chronic kidney disease and renal failure Flashcards
what are the clinical findings when someone is hypovolaemic as a result of kidney failure?
pulmonary oedema,
Hypertension
oedema
what are the symptoms you can get with hyperkalaemia? (when severe or chronic and stuff)
vomiting
ECG changes
neural and muscular activity
what are the ECG changes that can happen die to hyperkalaemia?
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)
what do reduced erythropoietin levels lead to clinically?
anaemia
what do reduced 1-25 vit D levels lead to?
reduced intestinal calcium absorption
->
hypocalcaemia
->
hyperparathyroidism
DRAW DIAGRAM explaining how you get hypocalcaemia from chronic renal failure

what does hypocalcaemia in renal failure cause?
hyperparathyroidsim
mechanism causing hyperparathyropidism in renal failure
what is the most likely way to die from CKD/ most dangeorus outcome?
cardiovascular disease and NOT end stage renal failure
which mechanism of CKD is mainly causing cardiovascular disease?
metabolic problems-
cardiovascular conditions that people with progressive CKD have an increasing risk for
6 higher risk
4 bit lower
higher:
non atherosclerotic CVD
arrythmias
valve calcification
arterial calcification
hemorrhagic stroke
sufdden cardiac death
bit lowe: atherosclerotic CVD event CAD
ishaemic stroke
PAD
WHAT are people with progressive CKD at an increasing risk of after a CVD event?
death
what are some risk factors for cardiovascular disease with kidney failure?
Hypertension!!
Diabetes!!
Lipid abnormalities
Additional risks
Inflammation
Oxidative stress
Mineral/bone metabolism disorder
what is the initial management of kidney failure?
really important - FLUID BALANCE IS TRHE FIRST THING YOU DO
hypovolaemic give fluids
hypervolaemic- trial of diuretics/ dialysis
+ hyperkalaemia management
what are the ways to manage hyperkalaemia?
drive K+ into cells: sodium bicarbonate or insulin dextrose (caution)
drive out of body - diuretics/ dialysis
reduce gut absorption: potassium binders
what are the 6 main aspects of long temr management of kidney failure?
end stage failure risk assessment
conservative treatment
home therapy
in centre therapy
transplantation
cardiovascular risk reduction
what are the possible conservative treatments for kidney failure?
- 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
what is the kidney failure risk equation? (KFRE)
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 .
on which patients CANT we use KFRE on?
not to be used on patients with changing egfr
what is KFRE calculated from
Age in years
Sex
CKD-EPI eGFR
Urine albumin creatinine ratio (ACR)
what is the use of KFRE?
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
what should you know about blood transfusions and patients with kidney disease that could potentially have transplant.
they shouldnt have them because transfusion leads to sensitization leads ot transplant failure
