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ESA 3- Urinary System > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney failure defined as?

A

Progressive and irreversible loss of renal function over a period of months to years

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2
Q

What is functioning renal tissue replaced by in chronic kidney failure?

A

Extra-cellular matrix

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3
Q

What does the replacement of functioning renal tissue by extra-cellular matrix give rise to histologically?

A
  • Glomerulosclerosis
  • Tubular interstitial fibrosis
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4
Q

What is the result of the replacement of functioning renal tissue with ECM?

A

There is progressive loss of both the excretory and hormone functions of the kidney

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5
Q

What are most glomerular diseases that lead to chronic renal failure characterised by?

A

The development of proteinuria and systemic hypertension

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6
Q

What are the causes of chronic kidney disease?

A
  • Immunologic
  • Infection
  • Genetic
  • Obstruction and reflux nephropathy
  • Hypertension
  • Vascular
  • Systemic disease
  • Cause unknown
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7
Q

What are the immunologic causes of chronic kidney disease?

A

Glomerulonephritis

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8
Q

What are the infectious causes of chronic kidney disease?

A

Pyelonephritis

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9
Q

What are the genetic causes of chronic kidney disease?

A
  • Polycystic kidney disease (PCK)
  • Alport’s syndrome
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10
Q

What systemic diseases can cause chronic kidney disease?

A
  • Diabetes
  • Myeloma
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11
Q

What are the stages of chronic kidney disease?

A

1-5

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12
Q

What is the GFR in stage 1 chronic kidney disease?

A

>90

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13
Q

What is the description of stage 1 CKD?

A

Kidney damage with normal or increased GFR

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14
Q

What evidence is needed to diagnose stage 1 CKD?

A

Other evidence of kidney damage (U/A or USS)

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15
Q

What % of the population have stage 1 CKD?

A

3.3

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16
Q

What is the GFR in stage 2 CKD?

A

60-89

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17
Q

What is the description of stage 2 CKD?

A

Kidney damage with mild GFR fall

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18
Q

What evidence is needed to diagnose stage 2 CKD?

A

Need other evidence of kidney damage (U/A or USS)

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19
Q

What % of the population have stage 2 CKD?

A

3%

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20
Q

What is the GFR in stage 3 CKD?

A

30-59

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21
Q

What is the description of stage 3 CKD?

A

30-59

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22
Q

Does stage 3 CKD present with symptoms?

A

May or may not

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23
Q

What % of the population have stage 3 CKD?

A

6%

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24
Q

What is the GFR in stage 4 CKD?

A

15-29

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25
Q

What is the description of stage 4 CKD?

A

Severe fall in GFR

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26
Q

Does stage 4 CKD present with symptoms?

A

Yes, worse than stage 3

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27
Q

What % of the population have stage 4 CKD?

A

0.2%

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28
Q

What is the GFR in stage 5 CKD?

A

<15 or RRT

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29
Q

What is the description of stage 5 CKD?

A

Established renal failure

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30
Q

When is dialysis started with stage 5 CKD?

A

<10ml/min GFR

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31
Q

What % of the population have stage 5 CKD?

A

0.1%

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32
Q

What systems can chronic kidney failure affect?

A
  • Cardiovascular
  • Haematology
  • Bone
  • CNS
  • General symptoms
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33
Q

What cardiovascular symptoms can chronic kidney failure cause?

A
  • Atherosclerosis
  • Cardiomyopathy
  • Pericarditis
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34
Q

What haematology symptoms can chronic kidney failure cause?

A

Anaemia

35
Q

Why can chronic kidney failure cause anaemia?

A

Decreased or resistance to erythropoietin

36
Q

What bone effects can chronic kidney failure have?

A
  • Renal bone disease
  • Osteitis fibrosa cystica
  • Osteomalacia
  • Non-bone (e.g. extra articular) calcification
37
Q

How does chronic kidney failure cause osteitis fibrosa cystica?

A
  • Decreased GFR means less phosphate is excreted, increasing its serum concentration.
  • It then forms complexes with free calcium, reducing its effective serum concentration
  • This stimulates the parathyroid to produce PTH, causing over activity of osteoclasts, leading to osteitis fibrosa cystica
38
Q

Why does chronic kidney failure cause osteomalacia?

A

Damage to the kidneys means less vitamin D undergoes its 2nd hydroxylation to its active form. This also cause hyperparathyroidism and osteomalacia

39
Q

What are the CNS symptoms of chronic kidney failure?

A
  • Neuropathy
  • Seizures
  • Coma
40
Q

What are the general symptoms of chronic kidney failure?

A
  • Tiredness
  • Breathlessness
  • Restless legs
  • Sleep reversal
  • Seizure
  • Aches and pains
  • Nausea and vomiting
  • Itching
  • Chest pain
41
Q

Are patients with CKD more likely to need dialysis or die from a CVS event?

A

Die from a CVS event

42
Q

What is a normal GFR range?

A

80-120ml/min

43
Q

How can renal function be expressed?

A

As a function of the normal GFR

44
Q

How can GFR be measured?

A

Via insulin clearance or 24hr creatanine clearance

45
Q

What needs to be done if creatanine is used to measure GFR?

A

Needs to be modified to estimated GFR (eGFR)

46
Q

How is GFR modified to eGFR?

A

By an equation to take into account age, sex, gender, and ethnicity

47
Q

Is creatinine a perfect maker for renal function?

A

No

48
Q

Why is creatanine not a perfect marker for renal function?

A
  • Someone with a GFR of 40% of normal can still have a normal creatinine level
  • Only accurate in adults
  • Only defines chronic kidney disease (not useful in acute renal failure)
49
Q

How is the cause of CKD assessed?

A
  • Auto-antibody screen
  • Complement
  • Immunoglobulin
  • ANCA
  • CRP
  • SPEP/UPEP
  • Imaging of kidneys
50
Q

What imaging of the kidneys is done to assess the cause of CKD?

A
  • Ultrasound
  • CT
  • MRI
51
Q

Why is ultrasound done in the assessment of CKD?

A

Looking at size and hydronephrosis

52
Q

What steps are taken in the conservative management of CKD?

A
  • To prevent or delay progression, there are several potentially modifiable risks
  • The patient should be monitored
53
Q

What risks are potentially modified in the conservative management of CKD?

A
  • Lifestyle
  • Treat diabetes (if present)
  • Treat blood pressure (if high)
  • ACE inhibitors / angiotensin receptor blockers
  • Lipid lowers
54
Q

What lifestyle changes can be made in CKD?

A
  • Smoking
  • Obesity
  • Exercise
55
Q

What lipid lowers are used in the conservative management of CKD?

A
  • Diet
  • Statins
56
Q

How should the patient be monitored in the conservative treatment for CKD?

A
  • Checking their eGFR
  • Indiciations for initiation of dialysis
57
Q

When is renal replacement therapy required?

A

When native renal function declines to a level when it is no longer adequate to support health

58
Q

What renal function is deemed to be no longer adequate to support health?

A

When GFR <10ml/min

59
Q

What is renal replacement therapy?

A

Either dialysis or renal transplantation

60
Q

What are the indications for dialysis?

A
  • Uraemic symptoms
  • Acidosis
  • Pericarditis
  • Fluid overload
  • Hyperkalaemia
61
Q

What are the types of dialysis?

A
  • Haemodialysis
  • Peritoneal dialysis
62
Q

What does haemodialysis require?

A

The creation of a arteriovenous (AV) fistula

63
Q

What is an arteriovenous fistula?

A

A connection between an artery and a vein

64
Q

What vessels is the arteriovenous fistula made between in haemodialysis?

A
  • Cephalic vein
  • Radial artery
65
Q

What is the purpose of the arteriovenous fistula in haemodialysis?

A

Provides vascular access

66
Q

Why does an arterioenous fistula provide vascular access?

A

The difference in pressure means that blood moves from the artery to the vein, causing it to dilate and develop a muscular wall

67
Q

What happens in haemodialysis?

A

The patient is connected up to dialysis machine, which allows for filtering of patients blood

68
Q

What does a dialysis machine contain to allow for filtering of the patients blood?

A

Highly purified water across a semi-permeable membrane

69
Q

What drugs need to be given in haemodialysis?

A

Anti-coagulants

70
Q

Why are anti-coagulants needed in haemodialysis?

A

To prevent the patients blood from clotting in the machine

71
Q

What are the advantages of haemodialysis over peritoneal dialysis?

A
  • Effective
  • 4/7 days free from treatment
  • Dialysis dose easily prescribed
72
Q

How long can people survive on haemodialysis?

A

>25 years

73
Q

What are the disadvantages of haemodialysis over peritoneal dialysis?

A
  • Fluid/diet restrictions
  • Limits holidays
  • Access problems
  • CVS instability
  • High capital cost
74
Q

What does peritoneal dialysis require?

A
  • The peritoneal membrane
  • Blood flow
  • Peritoneal dialysis fluid
75
Q

What happens in peritoneal dialysis?

A

Peritoneal dialysis fluid is put into the peritoneal cavity, and the dialysis occurs across the peritoneal membrane (semi-permeable membrane). The fluid is then drained away and disposed of

76
Q

What are the advantages of peritoneal dialysis over haemodialysis?

A
  • Low technology
  • Home technique
  • Easily learned
  • Allows mobility
  • CVS stability
77
Q

Who is peritoneal dialysis better for?

A

Elderly and diabetics

78
Q

What are the disadvantages of peritoneal dialysis over haemodialysis?

A
  • Frequent exchanges (~4/day)
  • No long term survivors yet
  • Frequent treatment failures
  • Peritonitis
  • Limited dialysis dose range
  • High revenue costs
79
Q

Who should be considered for renal transplantation?

A

All patients with progressive CKD or end-stage renal failure

80
Q

What are the sources of kidneys for transplantation?

A
  • Cadaver donors
  • Non-heart beating donors
  • Living related donors/friends
  • Autristic donors
81
Q

What location is a kidney transplanted too?

A

Not the normal anatomical location, but the iliac fossa

82
Q

Why is a kidney transplanted to the iliac fossa?

A

Because it can be easily connected to the iliac vessels and the bladder

83
Q

What are the advantages of renal transplantation?

A
  • Restores near normal renal function
  • Allows mobility and ‘rehabilitation’
  • Improved survival
  • Good long term results
  • Cheaper than dialysis
84
Q

What are the disadvantages of renal transplantation?

A
  • Not all are suitable
  • Limited donor supply
  • Operative morbidity and mortality
  • Life long immunosuppression
  • Still left with progressive CKD

ESA 3- Urinary System (13 decks)

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