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TCD Cases > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Apart from CKD, suggest 6 other causes of proteinuria

A
  1. Physical exercise
  2. Fever
  3. Pregnancy
  4. UTI
  5. Abnormally high BP
  6. Nephrotic/ Nephritic syndrome
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2
Q

In normally anatomy, at what vertebral level can the kidneys be found?

A

T12-L3

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3
Q

Recall the eGFR definition for CKD

A

< 60 ml/min/1.73m2 on at least 2 occasions separated by a period of at least 90 days

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4
Q

What is eGFR?

A

Creatine based estimation of glomerular filtration rate

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5
Q

Outline the therapeutic action of ACE inhibitors in the treatment of diabetic nephropathy

A

Reduction in glomerular hydrostatic pressure by preventing vasoconstriction of the efferent arterioles

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6
Q

Suggest 4 potential side effects of ACE inhibitors

A
  1. Dry cough
  2. Angio-oedema
  3. Hyperkalemia
  4. Hypotension
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7
Q

What 2 metabolic complications are associated with CKD Mineral bone disease?

A
  1. Hypocalcemia

2. Hyperparathyroidism

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8
Q

Suggest 4 potential metabolic complications of CKD

A
  1. CKDMBD
  2. Renal anemia
  3. Metabolic acidosis
  4. Hyperkalemia
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9
Q

Define azotemia

A

Elevation of nitrogenous metabolic waste in the blood due to failure of clearance by the kidneys

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10
Q

Define Uraemia

A

Clinical syndrome resulting from failing kidneys and progressive azotemia

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11
Q

Outline the 2 main endocrine functions of the kidney

A
  1. Activation of vitamin D

2. Renin and EPO synthesis

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12
Q

Suggest 6 population subgroups that are at increased risk of developing CKD during their lifetimes

A
  1. The elderly
  2. Family history of CKD
  3. Reduced kidney mass
  4. Low birth weight
  5. Ethnic minorities
  6. Low income
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13
Q

Outline 8 medical conditions that can cause direct kidney damage

A
  1. Diabetes
  2. Hypertension
  3. Autoimmune disease
  4. Systemic sepsis
  5. UTI
  6. Urinary stones
  7. Urinary obstruction
  8. Drug toxicity
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14
Q

Name 2 medical conditions that (in the setting of CKD) warrant immediate referral to renal services

A
  1. Malignant hypertension
  2. Hyperkalemia

(urgent referral also required for patients with nephrotic syndrome)

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15
Q

What is the target BP for patients with CKD?

A

130/80

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16
Q

What is the target BP for patients with CKD in a proteinuric state?

A

125/75

17
Q

Name the immunisations required for patients on renal replacement therapy

A
  1. Pneumococcal
  2. Influenza
  3. Hep B
18
Q

What is the normal average alveolar ventilation volume?

A

~ 5L/min

19
Q

Normal gas exchange is dependent on what 3 factors?

A
  1. Adequate alveolar ventilation
  2. Adequate pulmonary perfusion
  3. Minimal barrier to gaseous diffusion
20
Q

Recall 6 indications for dialysis in patients with kidney failure

A
  1. pH <7.25
  2. K+ >6.5
  3. Fluid overload
  4. Toxins (SLIME)
  5. Creatine >400
  6. Uraemic pericarditis
21
Q

Recall the 5 absolute contra-indications to peritoneal dialysis

A
  1. Active inflammatory bowel disease
  2. Ischaemic bowel
  3. Acute diverticulitis
  4. Abdominal abscess
  5. 3rd trimester of pregnancy
22
Q

What is the average survival of a kidney transplant graft

A

7-8 years

23
Q

Which arteries are involved in the arterial anastomosis of a renal transplant?

A

Renal artery of the graft is anastomosed to the right iliac artery of the recipient

24
Q

Briefly outline the mechanism of action of cyclosporine/ tacrolimus as immunsuprresive agents following solid organ transplantion

A

Inhibition of T lymphocyte activity.

25
Q

Name 2 immunosuppressive agents that target and interpret cell cycling in B and T cells

A
  1. MMF

2. Azathioprine

26
Q

What is the additional advantage of Sirolimus as an immunosuppressive agent in the management of solid organ transplantation?

A

Also target tumour cells thus used in the management of transplant related malignancy

27
Q

Recall 2 infections that are exclusively seen in immunosuppressed patients

A
  1. Cytomegalovirus colitis

2. PCP

28
Q

Recall 3 causes of ‘abdominal catastrophe’ in the immunocompromised patient

A
  1. Diverticulitis +/- Perforation
  2. Cholecystitis
  3. Pancreatitis
29
Q

What is the most common malignancy seen in renal transplant patients?

A

Squamous carcinoma of the skin

30
Q

What 2 characteristics of an AV fistula if observed in tandem - indicate an >90% chance of adequacy for dialysis

A
  1. Diameter >0.4 cm

2. Fistula blood flow > 500ml/min

31
Q

What are the 3 most common types of AV fistula used?

A
  1. Radiocephalic
  2. Brachiocephalic
  3. Transposed basilic fistula
32
Q

Suggest 2 clinical signs of central veins stenosis that may be seen in patients with an AV fistula

A
  1. Swollen extremity

2. Collateral veins

33
Q

Where is the hormone PTH secreted from?

A

Chief cells of the parathyroid gland

34
Q

What is the effect of serum calcium levels on PTH secretion?

A

High serum calcium levels inhibits the secretion of PTH

35
Q

Name the enzyme present in the kidney that catalyses the transfer of calcidiol into the active form of vitamin D Calcitriol

A

Vitamin D 1 alpha -hydroxylase

36
Q

Give 3 pre-renal causes of acute renal failure

A
  1. Renal artery stenosis
  2. Heart failure
  3. Haemorrhage
37
Q

Give 5 causes of renal papillary necrosis

A
  1. Severe acute pyelonephritis
  2. Diabetic nephropathy
  3. Obstructive nephropathy
  4. Analgesic nephropathy
  5. Sickle cell anemia

TCD Cases (25 decks)

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