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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
What are the symptoms of hyperkalaemia?
Cardiac Arrythmias, Neural and Muscular Activity, Vomiting
26
What are the ECG signs for hyperkalaemia?
Peaked T waves, Disappearing P waves (heart block), broadens + red amp QRS widening Asystole VT/VF
27
What is the cardiac complication with hyperkalaemia?
Asystole (medical emergency)
28
Impact of kidney failure on metabolism
CKD -> Phosphate retention + low 1-25vit D -> hypocalcaemia -> hyperparathyroidism
29
Risks for CVD
Hypertension Diabetes lipid abnormalities inflammation oxidative stress
30
How do you treat hypervolaemia?
Diuretics or Dialysis
31
What are the two ways of initially managing kidney failure
Fluid balance Treat the hyperkalaemia
32
What are the three mechanisms of treating hyperkalaemia?
Drive into cells (sodium bicarb) Drive out of body (diuretics/dialysis) Reduce Gut absorption (potassium binders)
33
Conservative treatment for end stage renal failure
EPO injections to correct anaemia Diuretics to correct salt,water overload Phosphate binders Vit D supplements symptom managment
34
What are the elements of home therapy for kidney failure?
Haemodialysis, Peritoneal Dialysis
35
What are the elements of in centre therapy for kidney failure?
Haemodialysis: 4 hours thrice a week
36
What is the long-term management of end-stage renal disease?
Conservative, Home Therapy, In-Centre, Transplantation, CVD risk reduction
37
What is KFRE?
Kidney Failure Risk Equation
38
Who is KFRE unsuitable for?
Patients with a rapidly changing eGFR
39
What is KFRE calculated from?
Age, Sex, CKD eGFR, urine ACR
40
Why is KFRE useful
Allows identification of high risk CKD px - targeted px education - referral to 2º care
41
Why must you avoid taking blood/inserting cannulas in the arms of renal px
They may rq dialysis in the future, the veins are necessary for fistula formation use veins in the back of the hand
42
Why must you avoid transfusions in transplantable px with renal disease
Transfusions sensitise immune system to foreign antigens, increases risk of transplant failure
43
How useful is it for urea to be a marker for assessing eGFR?
Poor indicator - confounded by diet, catabolism, GI bleeding, liver function
44
How useful is it for creatinine to be a marker for assessing eGFR?
Helpful trend but need to look at patient for context: muscle mass, age, race, sex etc.
45
How useful is it for radionuclide studies to be a marker for assessing eGFR?
(e.g. EDTA clearance) reliable but expensive
46
How useful is it for creatinine clearance to be a marker for assessing eGFR?
Difficult for elderly patients to collect an accurate sample, overestimates low GFRs - some secreted into urine trimethoprim affects secretion
47
How useful is it for insulin clearance to be a marker for assessing eGFR?
Laborious - only for research purposes
48
What is CKD-EPI?
CKD Epidemiology Collaboration - equation for eGFR High margin of error
49
Relationship between albumin, eGFR and risk of CKD
As albumin increases so does the risk of CKD As EGFR increases so does the risk of CKD ACR- albumin-creatinine ratio

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