Chronic Kidney disease Flashcards

1
Q

What defines chronic kidney disease?

A

Reduced kidney function or structural damage (or both) for 3 months with reduced GFR and abnormal creatinine and albumin

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2
Q

What is the significance of CDK1 vs CDK5?

A

CDK1: normal kidney
CDK5: renal failure, needs renal replacement therapy. Means GFR is <15

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3
Q

What are the 2 main risk factors for chronic kidney disease? Which ethnicities are more likely to acquire them?

A
  1. Hypertension: damages kidney function, higher in Africans
  2. Diabetes: vascular damage hurts the glomerulus, higher in Caribbean
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4
Q
Define the following renal diseases:
a) glomerulonephritis
b) polycystic kidney disease
c) chronic pyelonephritis
d) interstitial nephritis 
e) myeloma
f) outflow obstruction 
Which one is commonly in the FH?
A

A) Glomerulonephritis: immune-mediated acute inflammation of the kidney

b) polycystic kidney disease: inherited, dilated nephron causing fluid-filled cysts on kidney. Commonly in the FH
c) chronic pyelonephritis: characterized by chronic tubulointerstitial inflammation, causes end-stage renal disease
d) interstitial nephritis: inflamed space between tubules
e) Myeloma: malignant bone marrow tumour, kidney not producing EPO so bone marrow overworks

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5
Q

Name 4 systemic diseases that can induce kidney problems

A
  1. Heart failure: kidney doesn’t get enough blood flow
  2. Renovascular disease; e.g renal artery stenosis
  3. Multisystemic disease
  4. Vasculitis: inflammation of blood vessels
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6
Q

List 2 drugs that can induce kidney problems

A
  1. NSAIDS

2. Lithium

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7
Q

When is kidney dysfunction reversible? (4 scenarios)

A
  1. Relieving a urinary obstruction
  2. Immunosuppression in glomerulonephritis and vasculitis
  3. Treating accelerated hypertension
  4. Correcting a renal artery narrowing, e.g; stent
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8
Q

What 4 drugs should you NOT give in chronic kidney disease?

A
  1. NSAIDs: anti-inflammatory
  2. Antibiotics; preventing infection
  3. Diuretics; relieve fluid buildup
  4. Heparin; prevents blood clots
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9
Q

Name 8 complications of chronic kidney disease?

LCBPEAMM

A
  1. Loss of renal function; can’t excrete waste and retains too much
  2. CVS disease
  3. Bone disorder: normally kidneys create calcitriol which breaks down bone mass, parathyroid may overcompensate for lack of calcitriol by increasing PTH
    - Too much bone gets broken down
  4. Malignancy: thyroid and renal tract
  5. peripheral neuropathy and myopathy due to vasculature damage
  6. Malnutrition
  7. End-stage renal disease
  8. Renal anemia: kidney not producing enough erythropoietin required by the bone marrow to make RBCs
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10
Q

What is the prognosis of chronic kidney disease?

A

10-15% progress, 50% stable, 30% improve

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11
Q

What kinds of things might you find in a patient history with chronic kidney disease?
When do symptoms tend to present?

A

May have no symptoms until an advanced stage…
Fatigue, trouble concentrating, poor appetite, trouble sleeping, frequent urination (at night), may also be depressed/anxious due to these symptoms

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12
Q

What kinds of physical symptoms would you discover in a patient history with chronic kidney disease?

A

Swollen feet and ankles, dry and itchy skin, eye puffiness, muscle cramping due to hypocalcemia (less calcitriol means less Ca2+ gets resorbed and less bone breakdown)

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13
Q

What might you notice on an examination of a patient with chronic kidney disease?

A
  1. pallor; anemia
  2. cachexia
  3. dehydrated
  4. *tachypnoea; the body is in state of metabolic acidosis and breathes out more CO2 to compensate
  5. Hypertension; raised JVP
  6. *Distended bladder
  7. Peripheral edema or neuropathy
  8. frothy urine
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14
Q

What does frothy urine indicate?

A

Protein in the urine

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15
Q

Which investigations should you do on the patient? (6)

A
  1. Albumin creatinine ratio (ACR) >3mg/mmol
  2. Urine sediment and electrolyte abnormalities
  3. Abnormalities on biopsy
  4. structural abnormalities on imaging
  5. Measure eGFR
  6. Are they on any nephrotoxic drugs
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16
Q

How should you image any patient?

A

With a CT scan, but always know renal function before doing a CT scan as contrast can make the renal function worse

17
Q

What are hematinics? Give 3 examples

A

Nutrients required for the formation of blood cells; B12, folate, iron

18
Q

How should you manage anemia (including what you can give)? What should your target Hb level be?

A

Target: 100-120 g/L Hb
Check hematinics

Give:

  1. IV iron since it’s poorly absorbed in CKD
  2. ESAs: recombinant human EPO stimulating agents
19
Q

Describe how dialysis works and how often it should be done

A

Blood is taken from the patient, goes through a heparin pump and is dialyzed/cleansed, and sent back into the patient

4-hour treatment 3X a week

20
Q

How does dialysis correct acidosis?

A

Allows bicarbonate to diffuse into the blood

21
Q

What is the function of dialysis?

A

To maintain euvolemia (weight) and electrolytes in a patient

22
Q

What is a fistula? How can you tell if someone has had one?

A

Fistula: when you connect a vein to an artery it will arterialize over time (about 6 weeks) and can be used for dialysis.

A thrill can be felt or bruit heard once it has arterialized as the blood is moving from high - low pressure quickly

23
Q

Why is a fistula needed?

A

A vein will collapse if it is punctured too often

An artery will become damaged and lead to ischemia if punctured too often

24
Q

What is a graft/line? What are the pros and cons?

A

Synthetic plastic to rejoin a vein to an artery that can be punctured with a needle (for dialysis!)
Pros: don’t need to wait for it to arterialize
Cons: Increased risk of infection, over time venous drainage becomes damaged and patient can develop a swollen neck or face

25
Q

What is the difference between hemodialysis and peritoneal dialysis? What are some advantages of one over the other?

A

Hemodialysis: blood gets pumped out of body

Peritoneal: pumping fluid: Inserted into the peritoneal cavity; between parietal and visceral peritoneum as peritoneum acts as a semi-permeable membrane
Pros: fewer side effects, more gentle treatment done every day
Cons: bacterial peritonitis

26
Q

When should you remove a dialysis insertion?

A

If it is causing extreme side effects and if you have other access - if not you may need to handle the infection with antibiotics

27
Q

How do you match a renal transplant?

A

Matching HLA: human leukocyte antigen

28
Q

What are the types of donors?

A

Live: from anyone and can be altruistic (random)
Dead: categorized into “Heart beating” or “heart not beating” when kidney was removed

29
Q

What are some consequences/risks of having a renal transplant?

A

The body may attack the new kidney (may need to prescribe immunosuppressants).

Increased risk of sepsis (body thinks its an infection) and cancer

30
Q

When should you remove a dysfunctional kidney?

A

ONLY if the kidney is causing harm to the patient, e.g; polycystic kidney. If it isn’t, no point in risking infection by removing it

31
Q

What are the benefits of a renal transplant over dialysis?

A

Cost-effective, better quality of life, corrects symptoms and metabolism (improved patient survival)