes
- CHF
- Liver failure
- Nephrotoxic medicines
- Acute illness
What are some nephrotoxic medicines?
- NSAIDs
- Gentamicin
- ACE-is
What is the general approach to AKI?
- Identify high risk patients
- Assess and optimise volume status
- Stop nephrotoxic agents
- Review medications
- Monitor creatinine and urine output
Chronic kidney disease is an abnormality of kidney structure or function, present for >___ months that has implications for health
3
What is the gold standard for measuring GFR?
Insulin clearance
What factors does eGFR include?
- Age
- Weight
- Gender
- Serum creatinine
High creatinine can be reflective of high ___ and ____
Body size and muscle mass
Why might GFR be overestimated in patients in end stage renal disease?
- Increase in renal excretion
- Decrease in muscle mass
What are the two variables that are important for prognosis of CKD?
- GFR
- Albuminuria
What are the four main causes of CKD?
- Diabetic nephropathy
- Glomerulonephritis
- Hypertensive nephrosclerosis
- Polycystic kidney disease
What is the most common cause of glomerulonephritis
IgA nephropathy
What is target blood pressure for CKD?
- 140/80mmHg
- 110/80 mmHg in non diabetic patients
Why are ACEis and ARBs more effective in lowering blood pressure in CKD?
Patients often have activation of RAAS
When do CKD patients develop hyperphosphataemia? What are the sequelae?
- Stage III
- Secondary hyperoparathyroidism
- Fall in serum creatinine stage IV-V
How do you manage hyperphosophataemia?
- Dietary (phosphate restrict)
- Medical (phosphate binders)
Which hormones are produced by the kidney?
EPO
1,25OH vitamin D
BMP
Renin, angiotensin, bradykinin
CKD produces a metabolic ____ due to lack of excretion of ____
Metabolic acidosis
Lack of excretion of non-organic acids
What is uraemia?
Presence of urea in the blood
What are the treatment options for end stage kidney disease?
- Conservative
- Dialysis
- Renal transplant
