chronic kidney disease and renal failure

Question 1

what are the clinical findings when someone is hypovolaemic as a result of kidney failure?

Answer 1

pulmonary oedema,
Hypertension
oedema

Question 2

what are the symptoms you can get with hyperkalaemia? (when severe or chronic and stuff)

Answer 2

vomiting
ECG changes
neural and muscular activity

Question 3

what are the ECG changes that can happen die to hyperkalaemia?

Answer 3

the more common and particular ones:

• peaked T waves,
• P wave: 1) disappears, 2) reduced amplitude 3) broadens
• QRS widening

the more life threatening ones:

• asystole (flat lineP
• heart block
• VT/ VF ( ventricular tachy / ventricular fibrilation)

Question 4

what do reduced erythropoietin levels lead to clinically?

Answer 4

anaemia

Question 5

what do reduced 1-25 vit D levels lead to?

Answer 5

reduced intestinal calcium absorption
->
hypocalcaemia
->
hyperparathyroidism

Question 6

DRAW DIAGRAM explaining how you get hypocalcaemia from chronic renal failure

Answer 6



Question 7

what does hypocalcaemia in renal failure cause?

Answer 7

hyperparathyroidsim

Question 8

mechanism causing hyperparathyropidism in renal failure

Answer 8

Question 9

what is the most likely way to die from CKD/ most dangeorus outcome?

Answer 9

cardiovascular disease and NOT end stage renal failure

Question 10

which mechanism of CKD is mainly causing cardiovascular disease?

Answer 10

metabolic problems-

Question 11

cardiovascular conditions that people with progressive CKD have an increasing risk for

6 higher risk
4 bit lower

Answer 11

higher:
non atherosclerotic CVD
arrythmias
valve calcification
arterial calcification
hemorrhagic stroke
sufdden cardiac death

bit lowe: atherosclerotic CVD event CAD
ishaemic stroke
PAD

Question 12

WHAT are people with progressive CKD at an increasing risk of after a CVD event?

Answer 12

death

Question 13

what are some risk factors for cardiovascular disease with kidney failure?

Answer 13

Hypertension!!
Diabetes!!
Lipid abnormalities

Additional risks
Inflammation
Oxidative stress
Mineral/bone metabolism disorder

Question 14

what is the initial management of kidney failure?

Answer 14

really important - FLUID BALANCE IS TRHE FIRST THING YOU DO
hypovolaemic give fluids
hypervolaemic- trial of diuretics/ dialysis

+ hyperkalaemia management

Question 15

what are the ways to manage hyperkalaemia?

Answer 15

drive K+ into cells: sodium bicarbonate or insulin dextrose (caution)

drive out of body - diuretics/ dialysis

reduce gut absorption: potassium binders

Question 16

what are the 6 main aspects of long temr management of kidney failure?

Answer 16

end stage failure risk assessment

conservative treatment

home therapy

in centre therapy

transplantation

cardiovascular risk reduction

Question 17

what are the possible conservative treatments for kidney failure?

Answer 17

• erythropoietin injections to correct anaemia
  
  • diuretics to correct salt water overload
  • phosphate binders- bind phosphates to food so you can excrete
  • 1.25 vit d supplements
  • symptom management

Question 18

what is the kidney failure risk equation? (KFRE)

Answer 18

Validated risk prediction tool for kidney replacement therapy (progression to kidney failure) in the next two or five years for adults with STABLE chronic kidney disease (CKD) Stages 3A to 5 .

Question 19

on which patients CANT we use KFRE on?

Answer 19

not to be used on patients with changing egfr

Question 20

what is KFRE calculated from

Answer 20

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

Question 21

what is the use of KFRE?

Answer 21

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- rl important, can give them years of freedom!

3) aggressive risk factor management

4) referral to secondary care

Question 22

what should you know about blood transfusions and patients with kidney disease that could potentially have transplant.

Answer 22

they shouldnt have them because transfusion leads to sensitization leads ot transplant failure