Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y2 Urology > Chronic Kidney disease and Renal failure > Flashcards

Chronic Kidney disease and Renal failure Flashcards

1
Q

What kind of homeostatic functions do kidneys have? (3)

A

-

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What kind of endocrine functions do kidneys have?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What kind of excretory functions do kidneys have?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How do kidneys aid glucose metabolism?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens to the biochemistry of the blood when homeostatic function of the kidney fails?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What happens when endocrine function of the kidney fails?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens when excretory function of the kidney fails?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What else happens apart from failure of homeostatic function, endocrine function, excretory function and glucose metabolism in CKD?

A

increased cardiovascular risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the biggest driver of cardiovascular disease?

A

CKD

(more so than high cholesterol and smoking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is eGFR and how is it calculated?

A

mathematical estimate of GFR based on creatinine, age, sex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What do we call fast, deep breaths that occur in response to metabolic acidosis?

A

Kussmaul respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Volume assessment:

hyper/hypo or euvolemic?

A

hypoeuvolemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the acid/base assessment of this case?

A

Metabolic acidosis with respiratory compensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In suspected kidney failure, why do we do an ultrasound?

What can it tell us?

A

US –> to determine if this is an acute kidney injury or chronic
* if small kidneys (most likely CKD)
◦ due to fibrosis etc of glomerulus
* BUT kidney size can be preserved if you have CKD due to:
◦ diabetes,
◦ polycystic kidneys
◦ myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If you have CKD, when may kidney size be preserved?

A

diabetes,
polycystic kidneys
myeloma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If we see small kidneys on an US what does it tell us and why are they small?

A

if small kidneys (most likely CKD)
-> due to fibrosis etc of glomerulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Volume assess this patient

A

normovolaemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the acid base status of this patient?

A

Mild metabolic acidosis with respiratory compensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

salt and water…
do imbalances cause kidney disease or are they an effect of kidney disease?

A

both

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Kidney failure tends to _____ secretion of salt and water leading to:

  • ___
  • ___
  • ___
A

REDUCE

Hypertension - Oedema - Pulmonary oedema

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Usually kidney failure presents with a reduction in secretion of salt and water -> hypervolaemia

When may it be that a patient presents as hypovolaemic with kidney disease?

A

if your cause of acute kidney disease is vomiting etc, you can be hypovolemic

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Explain why.

A

if you have oedema, by definition you have excess extracellular fluid, and your total body sodium is increased, irrespective on your serum sodium levels

  • serum sodium is not reflective on your total sodium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why do we typically see hyperkalaemia in acidosis?

A

hydrogen ions swap for potassium ions when you have acidosis
therefore rise in serum potassium as potassium is usually IN cells

24
Q

What may be the physiological symptoms of acidosis?

A

anorexia
muscle catabolism

25
Q

What is extracellular sodium determined by?

A

EXTRACELLULAR SODIUM IS DETERMINED BY THE RELATIVE WATER AND SODIUM, RATHER THAN THE TOTAL SODIUM

26
Q

Why does intravascular potassium have to be managed very tightly?

A

because serum potassium normal range is ±3.5-5.0

27
Q

What are some causes of hyperkalaemia?

What are some symptoms with chronic hyperkalaemia?

A
28
Q

Name some changes you may see on an ECG as a result of hyperkalaemia.

A

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

‘sin’ waves seen that flatten progressively

29
Q

What can reduced erythropoietin levels lead to? (1)

A

anaemia

30
Q

What can reduced 1-25 Vit D levels lead to? (3)

A

Reduced intestinal calcium absorption
Hypocalcaemia
Hyperparathyroidism

31
Q

-

A

mistake on the diagram

  • low Vit D stimulates PTH production
32
Q

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

A

cardiovascular disease

33
Q

Name some standard and additional risks for cardiovascular disease.

A
34
Q

How should you initially manage hypovolaemia and hypervolaemia?

A

hypo: give fluids

hyper: trial of diuretics/dialysis

35
Q

What 3 ways can we initially manage hyperkalaemia and give examples of how we do this

A

drive into cells

drive out of the body

gut absorption

36
Q

What treatment can we use to drive potassium into cells?

A
  • sodium bicarbonate
  • insulin dextrose
37
Q

What treatment can we use to drive potassium out of the body?

A

diuretics / dialysis

38
Q

What treatment can we use to decrease potassium absorption in the gut?

A

potassium binders

39
Q

What kind of conservative treatment can patients with kidney disease get in the long term?

A
40
Q

What kind of home/centre therapy can patients with kidney disease get in the long term?

A
41
Q

What is the best, gold-standard treatment for end stage kidney failure?

A

transplantation (live donor ideally)

42
Q

What is the KFRE? What condition is it used for? Who do we use it for?

A

Kidney failure risk equation

for CKD (not AKI)

it provides the 2 and 5 year probability of treated kidney failure for a potential patient with CKD stage 3a to 5.

43
Q

How is KFRE calculated?

A

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

44
Q

Why do we use the KFRE?

A
  1. Patient understanding of their CKD diagnosis especially in the context of multi-morbidity
  2. Identification of high risk CKD patients:
    - targeted patient engagement/education
    - aggressive risk factor management
    - referral to secondary care
45
Q

Why is it important to avoid unnecessary blood transfusions in potential kidney transplant recipients?

A

exposure to multiple blood donations may cause alloimmunisation to human leucocyte antigen (HLA) class I antigens on white blood cells

transfusions -> sensitisation -> transplant failure

46
Q

What are some transitional methods of assessing GFR? (5)

A

urea
creatinine clearance
creatinine
inulin clearance
radionuclide studies

47
Q

What is the creatinine clearance equation

A

Creatinine Clearance = [[140 - age(yr)]weight(kg)]/[72serum Cr(mg/dL)] (multiply by 0.85 for women).

48
Q

Expand on the pros and cons of using urea to assess GFR.

A
49
Q

Expand on the pros and cons of using creatinine to assess GFR.

A
50
Q

Expand on the pros and cons of using radionuclide studies to assess GFR.

A

gold standard but rarely used

51
Q

Expand on the pros and cons of using creatinine clearance to assess GFR.

A
52
Q

Expand on the pros and cons of using inulin clearance to assess GFR.

A

gold standard, but rarely used

53
Q

At what number does the margin of error get large in eGFR

A

60

54
Q

What is ACR

A

albumin:creatinine ratio

55
Q

Increasing risk of…

A

CKD, AKI and CV

Y2 Urology (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions