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Uro > Chronic kidney disease and renal failure > Flashcards

Chronic kidney disease and renal failure Flashcards

1
Q

What are the four functions of the kidneys?

A

Homeostasis,
Endocrine,
Excretory,
Glucose Metabolism

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2
Q

What are the three parts of the kidneys’ homeostatic function?

A

Electrolyte,
Acid-Base,
Volume Balance

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3
Q

What are the key signs of kidney failure in homeostatic function?

A

Hyperkalaemia,
Low Bicarb, Low pH,
High Phosphate
salt and water imbalance

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4
Q

What are the two parts of the kidneys’ endocrine function?

A

Erythropoietin,
1-alpha-hydroxylase (vit D)

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5
Q

What are the key signs of kidney failure in endocrine function?

A

Low EPO - anaemia,
Low vitD - hyperparathyroidism, low calcium

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6
Q

What are the types of molecules excreted at the kidneys?

A

Nitrogenous,
Hormones,
Peptides
salts
h20

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7
Q

What type of molecules reach dangerous concentrations in the blood if kidney failure occurs?

A

Urea and Creatinine

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8
Q

What are the two parts of the kidneys’ glucose metabolism function?

A

Gluconeogenesis,
Insulin Clearance

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9
Q

effect of kidney failure on insulin

A

Causes decreased insulin rq, which can make diabetics go into hypos as they administering xs insulin

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10
Q

What general complication is most common following kidney failure?

A

Cardiovascular Risk

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11
Q

How does rate of kidney deterioration correlate with clinical presentation?

A

Slower deterioration is less likely to have clinical presentations

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12
Q

Symptoms of slow progressing kidney failure - CKD

A

Extreme lethargy, weakness, anorexia, flu like symptoms

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13
Q

How can an X-Ray show kidney failure?

A

Kidney can be seen to have taken up dye from urinary catheter

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14
Q

What are the clinical examination signs of CKD?

A

Dry’/Hypovolaemic Symptoms - pale, cold hands, decreased capillary refill, slow pulse, low bp, tachypnoea

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15
Q

Why is there tachypnoea in CKD?

A

Respiratory compensation during metabolic acidosis
XS H+ converted to CO2 which is removed by breathing

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16
Q

What would an ultrasound of someone with CKD show?

A

2 small shrunken kidneys

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17
Q

What is a fast progressing kidney failure be more likely of?

A

Acute Kidney Injury

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18
Q

What are the clinical examination signs of AKI?

A

Normovolaemic signs - normal temperature, HR, BP, resp rate

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19
Q

How would an ABG of someone with an AKI compare to CKD?

A

Milder metabolic acidosis but still respiratory compensation, just less extreme

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20
Q

What would an ultrasound of someone with AKI show?

A

Normal sized kidneys with no obstruction

21
Q

How does kidney failure affect salt and water secretion

A

reduces secretion leading to
- hypovolaemia
- hypertension
- oedema (+ pulmonary oedema)

22
Q

Effect of tubulointerstitial disorders on the kidneys

A

Can cause salt and water loss -> hypovolaemia and AKI
issues with concentrating urine

23
Q

Explain why hyperkalaemia occurs in kidney failure

A

Kidneys cannot excrete and hence retain H+ ions. H+ and K+ are swapped with an antiporter, so more K+ is retained and sent to blood

causes anorexia and muscle catabolism

24
Q

Causes of hyperkalaemia

A

decreased distal tubule K secretion
Acidosis

25
Q

What are the symptoms of hyperkalaemia?

A

Cardiac Arrythmias,
Neural and Muscular Activity,
Vomiting

26
Q

What are the ECG signs for hyperkalaemia?

A

Peaked T waves,
Disappearing P waves (heart block), broadens + red amp
QRS widening
Asystole
VT/VF

27
Q

What is the cardiac complication with hyperkalaemia?

A

Asystole (medical emergency)

28
Q

Impact of kidney failure on metabolism

A

CKD -> Phosphate retention + low 1-25vit D
-> hypocalcaemia
-> hyperparathyroidism

29
Q

Risks for CVD

A

Hypertension
Diabetes
lipid abnormalities
inflammation
oxidative stress

30
Q

How do you treat hypervolaemia?

A

Diuretics or Dialysis

31
Q

What are the two ways of initially managing kidney failure

A

Fluid balance
Treat the hyperkalaemia

32
Q

What are the three mechanisms of treating hyperkalaemia?

A

Drive into cells (sodium bicarb)
Drive out of body (diuretics/dialysis)
Reduce Gut absorption (potassium binders)

33
Q

Conservative treatment for end stage renal failure

A

EPO injections to correct anaemia
Diuretics to correct salt,water overload
Phosphate binders
Vit D supplements
symptom managment

34
Q

What are the elements of home therapy for kidney failure?

A

Haemodialysis, Peritoneal Dialysis

35
Q

What are the elements of in centre therapy for kidney failure?

A

Haemodialysis: 4 hours thrice a week

36
Q

What is the long-term management of end-stage renal disease?

A

Conservative, Home Therapy, In-Centre, Transplantation, CVD risk reduction

37
Q

What is KFRE?

A

Kidney Failure Risk Equation

38
Q

Who is KFRE unsuitable for?

A

Patients with a rapidly changing eGFR

39
Q

What is KFRE calculated from?

A

Age, Sex, CKD eGFR, urine ACR

40
Q

Why is KFRE useful

A

Allows identification of high risk CKD px
- targeted px education
- referral to 2º care

41
Q

Why must you avoid taking blood/inserting cannulas in the arms of renal px

A

They may rq dialysis in the future, the veins are necessary for fistula formation
use veins in the back of the hand

42
Q

Why must you avoid transfusions in transplantable px with renal disease

A

Transfusions sensitise immune system to foreign antigens, increases risk of transplant failure

43
Q

How useful is it for urea to be a marker for assessing eGFR?

A

Poor indicator - confounded by diet, catabolism, GI bleeding, liver function

44
Q

How useful is it for creatinine to be a marker for assessing eGFR?

A

Helpful trend but need to look at patient for context: muscle mass, age, race, sex etc.

45
Q

How useful is it for radionuclide studies to be a marker for assessing eGFR?

A

(e.g. EDTA clearance) reliable but expensive

46
Q

How useful is it for creatinine clearance to be a marker for assessing eGFR?

A

Difficult for elderly patients to collect an accurate sample, overestimates low GFRs - some secreted into urine
trimethoprim affects secretion

47
Q

How useful is it for insulin clearance to be a marker for assessing eGFR?

A

Laborious - only for research purposes

48
Q

What is CKD-EPI?

A

CKD Epidemiology Collaboration - equation for eGFR
High margin of error

49
Q

Relationship between albumin, eGFR and risk of CKD

A

As albumin increases so does the risk of CKD
As EGFR increases so does the risk of CKD

ACR- albumin-creatinine ratio

Uro (7 decks)

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