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Y2 Urology And Renal > chronic kidney disease and renal failure > Flashcards

chronic kidney disease and renal failure Flashcards

1
Q

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

A

homeostatic function
endocrine function
excretory function
glucose metabolism

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2
Q

what are the homeostatic functions of a healthy kidney?

A

electrolyte balance
acid-base balance
volume homeostasis

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3
Q

what are the endocrine functions of a healthy kidney?

A

production of erythropoietin and 1 alpha-hydroxylase vitamin D

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4
Q

what are the excretory functions of a healthy kidney?

A

nitrogenous waste, hormones, peptides, salt and water

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5
Q

what is the glucose metabolism function of a healthy kidney?

A

gluconeogenesis and insulin clearance

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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

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

A

increased urea and creatinine.
lower insulin requirement

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9
Q

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?

A

increased cardiovascular risk

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10
Q

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

A

determine whether hypo/euvo/hypervolaemic
BP
JVP
cap refill

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11
Q

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

A

because of respiratory compensation for metabolic acidosis

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12
Q

what does poor skin turgor indicate?

A

severe dehydration

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13
Q

what changes to ABG occur in kidney failure?

A

decreased pH
decreased pCO2
increased pO2
decreased bicarb.

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14
Q

what is the vesicoureteral reflux?

A

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

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15
Q

what investigations are first choice for suspected kidney failure?

A

ultrasound (UUS KUB)
size of kidneys
check for obstruction

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16
Q

what are the three main effects associated with acidosis?

A

hyperkalaemia
anorexia
muscle catabolism

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17
Q

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

A

hyperytension
oedema
pulmonary oedema

18
Q

is Hb high or low in chronic kidney disease?

A

low if chronic
can be normal in acute

19
Q

how does acidosis cause hyperkalaemia?

A

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

20
Q

what are some of the causes of hyperkalaemia?

A

low distal tubule potassium
acidosis

21
Q

what are some of the symptoms of hyperkalaemia?

A

cardiac arrythmias
neural and muscular activity
vomiting

22
Q

what are the concerning complications of hyperkalaemia?

A

ECG changes showing arrhythmias - ventricular can be fatal

23
Q

what ECG changes can be seen in hyperkalaemia?

A

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

24
Q

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

A

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

25
Q

what does USS KUB indicate?

A

normal sized kidneys with no obstruction

26
Q

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

A

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

27
Q

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

A

reduced intestinal calcium absorption so reduced serum calcium and hyperparathyroidism

28
Q

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

A

low phosphate diet
phosphate binding tablets

29
Q

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

A

cardiovascular disease

30
Q

how does kidney failure affect cardiovascular risk?

A

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

31
Q

what is a fistula (dialysis)

A

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

32
Q

outline the initial steps of management for kidney failure?

A

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

33
Q

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

A

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

34
Q

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

A

diuretics
dialysis
potassium binders

35
Q

why should transfusions be avoided in transplantable patients with CKD?

A

transfusions leads to sensitisation leading to transplant failure

36
Q

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

A

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

37
Q

what are the long term management options for kidney failure?

A

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

38
Q

why is urea a poor indicator of GFR?

A

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

39
Q

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

A

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.

40
Q

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

A

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

41
Q

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

A

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)

42
Q

when is inulin clearance used to assess GFR?

A

Laborious - used for research purposes only

Y2 Urology And Renal (7 decks)

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