Chronic Kidney Disease and Renal Failure Flashcards

1
Q

What are the functions of the kidney?

A

Homeostatic
Excretory
Endocrine
Glucose

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2
Q

What are the homeostatic functions?

A

Electrolyte balance
Acid-base balance
Volume homeostasis
Salt and water

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3
Q

What are excretory functions?

A

Nitrogenous waste
Hormones
Peptides
Middle sized molecules

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4
Q

What are the endocrine functions?

A

Erythropoietin
1 alpha-hydroxylase vitamin D

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5
Q

What are the glucose metabolism functions?

A

Gluconeogenesis
Insulin clearance

Failure results in increase in cardiovascular risk

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6
Q

What does the clinical presentation of kidney failure depend on?

A

Rate of deterioration
Cause of kidney failure

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7
Q

What does chronic kidney disease cause to kidney size?

A

Shrunken kidney size

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8
Q

In what cases of CKD, can kidney size be preserved?

A

Diabetes
Myeloma
Amyloid

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9
Q

What does acute kidney disease cause to kidney size?

A

Preserved size

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10
Q

Kidney failure tends to reduce secretion of salt and water leading to?

A

Hypertension
Oedema
Pulmonary oedema

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11
Q

In CDK, in tubulointerstitial disorders, what may be seen?

A

Salt and water loss due to damage to concentrating mechanism

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12
Q

In AKD if the cause was that you were vomiting or losing a lot of fluid, what could you be?

A

Hypovolemic

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13
Q

Is there any relation between total sodium and serum sodium?

A

Hyponatremia is NOT equal to reduced total body sodium

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14
Q

What is an odeoma?

A

Excess extracellular fluid and your total body sodium is increased. More water excess than salt

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15
Q

Explain the acidosis in kidney failure?

A

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

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16
Q

What causes hyperkalaemia?

A

The reduced ability to excrete potassium (reduced distal tubule potassium secretion)
The effect of acidosis

17
Q

How are sodium levels figured?

A

By the relative sodium and water levels rather than the actual sodium itself

18
Q

What are symptoms of of hyperkalaemia?

A

Cardiac arrhythmias
Neural and muscular activity
Vomiting

19
Q

What are the signs on an ECG for hyperkalaemia?

A

Peaked T waves
P wave - broadens, reduced amplitude, disappears
QRS widening
Heart block
Asystole
VT/VF

20
Q

In kidney failure, if you get reduced erythropoietin, what do you get?

A

Anaemia

21
Q

In kidney failure, if you have reduced 1-25 Vitamin D levels, what do you get?

A

Reduced intestinal calcium absorption
Hypocalcemia
Hyperparathyroidism

22
Q

How does kidney failure lead to hyperparathyroidism?

A
23
Q

What is a patient with CKD more likely to die from?

A

Cardiovascular disease than end stage renal failure

24
Q

What treatment when hypovolemic?

A

Give fluids

25
Q

What treatment when hypervolemic?

A

Trial of diuretics or dialysis

26
Q

With hyperkaliemia, what:

Drives into cells?

Drives out of the body?

Gut absorption

A

Sodium bicarbonate / insulin dextrose (caution)

Diuretics/dialysis

Potassium binders

27
Q

Is AKI or CKD be reversed?

A

Acute can be as it was an event that led to damage but CKD is a continuous process so can’t be reversed

28
Q

In terms of long-term management of Kidney failure, what conservative treatment can you give?

A
  • erythropoietin injections to correct anaemia
    • diuretics to correct salt water overload
    • phosphate binders
    • 1.25 vit d supplements
    • symptom management
29
Q

In terms of long-term management of Kidney failure, what therapy is available

A

Home therapy
- haemodialysis
- peritoneal dialysis/assisted programmes
In Centre therapy
- haemodialysis, 4 hours 3 times a week

30
Q

What is the best treatment for Kidney failure and what needs to also be managed?

A

Transplantation

Cardiovascular risks

31
Q

What is the kidney failure risk equation calculated from?

A

Age in years
Sex
CKD-EPI eGFR
Urine albumin creatinine ratio (ACR)

32
Q

What is the use of the kidney failure risk equation?

A

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

33
Q

When can the kidney failure risk equation be used?

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.

34
Q

Why should transfusions be avoided in transplantable patients with kidney disease?

A

As the transfusions sensitize them and could lead to transplant failure

35
Q

What are the traditional methods for checking for GFR? And what are the downsides?

A
36
Q

Which equation is recommended by NICE guidance to estimate GFR using serum creatinine?

A

CKD-EPI

37
Q

What change in GFR and ACR increases risk of kidney failure?

A

Decrease in GFR (up to G5)
And increase in ACR (up to A3)