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BRS YR2 > Chronic Kidney Disease and Renal Failure > Flashcards

Chronic Kidney Disease and Renal Failure Flashcards

1
Q

What are the different functions of the kidney?

A
  • homeostatic function
  • excretory function
  • endocrine function
  • glucose metabolism
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2
Q

What is the homeostatic function of the kidney?

A
  • electrolyte balance
  • acid-base balance
  • volume homeostasis
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3
Q

Which hormones does the kidney secrete?

A
  • erythropoietin
  • 1 alpha-hydroxylase vitamin D
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4
Q

What do the kidneys excrete?

A
  • nitrogenous waste
  • hormones
  • peptides
  • middle sized molecules
  • salt and water
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5
Q

What is the glucose metabolism function of the kidney?

A
  • gluconeogenesis
  • insulin clearance
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6
Q

What is the impact of the loss of the homeostatic function of the kidney?

A
  • increased potassium
  • reduced bicarbonate
  • reduced pH
  • increased phosphate
  • salt and water imbalance
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7
Q

What is the impact of the loss of the excretory function of the kidney?

A
  • increased urea
  • increased creatinine
  • reduced insulin requirement
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8
Q

What is the impact of the loss of the endocrine function of the kidney?

A
  • reduced calcium
  • anaemia
  • increase parathyroid hormone levels
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9
Q

What is the impact of the loss of the glucose metabolism function of the kidney?

A

increased cardiovascular risk

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10
Q

What impacts the clinical presentation of kidney failure?

A

the rate of deterioration

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11
Q

What causes the tachypnoea with normal oxygen and clear lungs on auscultation?

A

Kussmaul respiration
- rapid deep breathing at a consistent pace
- indicates metabolic acidosis

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12
Q

What are the general symptoms of end stage renal failure?

A
  • lethargy
  • weakness
  • anorexia
  • hypovolemia
  • hypotension
  • hyperkalaemia
  • hyponatraemia
  • metabolic acidosis
  • raised urea and creatinine
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13
Q

What tends to be the impact of kidney failure on the salt water balance?

A

reduce secretion of salt and water, which can cause:

  • hypertension
  • oedema
  • pulmonary oedema
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14
Q

What is the impact of tubulointerstitial disorders on the salt water balance?

A
  • damage to the concentrating mechanism causing salt and water loss
  • hypovolemia
  • causes AKI
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15
Q

How can renal failure cause metabolic acidosis?

A
  • reduced H+ excretion
  • cells take up hydrogen ions, forcing out K+ ions
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16
Q

What is the effect of this acidosis caused by renal failure?

A
  • anorexia
  • muscle catabolism
  • weight and muscle mass loss
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17
Q

What can cause hyperkalaemia?

A
  • acidosis
  • reduced distal tubule potassium secretion
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18
Q

What are the symptoms of hyperkalaemia?

A
  • cardiac arrhythmias
  • neural and muscular activities
  • vomiting
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19
Q

What are the symptoms of hyperkalaemia dependent on?

A

chronicity

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20
Q

What ECG changes can be caused by hyperkalaemia?

A
  • peaked T waves
  • P wave broadened, reduced amplitude, or disappears
  • QRS widening
  • heart block
  • asystole
  • VT/VF
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21
Q

What is the impact of reduced erythropoietin?

A

anaemia

22
Q

What is the impact of reduced 1-25 vitamin D levels?

A
  • reduced intestinal calcium absorption
  • hypocalcaemia
  • hyperparathyroidism
23
Q

What is the impact of phosphate reteintion?

A
  • lowers 1-25 vitamin D
  • worsened hypocalcaemia
  • leads to increased hyperparathyroidism
24
Q

What is the major predictor of end stage renal failure?

A

CKD

25
Q

What is the major outcome for a patient with CKD?

A

cardiovascular disease

  • arterial calcification
  • sudden cardiac death
26
Q

What is the cardiovascular risk factors with renal failure?

A
  • hypertension
  • diabetes mellitus
  • lipid abnormalities
  • inflammation
  • oxidative stres
  • mineral/bone metabolism disorder
27
Q

What is the initial management of kidney failure?

A

hypovolaemic: IV fluids
hypervolaemic: trial diuretics/dialysis

28
Q

How do you manage hyperkalaemia?

A 
drive into cells
- sodium bicarbonate
- insulin dextrose (caution)
drive out of body
- diuretics/dialysis
gut absorption
- potassium binders
29
Q

What are the conservative treatments available for kidney failure?

A
  • erythropoietin injections (anaemia)
  • diuretics (oedema)
  • phosphate binders
  • 1,25 Vit D supplements
    (symptom managment)
30
Q

What are the home treatments available for kidney failure?

A
  • haemodialysis
  • peritoneal dialysis/assisted programs
31
Q

What are the in-centre treatments available for kidney failure?

A

haemodialysis (4hr x 3/week)

32
Q

What is the last line treatment for kidney failure?

A

transplantation

33
Q

How does hyperphostate present?

A

itchiness

34
Q

What should be avoided in transplantable patients with kidney disease?

A
  • avoid transfusion, can lead to sensitisation and then increase risk of transplant failure
  • blood should be taken from the back of the hand and not the antecubital fossa
  • preserves veins for fistulas needed for dialysis
35
Q

Is urea an accurate indicator of kidney failure?

A
  • poor indicator
  • can be masked by diet, catabolic state, GI bleeding, drugs and liver function
36
Q

Is creatinine an accurate indicator of kidney failure?

A
  • TREND is helpful
  • affected by muscle mass, age, race and sex
37
Q

Are radionuclide studies an accurate indicator of kidney failure?

A
  • reliable but expensive
  • measures EDTA clearance
38
Q

Is creatinine clearance an accurate indicator of kidney failure?

A
  • difficult for elderly patients to collect and accurate sample
  • overestimates GFR at low GFR (small amounts of creatinine is also secreted into urine)
39
Q

Is inulin clearance an accurate indicator of kidney failure?

A
  • laborious
  • used for research purposes only
40
Q

What indicators are used to indicate kidney failure?

A

eGFR (using CKD epidemiology collaboration)

41
Q

What impacts the efficacy of the CKD-EPI?

A

a high/normal eGFR

42
Q

What must be looked at when suspected kidney failure with normal eGFR/kidney function?

A

creatinine levels/trends

43
Q

If a patient is dehydrated, the filtrate present in which part of the nephron will have the highest osmolarity?

A

Tip of Loop of Henle

44
Q

What is likely to cause the highest osmolarity?

A

patient suffering with hepatic cirrhosis

45
Q

What solute has no effect on ADH production?

A

urea

46
Q

Why do most diuretics increase potassium excretion?

A

The increase in flow rate is detected in the collecting duct and directly stimulates potassium excretion

47
Q

An athlete after finishing their London Marathon run drank 2L of distilled water. How could you describe their body fluids?

A

decrease in plasma osmolarity

48
Q

Sodium excretion is very limited (less than 1% of filtered load) and several mechanisms exist to tightly regulate it. Increasing sodium excretion reduces water retention. Potassium excretion can vary over a very large range (from 1 to 80% of filtered load). Why doesn’t this variability in potassium excretion have a marked effect on water balance?

A

The amount of potassium in the plasma and extracellular is much lower than the amount sodium so that variations in this amount are insufficient to have a marked effect on water balance.

49
Q

Mr Holmes (65 years old, 75 Kg) is being treated with a loop diuretic and Mr Smith (66 years old, 74 Kg) with a thiazide diuretic for past 3 weeks (assume that the doses of the respective treatments allow an equivalent inhibition of [Na+] reabsorption). Both the individuals are drinking insufficient but equivalent amount of water. Which of the following statement is likely to be true?

A

Mr Holmes urine will have lower osmolarity than Mr Smiths.

50
Q

How is kidney failure diagnosed?

A

Elevated plasma urea and creatinine

51
Q

What will an ultrasound of kidney failure from chronic kidney disease show?

A

2 small shrunken kidneys

52
Q

How will acute renal failure present

A
  • normovolemic
  • normal sized kidneys with no obstruction
  • rapid deteriation
  • reduced urinary output

BRS YR2 (67 decks)

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