Chronic Kidney Disease

Question 0

Describe the ways in which chronic kidney failure affects the cardiovascular, haemopoietic, musculoskeletal and nervous system

Answer 0

Cardiovascular -
Haematopoietic - decreased erythropoietin production –> resistance –> decreased RBC survival = anaemia
Musculoskeletal - metabolic bone disease, osteomalacia, osteitis fibrosa (decreased GFR –> increased phosphate, decreased active vit. D –> decreased calcium –> increased PTH)
Nervous - acidosis

Question 1

List some of the main causes of chronic kidney failure

Answer 1

Systemic (diabetes), vascular, hypertension, genetic, pyelonephritis, glomerulonephritis

Question 2

Describe how renal function in measured

Answer 2

Serum creatinine - measures renal function, depends on muscle mass, age, sex, race
Glomerular filtration rate (GFR) - using inulin clearance, 51Cr EDTA clearance
eGFR - only accurate in adults, correction needed for black patients, only defines chronic kidney disease

Question 3

Describe the assessment of the cause of CKD

Answer 3

Auto antibody screen
Imaging (USS, CT, MRI)
Biopsy

Question 4

Describe the principles of conservative management of chronic kidney disease

Answer 4

Prevention/delay progression:
Lifestyle - smoking, obesity, lack of exercise
Treat diabetes if present
Treat blood pressure 
ACEi
Lipid lowering drugs

Question 5

Describe indications for renal replacement therapy

Answer 5

eGFR of 8-10ml/min
Pericarditis
Fluid overload
Hyperkalaemia

Question 6

Describe the principles of haemodialysis

Answer 6

Blood and dialysate flow in countercurrent fashion to maximise the clearance of solute
Unit based (4h, 3x week)
+ less responsibility, days off
- travel time/waiting, big restriction on fluid/food intake
Can’t move down a fistula
Dialysis catheter into RA

Question 7

Describe the principles of peritoneal dialysis

Answer 7

Waste products cross the semipermeable membranes into the peritoneal space
CAPD 4-5 bags/day, 30 min exchange
APD overnight dialysis
+ self sufficient, less fluid/food restrictions, fairly easy to travel with CAPD, renal function preserved initially
- frequent daily exchanges, overnight, responsibility, no ‘days off’
Risk of peritonitis, exit or tunnel site infections
Development of hernias

Question 8

Describe the principles of kidney transplant

Answer 8

Kidneys matched - tissue match, time on waiting list, age
Kidney placed in iliac fossa (original, diseased kidneys remain)
+ improved QOL
- peri operative risk, malignancy, infection
Option of live donor, deceased after brain death, decreased after circularity death, non heart beating