chronic kidney disease and renal failure

Question 1

what are the homeostatic function of the kidneys

Answer 1

electrolyte balance
acid base balance
volume homeostasis

Question 2

what are the endocrine functions of kidneys

Answer 2

production of erythropoietin

production of 1alpha hydroxylase for vitD

Question 3

what are the excretory functions of the kidneys

Answer 3

nitrogenous base
hormones
peptides
'middle sized molecules'
salt and water

Question 4

what are the kidneys roles in glucose metabolism

Answer 4

gluconeogenesis

insulin clearance

Question 5

what happens when homeostatic function in kidneys fail

Answer 5

increased potassium
decreased bicarbonate
decrease in ph
increased phosphate
salt and water imbalance

Question 6

what happens when endocrine function in kidneys fail

Answer 6

hypocalcaemia
hyperparathyroidism to compensate
anaemia from reduced erythropoeitin

Question 7

what happens when excretory function in kidneys fail

Answer 7

increased urea
increased creatinine
decrease in insulin requirement

Question 8

what effect can kidney failure have on cardiovascular risk

Answer 8

increase it

Question 9

clinical signs of kidney failure

Answer 9

symptoms of extreme lethargy, weakness and anorexia
severe hypotension - from vol depletion
elevated plasma urea and creatinine
usually small kidneys

Question 10

what is used to make diagnosis of renal failure

Answer 10

elevated plasma urea and creatinine

Question 11

complications of renal failure

Answer 11

hyperkalaemia
hyponatraemia
metabolic acidosis
anaemia

Question 12

kidney failure tends to reduce secretion of salt and water leading to

Answer 12

hypertension
oedema
pulmonary oedema

Question 13

what are some other causes of salt and water loss

Answer 13

tubulointerstitial disorders - damage to concentrating mechanism
hypovolemia can also cause aki

Question 14

what causes acidosis

Answer 14

reduce excretion of h+ ions
retention of acid bases by cells
forces k+ out cells

Question 15

what does acidosis lead to

Answer 15

anorexia
muscle catabolism
leads to weakness

Question 16

what are some cause of hyperkalaemia in renal failure

Answer 16

decreased distal tubule potassium secretion

acidosis

Question 17

what are the symptoms of hyperkalaemia

usually depends on chronicity

Answer 17

cardiac arrythmias
neural and muscular activity
vomiting

Question 18

what are some ecg changes that can be seen in a patient with hyperkalaemia

Answer 18

peaked t waves
p wave broadens- reduced amplitude then diasappear
qrs widening
heart block
asystole
vt/vf

Question 19

what are the standard cardiovascular risk with kidney failure

Answer 19

hypertension
diabetes
lipid abnormalities

Question 20

how to initially manage hypovolemia

Answer 20

give fluids

Question 21

how to initially manage hypervolemia

Answer 21

trial of diuretics / dialysis

Question 22

what are some ways to manage hyperkalaemia in kidney failure

Answer 22

-drive k+ into cells - sodium bicarbonate and insulin dextrose (caution)
- drive k+ out of body - diuretics/ dialysis
gut absorption - potassium binders

Question 23

what is the conservative long term treatment for kidney failure

Answer 23

• erythropoietin injections to correct anaemia
• diuretics to correct salt overload
• phosphate binders
• 1.25 vit d supplements
• symptom management

Question 24

what is the home therapy to treat kidney failure

Answer 24

haemodialysis

peritoneal dialysis/assisted programmes

Question 25

in centre therapy for long term management for kidney failure

Answer 25

haemodialysis
4hrs for 3 times a week
aim for transplantation for all healthy patients

Question 26

methods for assessing gfr

Answer 26

1. urea - poor indicator and confounded by diet,catabolic state, gi bleeding,drugs, liver function
2. creatinine - affected by mass,age, race, sex
3. creatinine clearance - difficult for elderly patients to collect accurate sample and overestimates gfr
4. inulin clearance - used for research purposes
5. radionuclide studies for edta clearance, reliable but expensive

Question 27

how do you work out an estimated gfr

Answer 27

serum creatinine