Chronic Kidney Disease Flashcards by laura edgar

What are the 3 general functions of the kidney?

homeostasis
metabolic/endocrine
excretion of drugs and drug metabolites

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What are the metabolic/endocrine functions of the kidneys?

Vitamin D
EPO
RAAS

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What are the homeostatic functions of the kidneys?

elimination of waste
water volume
electrolytes
acid-base
blood pressure

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How is kidney function measured?

traditionally via serum creatinine

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What is serum creatinine influenced by?

Is it sensitive to small changes in function?

sex, ethnicity, age, body mass, diet, exercise

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What is eGFR?

calculated from creatine, age, sex, ethnicity,
better reflection of kidney function
best measure for use in stable renal function

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What is the definition of chronic kidney disease (CKD)?

irreveserrible and progress kidney disease

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What are the stages of CKD, defined by eGFR?

Stage 1 >90
Stage 2 >60
Stage 3 >25
Stage 4 >15
Stage 5 <15

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What is the prognosis of Stage 5 CKD without treatments?

What are the treatments?

Insufficient renal function to sustain life/health
–> death
haemodialysis, peritoneal dialysis, kidney transplantation

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What patients are likely to have CKD?

diabetes, hypertension, multiple drugs especially NSAIDs, elderly
- other causes are genetic e.g. polycystic kidney disease or rare e.g. vasculitis or both

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How is CKD related to socio-economic status?

mean GFR decreases with increased deprivation

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What are the risk factors associated with CKD?

age, hypertension, diabetes, smoking and poor education

black and into-asian populations

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What are the 6 classifications of CKD causes?

systemic diseases - diabetes, hypertension
immune mediated diseases - membranous nephropathy, igA nephropathy
infectious diseases - HIV, HBV, HCV, TB
genetic diseases - polycystic kidneys, cystinosis
arterial diseases - atherosclerosis
obstruction - tumours, stones, fibrosis

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What are the histological signs of CKD?

chronic glomerulorephritis

sclerosed glomeruli, atrophied tubules, replaced by scar tissue

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What is the pathology of diabetic nephropathy?

thickening of basement membrane
mesangial expansion: hyperglycaemia stimulates increased metric production by mesangial cells, stimulation of TGF-b release
glomerulosclerosis: due to intraglomerular hypertension or ischaemic damage

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What are 9 complications of chronic kidney disease?

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anaemia
hypertension
disturbed calcium/phosphate homeostasis
cardiovascular disease
bone disease
abnormal handling of drugs
immune suppression
bleeding tendency
complications of treatment

What are the two aspects to failure of fluid homeostasis and what does this lead to?

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Inability to concentrate urine
- loss of diurnal rhythm of urine excretion
- osmotic diuresis of surviving glomeruli
- limited rate of water excretion 
Inability to excrete water load
- dilution hyponatraemia
- oedema 
- hypertension

What is the treatment for fluid overload?

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diuretics
salt restriction
fluid restriction

dialysis
transplantation

How is sodium affected and what are the consequences of this?

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loss of nephrons reduces ability to excrete salt and water
major cause of hypertension and fluid overload
sodium must be within normal range for normal neurological function
high or low sodium levels leads to confusion, fits and coma (CNS dysfunction)

How is potassium affected and what are the consequences of this?

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enormous functional reserve to excrete potassium
severe hyperkalaemia when GFR <10ml/min
Due to:
excessive load
interference with potassium excretion
acidosis with volume contraction
diabetic nephropathy

What are the consequences of hyperkalaemia?

How does the ECG trace change?

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alterations in membrane excitability
cardiac arrhythmias
ECG changes
tall T waves
long QRS interval
long PR interval
cardiac arrest

What is the treatment to prevent hyperkalaemia and hypernatraemia?

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salt restricition
potassium restriction

dialysis
tranplant

What are the symptoms of metabolic acidosis?

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increased respiratory drive --> SOB
chest pain
confusion
bone pain
demineralisation of bone

What is the treatment for metabolic acidosis?

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sodium bicarbonate

dialysis/transplant

What 3 hormones are produced in the kidney and what are they responsible for?

vitamin D - calcium metabolism erythropoietin - RBC production renin - blood pressure control

When is PTH released? | What are its effects?

Low Ca2+ PTH release activates Vit D in kidneys increases bone resorption

What classical cases are there for hyperparathyroidism and hyperphosphataemia?

brown tumours rugger jersey spine both due to demineralisation of bone

What is ectopic calcification?

calcium deposits in soft tissue due to high PTH levels in kidney disease

What treatment prevents bone disease and ectopic calcification?

active Vit D replacement phosphate restriction phosphate binders calcimimetics parathyroidectomy

What is the impact of renal anaemia?

``` impaired quality of life - reduced exercise capacity - impaired cognition transfusion requirement - iron overload - blood-borne infection risk of left ventricular hypertrophy increased CV disease in patients with CKD and anaemia vs those with CKD without anaemia ```

What is the treatment more renal anaemia?

recombinant EPO

What are the mechanisms for renal hypertension?

``` sodium retention volume expansion RAS activation sympathetic NS activity endothelial dysfunction ```

What are the consequences of hypertension?

accelerates decline of kidney function | contributes to cardiovascular risk (stroke, MI, heart failure)

What is the treatment for hypertension in CKD?

salt restriction diuretics RAS blockade other antihypertensives

What are the consequences of failure in excretory function?

accumulation of toxic waste products - creatinine rises only after significant renal damage - retention of nitrogenous waste - retention of urate - retention of phosphate

What is the treatment for uraemia?

dialysis or transplantation | why not protein restriction? --> malnutrition

What are the consequences of the accumulation of the following? 1. insulin 2. opiates 3. antibiotics 4. sedatives 5. digoxin

1. hypoglycaemia 2. confusion/narcosis 3. affect brain function, encephalopathy 4. respiratory arrests 5. cardiac glycoside used to treat AF --> causes arrythmias

What is the treatment to prevent drug toxicity?

modify prescription | change drug type/dose

What are the major modifiable risk factors in CKD?

uncontrolled underlying disease hypertension proteinuria smoking

Chronic Kidney Disease Flashcards

(39 cards)