Chronic Kidney Disease Flashcards
Apart from CKD, suggest 6 other causes of proteinuria
- Physical exercise
- Fever
- Pregnancy
- UTI
- Abnormally high BP
- Nephrotic/ Nephritic syndrome
In normally anatomy, at what vertebral level can the kidneys be found?
T12-L3
Recall the eGFR definition for CKD
< 60 ml/min/1.73m2 on at least 2 occasions separated by a period of at least 90 days
What is eGFR?
Creatine based estimation of glomerular filtration rate
Outline the therapeutic action of ACE inhibitors in the treatment of diabetic nephropathy
Reduction in glomerular hydrostatic pressure by preventing vasoconstriction of the efferent arterioles
Suggest 4 potential side effects of ACE inhibitors
- Dry cough
- Angio-oedema
- Hyperkalemia
- Hypotension
What 2 metabolic complications are associated with CKD Mineral bone disease?
- Hypocalcemia
2. Hyperparathyroidism
Suggest 4 potential metabolic complications of CKD
- CKDMBD
- Renal anemia
- Metabolic acidosis
- Hyperkalemia
Define azotemia
Elevation of nitrogenous metabolic waste in the blood due to failure of clearance by the kidneys
Define Uraemia
Clinical syndrome resulting from failing kidneys and progressive azotemia
Outline the 2 main endocrine functions of the kidney
- Activation of vitamin D
2. Renin and EPO synthesis
Suggest 6 population subgroups that are at increased risk of developing CKD during their lifetimes
- The elderly
- Family history of CKD
- Reduced kidney mass
- Low birth weight
- Ethnic minorities
- Low income
Outline 8 medical conditions that can cause direct kidney damage
- Diabetes
- Hypertension
- Autoimmune disease
- Systemic sepsis
- UTI
- Urinary stones
- Urinary obstruction
- Drug toxicity
Name 2 medical conditions that (in the setting of CKD) warrant immediate referral to renal services
- Malignant hypertension
- Hyperkalemia
(urgent referral also required for patients with nephrotic syndrome)
What is the target BP for patients with CKD?
130/80
What is the target BP for patients with CKD in a proteinuric state?
125/75
Name the immunisations required for patients on renal replacement therapy
- Pneumococcal
- Influenza
- Hep B
What is the normal average alveolar ventilation volume?
~ 5L/min
Normal gas exchange is dependent on what 3 factors?
- Adequate alveolar ventilation
- Adequate pulmonary perfusion
- Minimal barrier to gaseous diffusion
Recall 6 indications for dialysis in patients with kidney failure
- pH <7.25
- K+ >6.5
- Fluid overload
- Toxins (SLIME)
- Creatine >400
- Uraemic pericarditis
Recall the 5 absolute contra-indications to peritoneal dialysis
- Active inflammatory bowel disease
- Ischaemic bowel
- Acute diverticulitis
- Abdominal abscess
- 3rd trimester of pregnancy
What is the average survival of a kidney transplant graft
7-8 years
Which arteries are involved in the arterial anastomosis of a renal transplant?
Renal artery of the graft is anastomosed to the right iliac artery of the recipient
Briefly outline the mechanism of action of cyclosporine/ tacrolimus as immunsuprresive agents following solid organ transplantion
Inhibition of T lymphocyte activity.
Name 2 immunosuppressive agents that target and interpret cell cycling in B and T cells
- MMF
2. Azathioprine
What is the additional advantage of Sirolimus as an immunosuppressive agent in the management of solid organ transplantation?
Also target tumour cells thus used in the management of transplant related malignancy
Recall 2 infections that are exclusively seen in immunosuppressed patients
- Cytomegalovirus colitis
2. PCP
Recall 3 causes of ‘abdominal catastrophe’ in the immunocompromised patient
- Diverticulitis +/- Perforation
- Cholecystitis
- Pancreatitis
What is the most common malignancy seen in renal transplant patients?
Squamous carcinoma of the skin
What 2 characteristics of an AV fistula if observed in tandem - indicate an >90% chance of adequacy for dialysis
- Diameter >0.4 cm
2. Fistula blood flow > 500ml/min
What are the 3 most common types of AV fistula used?
- Radiocephalic
- Brachiocephalic
- Transposed basilic fistula
Suggest 2 clinical signs of central veins stenosis that may be seen in patients with an AV fistula
- Swollen extremity
2. Collateral veins
Where is the hormone PTH secreted from?
Chief cells of the parathyroid gland
What is the effect of serum calcium levels on PTH secretion?
High serum calcium levels inhibits the secretion of PTH
Name the enzyme present in the kidney that catalyses the transfer of calcidiol into the active form of vitamin D Calcitriol
Vitamin D 1 alpha -hydroxylase
Give 3 pre-renal causes of acute renal failure
- Renal artery stenosis
- Heart failure
- Haemorrhage
Give 5 causes of renal papillary necrosis
- Severe acute pyelonephritis
- Diabetic nephropathy
- Obstructive nephropathy
- Analgesic nephropathy
- Sickle cell anemia
