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Med emerg > Acute and Chronic Kidney Disease > Flashcards

Acute and Chronic Kidney Disease Flashcards

1
Q

Acute kidney injury and chronic kidney disease:

A
  • AKI and CKD supersede old terminology of acute and chronic renal failure (pre 2009)
  • severe reduction in renal function - many causes
  • acute or chronic
  • acute - sudeen onset - tends to be reversible whereas
    chronic is slow, progressive loss of nephrons and decrease in GFR, not reversible.
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2
Q

Acute kidney injury:

A

Rapid and sudden deterioration of renal function
• Resuling in retention of metabolic wastes – Azotaemia
• Impaired fluid and electrolyte balance
• Usually develops over hours/days
• Usually follows
– Severe prolonged hypotension
– Hypovolemia
– Exposure to nephrotoxic agent

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3
Q

Acute kidney injury (AKI)

A 
Usually     
– Decreased urine output (oliguria)    
• < 400    ml/day    (30    ml/h)    
– Increased serum  creatinine
– Increase BUN (Blood urea nitrogen)    
– Usually reversible
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4
Q 
Acute kidney injury (AKI) 
causes 
- Prerenal? 
- intrarenal?
- postrenal?
A

Prerenal: impaired blood flow: hypotension, ischemia, low cardiac output, haemorrhage, surgery

intrarenal - acute glomerulonephritis or acute tubular necrosis - aminoglycoside antibiotics

postrenal - urinary tract obstruction

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5
Q

Clinical Progression of Acute kidney injury:

phase one - initiation phase:

A
  1. Initiation phase
    • Reduced perfusion, renal injury evolving
    • Prevention of injury is possible
    • Oliguria, sometimes anuria begins within 1 day of precipitating event
    • Lasts 1 – 3 weeks
    • Increased BUN and plasma
    creatinine
    • Other manifestations depend on the underlying cause
    • Hyperkalemia, hyperphosphatemia
    (frome cellular breakdown)
    • Fluid retention/edema
    • If cardiac disease – symptoms of congestive heart failure
    • Nausea, vomiting, fatigue, accompany electrolyte imbalances and uremia
    • Poor wound healing
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6
Q

Clinical Progression of Acute kidney injury:

Phase two - Maintenance Phase:

A

Maintenance Phase
• Period of establish renal injury and dysfunction
• May last weeks to months
• Urine output lowest during this phase
• Serum creatinine increases
• BUN increase

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7
Q

Clinical Progression of Acute kidney injury:

phase three - Recovery phase:

A

• Interval when renal injury is repaired
• Normal renal function restablished
• Diuresis is common during this phase
– During the diuretic phase the tubules are still recovering secretory and
reabsorptive function
– Na+ and K+ lost in urine
– Risk of hypocalemia is greater
– Volume depletion may ensue, with fluid loss of 3-­‐4L/day
– Fluid and electrolyte balance must be carefully monitored
• Decline in serum
creatinine and urea
• Increase in creatinine clearance
• Return to normal function may take 3-­‐12 months
• Approximately 30% people do not fully recover normal GFR or tubular function

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8
Q

Chronic kidney disease:

A
  • gradual loss of nephrons until the remainder cannot carry out normal renal function
  • slow but irreversible
  • results in end stage renal disease
  • ESRD requires dialysis or maintenance for survival

progressive loss of renal function with systemic diseases such as hypertension, diabetes mellites or intrinsic kidney diseases

the national kidney foundation definition
- GFR < 60ml/min/1.73m2

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9
Q

chronic kidney disease risk factors:

A
  • intact nephrons can enlarge and increase function - compensate for loss
  • one kidney can take overall function: 50% nephron loss and 50% reduction in GFR
  • may not see impaired function until 75-80% loss of nephrons
  • alterations to nephrons and increased flow may lead to further damage and loss.
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10
Q

chronic kidney disease:

- what is it thought to be associated with?

A

The progression of CKD is thought to be associated with a common pathogenic process regardless of the initial disease

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11
Q

chronic kidney disease:
- how many stages are there?
-

A
  • 5 stages related to progressive GFR
  • replaces “diminished renal reserve” “renal insufficiency” “chronic renal failure” etc..
  • internationally agreed classification of chornic kidney disease (CKD) adapted from the national kidney foundation. 3, 5.
  • stage description based on GFR (ml/1.73m2)
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12
Q

stages based on GFR in ml/ min/ 1.73m2:

A

stage 1 - kidney damage with normal (<90) previous or increased GFR 3.3%

stage 2 - kidney damage with mildly decreased GFR (60-89) = 3.0%

stage 3 - modKD, decreased GFR (30-59) =4.3%

stage 4 severeKD, decreased GFR (15-29) = 0.2%

stage 5 - end stage KD/kidney failure (<15 Ml /min/1.73m2

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13
Q

notes for stage 1 and 2

A
  • diagnosis of stage 1 and 2 CKD requires presence of kidney damage for >3 months
  • pathological abnormalities of the kidney or abnormalities in the composition of urine such as: — haematuria or proteinuria, or abnormalities in imaging tests (scaring) with decreased GFR (stage 2) or without decreased GFR (stage 1)
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14
Q

stage 1: kidney damage with normal or > GFR

A
  • GFR >75% at least 90ml/min/1.73m2
  • evidence of kidney damage without decreased GFR or with increased GFR
  • usually no symptoms
  • hypertension common
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15
Q

stage 2: mild kidney damage

A
  • asymptomatic, plasma and urine creatinine and urea rising but is normal range, symptoms subtle, hypertension.
  • evidence of damage, e.g. in urine
  • increasing parathyroid hormone and early
  • bone disease
  • GFR down to 50%: 60-89 ml/min/1.73m2
  • loss may become progressive
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16
Q

stage 3: moderately reduced GFR/moderate kidney damage:

A
  • (GFR - 30%-%0% = 30-59 ml/min)
  • may be asymptomatic even with reduction by 70% mild symptoms, hypertension.
  • signs of kidney damage and possible signs of other organ dysfunction
  • mild azotaemia (raised creatinine and urea)
  • anemia (loss of erythoprotein - EPO); polyuria, notaria due to decreased concentrating ability of nephrons
  • hypovolaemia, sodium loss, dehydration
  • uremia if under stress.
17
Q

stage 4:

- severely reduced GFR (SF-GFR)

A
  • GFR 10-25%, <30ml/min
  • increasing creatinine and urea (azotaemia)
  • increased triglycerides
  • normal blood volume and concentration not maintained – sodium and water retention.
  • oliguria and fluid overload
  • load delivered to remaining nephrons too high, cannot reabsorb, excrete or concentrate
18
Q

stage 4 continued:

A 
Consequence of CKD = hypertension    
• Increased creatinine, urea, anaemia
• Edema,    electrolyte    imbalances    
• Metabolic    acidosis    
• When GFR =25% -­‐ Hyperkalemia,    
hyperphosphatemia
,hypercalcemia
• Increased    renal    phosphate    secretion    
• Decreased Vit D synthesis    
from    bone    
• Increased  Ca2+ resorption from b
• Decreased    Ca2+    absorption    from    gut    
• Urine with fixed low specific gravity
19
Q

stage 4 continued:

A
  • Anaemia due to decreased EPO (erythropoietin)
  • lytic bone disease
  • new staging indicates uraemia in stage 5 ut changes to organ/system function are progressive throughout CKD, and effects may vary with disease process and its location is the kidney.
  • possible alteration in blood coagulability
  • frequent infections and risk of malignancy
  • raised insulin and lowered thyroid hormone
20
Q

stage 5: end stage renal disease:

A
  • GFR <15 ml/min/1.73m2; <10%normal
  • oliguria or anuria, severe fluid overload
  • major disturbances of fluid and electrolytes, e.g: metabolic acidosis, decreased plasma K+ and phosphate
  • uraemia, with anorexia, fatigue, pruritic, vomiting, diarrhoea, weight loss
  • major disorders of most body systems
  • neurological syndromes - e.g. restless legs, hiccups, sleeplessness, weakness.
21
Q

end stage renal disease continued:

A
  • increased risk of blood coagulation, chronic inflammation
  • cardiovascular disorder due to hypertension and dyslipidaemia, calcium deposition
  • need to control food and water intake
  • after 1 week of untreated renal failure,
  • acidotic coma with deep and rapid respiration
  • arterial pressure falls rapidly in the last day
  • death usually ensues at PH 6.8
22
Q

treatment options:

A
  • dialysis
  • Haemodialysis
  • Peritoneal dialysis
  • transplantation

Med emerg (18 decks)

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