Chronic Kidney Disease and Renal Failure Flashcards
What are the functions of the kidney?
Homeostatic
Excretory
Endocrine
Glucose
What are the homeostatic functions?
Electrolyte balance
Acid-base balance
Volume homeostasis
Salt and water
What are excretory functions?
Nitrogenous waste
Hormones
Peptides
Middle sized molecules
What are the endocrine functions?
Erythropoietin
1 alpha-hydroxylase vitamin D
What are the glucose metabolism functions?
Gluconeogenesis
Insulin clearance
Failure results in increase in cardiovascular risk
What does the clinical presentation of kidney failure depend on?
Rate of deterioration
Cause of kidney failure
What does chronic kidney disease cause to kidney size?
Shrunken kidney size
In what cases of CKD, can kidney size be preserved?
Diabetes
Myeloma
Amyloid
What does acute kidney disease cause to kidney size?
Preserved size
Kidney failure tends to reduce secretion of salt and water leading to?
Hypertension
Oedema
Pulmonary oedema
In CDK, in tubulointerstitial disorders, what may be seen?
Salt and water loss due to damage to concentrating mechanism
In AKD if the cause was that you were vomiting or losing a lot of fluid, what could you be?
Hypovolemic
Is there any relation between total sodium and serum sodium?
Hyponatremia is NOT equal to reduced total body sodium
What is an odeoma?
Excess extracellular fluid and your total body sodium is increased. More water excess than salt
Explain the acidosis in kidney failure?
Increase in H+ ions retention
Therefore swap with potassium (main intracellular ion) and it leaves the cell and leads to an increase
Can cause anorexia and muscle catabolism
What causes hyperkalaemia?
The reduced ability to excrete potassium (reduced distal tubule potassium secretion)
The effect of acidosis
How are sodium levels figured?
By the relative sodium and water levels rather than the actual sodium itself
What are symptoms of of hyperkalaemia?
Cardiac arrhythmias
Neural and muscular activity
Vomiting
What are the signs on an ECG for hyperkalaemia?
Peaked T waves
P wave - broadens, reduced amplitude, disappears
QRS widening
Heart block
Asystole
VT/VF
In kidney failure, if you get reduced erythropoietin, what do you get?
Anaemia
In kidney failure, if you have reduced 1-25 Vitamin D levels, what do you get?
Reduced intestinal calcium absorption
Hypocalcemia
Hyperparathyroidism
How does kidney failure lead to hyperparathyroidism?
What is a patient with CKD more likely to die from?
Cardiovascular disease than end stage renal failure
What treatment when hypovolemic?
Give fluids
What treatment when hypervolemic?
Trial of diuretics or dialysis
With hyperkaliemia, what:
Drives into cells?
Drives out of the body?
Gut absorption
Sodium bicarbonate / insulin dextrose (caution)
Diuretics/dialysis
Potassium binders
Is AKI or CKD be reversed?
Acute can be as it was an event that led to damage but CKD is a continuous process so can’t be reversed
In terms of long-term management of Kidney failure, what conservative treatment can you give?
- erythropoietin injections to correct anaemia
- diuretics to correct salt water overload
- phosphate binders
- 1.25 vit d supplements
- symptom management
In terms of long-term management of Kidney failure, what therapy is available
Home therapy
- haemodialysis
- peritoneal dialysis/assisted programmes
In Centre therapy
- haemodialysis, 4 hours 3 times a week
What is the best treatment for Kidney failure and what needs to also be managed?
Transplantation
Cardiovascular risks
What is the kidney failure risk equation calculated from?
Age in years
Sex
CKD-EPI eGFR
Urine albumin creatinine ratio (ACR)
What is the use of the kidney failure risk equation?
Patient understanding of their CKD diagnosis especially in the context of multi-morbidity
Identification of high risk CKD patients:
targeted patient engagement/education
aggressive risk factor management
referral to secondary care
When can the kidney failure risk equation be used?
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.
Why should transfusions be avoided in transplantable patients with kidney disease?
As the transfusions sensitize them and could lead to transplant failure
What are the traditional methods for checking for GFR? And what are the downsides?
Which equation is recommended by NICE guidance to estimate GFR using serum creatinine?
CKD-EPI
What change in GFR and ACR increases risk of kidney failure?
Decrease in GFR (up to G5)
And increase in ACR (up to A3)
