Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney disease?

A

CKD is a decline in renal function for more than 3 months. Staging is based on the eGFRa and albuminuria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the features of CKD?

A

CKD presents through routine monitoring and incidental findings or symptoms related to lost renal function. There is typically normal cystic anaemia and high parathyroid hormone due to renal dysfunction and kidneys may be atrophic and unable to regain lost function. Symptoms are typically asymptomatic and appear on advanced renal disease,with vomiting, fatigue, abnormal fluid overload.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is Stage 1 of CKD?

A

eGFR greater/equal to 90 ml/min.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is Stage 2 of CKD?

A

60-89.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is Stage 3a of CKD?

A

45-59 ml/min.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Stage 3b of CKD?

A

30-44 ml/min.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is Stage 4 of CKD?

A

15-29

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Stage 5 of CKD?

A

Less than 15 ml/min.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is are the ranges for albuminuria?

A

Less than 30mg/L is normal to mildly increased,

30-299 mg/L ks is moderately increased,

Greater than 300 mg/L indicates severely increased albumin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the common causes of CKD?

A

-> Progression of acute kidney injury
-> Hypertension
-> Can be caused by Cushing’s disease, tumours, thyroid issue
-> Diabetes
-> Polycystic kidney disease
-> Cardiovascular disease
->Glomerulonephritis where autoimmune reaction against the glomerular basem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How does hypertension damage the kidneys?

A

Hypertension causing hyper filtration and damage to the blood vessels and create thickening via protein deposition of hyaline causing hyaline arteriosclerosis. The high BP leads to hypoxia which damages the renal tubular cells and mesangial cells release TGF-beta that activates fibroblasts and leads to glomerulosclerosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How does diabetes harm the kidneys?

A

Diabetes causes non-enzymatic glycation where high circulating blood glucose binds with proteins and lipids which are a highly inflammatory and damages the efferent arteriole, causing both hyaline arteriosclerosis and atherosclerosis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a normal albumin-creatinine ratio?

A

Less than 30 mg/L,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does an albumin creatinine ratio less than 30 indicate?

A

Albumin-creatinine ratio less than 3= mild or no albuminuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What does albumin-creatinine ratio between 3-30 mg/L indicate?

A

Moderate albuminuria or microalbuminuria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What does an albumin-creatinine ratio over 30% indicate?

A

Moderate albuminuria or microalbuminuria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How does rheumatoid arthritis affect the kidneys?

A

Rheumatoid arthritis causes damage to the blood vessels due to the chronic inflammation which causes hyaline arteriosclerosis and reduces renal perfusion. Alternatively, the autoimmune nature of rheumatoid arthritis can lead to glomerulonephritis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is hyperkalemia corrected?

A

-> Insulin stimulates the Na+/K+ ATPase pump for exchange of K+ into ureter to be excreted. It promotes uptake of K+ into cells.
* Salbutamol activates pancreatic beta receptors for the release of insulin that indirectly lowers K+
* IV HCO3 to remove excess K+ via the HCO3-/K+ exchanger

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is albuminuria treated?

A

Addressing albuminuria through ACE inhibitors and ARBs (angiotensin receptor 2 blockers) to reduce systemic vascular resistance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the management for CKD?

A

Correcting hypocalcaemia through treating the underlying Vitamin D deficiency through supplements like calcitriol and ergocalcifero
-> Addressing secondary hyperparathyroidism through cinacalcet to reduce PTH production
Kidneys are important in immune homeostasis so in CKD, it is important that patients receive vaccines like pneumococcal and flu and Hep.
Correcting high levels of circulating LDLS through statins
Sodium polystyrene for excretion of Na+ through stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How is platelet dysfunction treated?

A

Correcting platelet dysfunction through desmopressin which increases platelet activation

22
Q

What are the signs of disease in CKD?

A

Oedema
Peripheral vascular disease such as vasculitis
Flapping tremor/asterexis from uraemia
Pericardial oedema and effusion, increased JVP and BP

Pulmonary oedema and effusion

23
Q

What is the first line treatment for Stage 1/2 CKD?

A

First line treatment of Stage 1/2 kidney disease is with an ACE inhibitor or angiotensin receptor blocker (ARB) to prevent further glomerulosclerosis. This will temporarily cause a decrease in GFR and rise in creatinine along with statin.

24
Q

What is the second line treatment for stage 1/2 CKD?

A

Second line of treatment is calcium channel blocker
SGLT-2 inhibitor which is useful for hyperglycaemia and also reduces proteinuria by preventing podocyte apoptosis. This is reccomended by NICE for those on ACE or ARB medication.

25
Q

What is the first lime treatment for Stage 3/4 CKD?

A

Pharmacological management is the same as Stage 1, with greater emphasis on education for healthier lifestyle choices and supplementary vitamins for anaemia and vitamin D.

26
Q

What is the treatment for Stage 5 CKD?

A

First line treatment: Peritoneal or haemolytic dialysis
Second line treatment: Transplantation

27
Q

What is obstructive uropathy?

A

Obstructive uropathy is a generalised term to describe the blockage of urine flow due to a disorder in the urinary system, that leads to a back up of urine into the kidneys and results in hyrdronephrosis which causes atrophy of renal parenchyma and leads to CKD and increased inappropriate RAAS activation.

28
Q

What is the cause of obstructive uropathy?

A

Benign prostatic hyperplasia/hypertrophy
Prostate cancer
Vesico-ureteric obstruction/ pelvo-ureteric obstruction
Bladder neck stenosis
Retroperitoneal fibrosis
Lymphatic obstruction

29
Q

What are the risk factors for obstructive uropathy?

A

BPH
Anticholinergic and alpha-blocker medications which prevent the relaxation of the external urethral sphincter
Opioids like codeine bind to the mu/delta receptors and cause urinary retention

30
Q

What are the signs and symptoms of obstructive uropathy?

A

Unilateral Flank pain, difficulty passing urine, nocturnal, distendable abdomen with percussable dull bladder.

31
Q

What are the investigations for obstructive uropathy?

A

FBC
Ultrasound of kidneys, ureter and bladder to assess for stones
Urine dipstick test
CT scan
PSA blood test
Serum urea-creatinine ratio

32
Q

What is the management of BPH?

A

Behavioural: avoiding caffeine and alcohol, voiding twice in a row, increasing the time between urination through distraction methods
Pharmacological: alpha-adrenergic receptor blockers, 5-alpha reductase inhibitors to prevent the formation of 5-alpha reductasse

Surgical management through transurethral resection of the prostate to remove the section causing issues, or complete removal of the prostate.

33
Q

What are the indications for peritoneal dialysis?

A

Peritoneal dialysis is indicated for patients with difficulty with vascular access, chronic infections, orloss of pressure regulation.

Patients must have good dexterity and vision in order to perform this to prevent infection.

34
Q

What is the most common infection in peritoneal dialysis?

A

The most common is staphylococcus aureus and staphylococcus epididermis, which can be treated by adding vancomycin and ceftazidime into the fluid.

35
Q

What is the process of peritoneal dialysis?

A

Peritoneal dialysis works by inserting a catheter into the peritoneal membrane and installing sterile dialysate solution into the peritoneal cavity with the periotneum acting as a semi-permeable membrane and there is a lag period called dwelling, where toxins from the blood pass from the blood into the fluid which occurs for several hours until the waste is then removed through the catheter into a separate drainage bag.

36
Q

What are the risks of peritoneal dialysis?

A

Risks include catheter site infection, bacterial peritonitis, hernia, diabetes due to high glucose content of the fluid and sclerosing peritonitis.

37
Q

What is the process of Haemodialysis?

A

Haemodialysis involves forming an arteriovenous fistula, by adhering a vein and artery together and takes 2 months to form and create an access point for the dialysis machine. There is a concentration gradient so urea and waste and phosphates move out from the blood into the dialysate fluid. The dialysate fluid is rich in nutrients so the concentration gradient prevents this leaving the blood.

38
Q

What is the risk of Haemodialysis?

A

Haemodialysis has a risk of disequilibrium syndrome where fluid shifts results in oedema and neurological confusion. There is a greater risk for those first starting dialysis treatment or returning to treatment after a long break.

High levels of aluminium in the dialysate fluid can result in dialysate encephalopathy/dementia, a subacute condition which is characterised by seizures, confusion and psychosis

39
Q

What is chronic renal failure?

A

Chronic renal failure is when the GFR is less than 15 or stage 4 of CKD, and patients will typically be managed with renal replacement therapy with dialysis until they await transplantation. Renal failure commonly occurs due to diabetes and hypertension.

40
Q

What are the contraindications for renal transplantation?

A

Cardiac or pulmonary disease
Malignancy
Infection
Drug dependence
Active psychiatric disorder: transplantation increases the risk of recccurrence and the likelihood of non compliance
BMI over 35

41
Q

What are the complications with renal transplants?

A

The complications with renal transplantation therapy are
Haemorrhaging, renal artery stenosis, infection due to immunosuppression, renal vein thrombosis, arterial stenosis and lymphocele.
Long term complications include infection with cytomegalovirus and post-transplant steroids due to steroids reducing the body’s sensitivity to insulin. Transplantation increases the risk of cancers due to the immunosuppression such as cervical cancer, non-hodgkin’s lymphoma and cervical cancer.

42
Q

How is kidney transplant matched?

A

It is essential that serum cross-matchin and HLA matching is performed to prevent rejection, especially for MHC CLass II to ensure graft survival to avoid immune response by CD4+ T cells.

Recipient and donor kidney should ideally be within a 10 year range kidneys are matched based on best compatibility

43
Q

What is human leukocyte antigen?

A

Tissues have human leukocyte antigens, which are cell-surface proteins that code for recognition of self-tissues to prevent destruction of organs by the immune system. IN transplantation, it is important that the HLA antigen and serum is cross matched to prevent donor rejection.

44
Q

What is serum cross matching?

A

Serum cross-matching is identifying the presence of antibodies in the recipient against the donor tissue to avoid hyperacute rejection.

45
Q

What happens in HLA mismatch?

A

The antibodies produced are complementary to the HLA like IgG which can stimulate activation of the complement cascade like C3 convert age and C5 convertase for inflammation and a MAC complex of C5-C9 that creates pores and damages the host tissue and causes endothelial damage which releases chemokines that attracted other immune cells and leads to renal vein thrombosis

46
Q

What is major histocompatibility complex?

A

Major histocomopatiblity complex MHC is a cell surface protein which carries fragments of foreign antigens and interacts with T cells for the formation of complementary antibodies. MHC is a generalised term and the human version of

47
Q

What is MHC Class I?

A

MHC Class I is expressed on all nucueated cells, interacts with CD8+ T cells and includes HLA-A, HLA-B and HLA-C

48
Q

What is MHC Class II?

A

MHC Class II is expressed on monocytes and lymphocytes and interacts with CD4+ T cels and includes HLA-DQP, HLA-DQ, HLA-DR2, HLA-DR3, HLA-DR4.

49
Q

What is tissue typing?

A

Tissue typing for kidney transplantation involves matching for HLA-A, HLA-B and HLA-DR, with two of each inherited from both parents.

50
Q

What is cross-matching?

A

Cross matching involves adding the recipient’s blood plasma to donor RBCs to test for antibody reactions that are pre-formed, through blood transfusions or pregnancy in order to prevent hyperacute graft rejection.

Year 3 (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions