chronic kidney disease and renal failure

Question 1

what are the four types of function of the healthy kidney?

Answer 1

homeostatic function
endocrine function
excretory function
glucose metabolism

Question 2

what are the homeostatic functions of a healthy kidney?

Answer 2

electrolyte balance
acid-base balance
volume homeostasis

Question 3

what are the endocrine functions of a healthy kidney?

Answer 3

production of erythropoietin and 1 alpha-hydroxylase vitamin D

Question 4

what are the excretory functions of a healthy kidney?

Answer 4

nitrogenous waste, hormones, peptides, salt and water

Question 5

what is the glucose metabolism function of a healthy kidney?

Answer 5

gluconeogenesis and insulin clearance

Question 6

in kidney failure, how is the homeostatic function of the kidney affected?

Answer 6

causes an increase in potassium and phosphate, a decrease in bicarbonate and pH and results in salt and water imbalance

Question 7

how is the endocrine function of the kidney altered due to kidney failure?

Answer 7

reduced calcium
increased PTH
results in anaemia (due to lack of erythropoetin)

Question 8

HOW IS EXCRETORY FUNCTION OF THE KIDNEY ALTERED DUE TO KIDENY FAILURE?

Answer 8

increased urea and creatinine.
lower insulin requirement

Question 9

the change in homeostatic, endocrine, excretory, and glucose function of the kidney due to kidney failure, overall results in an increased risk of what type?

Answer 9

increased cardiovascular risk

Question 10

what are the most important observatioons of a patient with kidney failure?

Answer 10

determine whether hypo/euvo/hypervolaemic
BP
JVP
cap refill

Question 11

why might a patient with kidney failure be tachypoenic (kussmaul respiration)?

Answer 11

because of respiratory compensation for metabolic acidosis

Question 12

what does poor skin turgor indicate?

Answer 12

severe dehydration

Question 13

what changes to ABG occur in kidney failure?

Answer 13

decreased pH
decreased pCO2
increased pO2
decreased bicarb.

Question 14

what is the vesicoureteral reflux?

Answer 14

retrograde flow of bladder urine into the ureters due to lack of component valve system in ureters
can lead to pylonephritis and scarring

Question 15

what investigations are first choice for suspected kidney failure?

Answer 15

ultrasound (UUS KUB)
size of kidneys
check for obstruction

Question 16

what are the three main effects associated with acidosis?

Answer 16

hyperkalaemia
anorexia
muscle catabolism

Question 17

kidney failure tends to reduce secretion of salt and water, what does this lead to?

Answer 17

hyperytension
oedema
pulmonary oedema

Question 18

is Hb high or low in chronic kidney disease?

Answer 18

low if chronic
can be normal in acute

Question 19

how does acidosis cause hyperkalaemia?

Answer 19

blood contains excess H+
H+ enters cells in exchange for K+
K+ conc. in cells is lowered so it is not excreted as well resulting in hyperkalaemia

Question 20

what are some of the causes of hyperkalaemia?

Answer 20

low distal tubule potassium
acidosis

Question 21

what are some of the symptoms of hyperkalaemia?

Answer 21

cardiac arrythmias
neural and muscular activity
vomiting

Question 22

what are the concerning complications of hyperkalaemia?

Answer 22

ECG changes showing arrhythmias - ventricular can be fatal

Question 23

what ECG changes can be seen in hyperkalaemia?

Answer 23

peaked T waves
broadened and reduced P waves
QRS widening
heart block
asystole
VT/VF

Question 24

what happens to: urea, creatinine, sodium, potassium and haemoglobin in kidney failure?

Answer 24

inc. urea
inc . creatinine
sodium can be anywhere
inc. pottasium
low Hb

Question 25

what does USS KUB indicate?

Answer 25

normal sized kidneys with no obstruction

Question 26

other than kidney failure, what other type of disease could be causing salt and water loss resulting in AKI

Answer 26

Salt and water loss may be seen in tubulointerstitial disorders – damage to concentrating mechanism & hypovolemia may be the cause of AKI.

Question 27

how does kidney failure result in reduced 1-25 Vit. D levels?

Answer 27

reduced intestinal calcium absorption so reduced serum calcium and hyperparathyroidism

Question 28

how can the effects of kidney failure on metabolism be treated?

Answer 28

low phosphate diet phosphate binding tablets

Question 29

for patients with CKD, what is a more likely outcome, end stage renal failure or cardiovascular disease?

Answer 29

cardiovascular disease

Question 30

how does kidney failure affect cardiovascular risk?

Answer 30

inflammation oxidative stress mineral/bone metabolism disorder calcification of valves and vessels

Question 31

what is a fistula (dialysis)

Answer 31

artificial connection of vein to artery, causes the vein to swell but allows easier dialysis

Question 32

outline the initial steps of management for kidney failure?

Answer 32

1.fluid balance -give fluids/ dialysis 2. hyperkalaemia - either drive sodium into cells or out of the body

Question 33

in the management of kidney failure, what can be given to help drive sodium into cells and treat hyperkalaemia?

Answer 33

sodium bicarbonate insulin dextrose (caution due to high risk of hypoglycaemia)

Question 34

in the managament of kidney failure, what is given to drive sodium out of the body and treat hyperkalaemia?

Answer 34

diuretics dialysis potassium binders

Question 35

why should transfusions be avoided in transplantable patients with CKD?

Answer 35

transfusions leads to sensitisation leading to transplant failure

Question 36

what cautions should be made regarding patients veins in those with CKD?

Answer 36

SAVE VEINS require fistulas for dialysis avoid venepuncture or IV in antecubital fossa or cephalic vein use dorsum veins

Question 37

what are the long term management options for kidney failure?

Answer 37

transplantation is aim if possible conservative treatment - erythropoetin injections, diuretics, phosphate binders, 1-25 Vit.D supplements dialysis- hemodialysis and peritoneal dialysis

Question 38

why is urea a poor indicator of GFR?

Answer 38

confounded by diet, catabolic state, GI bleeding, drugs, liver function etc.

Question 39

what is the kidney failure risk equation (KFRE) and what patients should it NOT be used on?

Answer 39

Validated risk prediction tool for kidney replacement therapy in the next two or five years for adults with STABLE chronic kidney disease (CKD) Stages 3A to 5 . NOT to be used in patient with rapidly changing eGFR.

Question 40

what needs to be considered when using creatinine to assess GFR?

Answer 40

Affected by muscle mass, age, race, sex etc. Need to look at the patient when interpreting the result. TREND helpful.

Question 41

what needs to be considered when using creatinine clearance to assess GFR?

Answer 41

Difficult for elderly patients to collect an accurate sample Overestimates GFR at low GFR (as a small amount of creatinine is also secreted into urine)

Question 42

when is inulin clearance used to assess GFR?

Answer 42

Laborious - used for research purposes only