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Z YEAR 2 BRS GASTRO > Chronic Kidney Disease and Renal Failure > Flashcards

Chronic Kidney Disease and Renal Failure Flashcards

1
Q

What is the homeostatic function of kidneys in health?

A
  1. Electrolyte balance
  2. Acid-base balance
  3. Volume homeostasis
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2
Q

What is the excretory function of kidneys in health?

A
  1. Nitrogenous waste
  2. Hormones
  3. Peptides
  4. “middle sized molecules”
  5. Salt and water
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3
Q

What is the endocrine function of kidneys in health?

A
  1. Erythropoietin

2. 1-alpha hydroxylase vitamin D

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4
Q

What is the glucose metabolism function of kidneys in health?

A
  1. Gluconeogenesis

2. Insulin clearance

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5
Q

What happens to the homeostatic function in kidney failure?

A
  1. Increase potassium
  2. Decrease bicarbonate
  3. Decrease pH
  4. Increase phosphate
  5. Salt and water imbalance
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6
Q

What happens to the excretory function in kidney failure?

A
  1. Increase urea
  2. Increase creatinine
  3. Decrease insulin requirement
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7
Q

What happens to the endocrine function in kidney failure?

A
  1. Decrease calcium
  2. Anaemia
  3. Increase parathyroid hormone
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8
Q

What happens as the kidney fails?

A

Increase cardiovascular risk

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9
Q

Since kidney failure tends to reduce secretion of salt and water what does this lead to?

A
  1. Hypertension
  2. Oedema
  3. Pulmonary oedema
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10
Q

What are the causes of hyperkalaemia?

A
  1. Decrease distal tubule potassium secretion

2. Acidosis

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11
Q

What are the symptoms of hyperkalaemia?

A
  1. Cardiac arrhythmias
  2. Neural and muscular activity
  3. Vomiting
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12
Q

What are the ECG changes in hyperkalaemia?

A
  1. Peaked T waves
  2. P wave
    - broadens
    - reduced amplitude
    - disappears
  3. QRS widening
  4. Heart block
  5. Asystole
  6. VT/VF
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13
Q

What does reduced erythropoietin lead to?

A

Anaemia

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14
Q

What does reduced 1-25 vit D levels lead to?

A
  1. Reduced intestinal calcium absorption
  2. Hypocalcaemia
  3. Hyperparathyroidism
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15
Q

What does chronic renal failure lead to?

A
  1. Phosphate retention
  2. Low levels of 1-25 Vit D
    - Lead to hypocalcaemia + hyperparathyroidism
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16
Q

What can CKD predict?

A
  • End stage renal failure

- But more likely to die from cardiovascular

17
Q

What is the standard cardiovascular risk for kidney failure?

A
  • Hypertension
  • Diabetes
  • Lipid abnormalities
18
Q

What are the additional cardiovascular risks for kidney failure?

A
  • Inflammation
  • Oxidative stress
  • Mineral/bone metabolism disorder
19
Q

What is the initial management for kidney failure and fluid balance?

A
  1. Hypovolemic: give fluids

2. Hyervolaemic: trial of diuretics/dialysis

20
Q

What is the initial management for kidney failure and hyperkalamia?

A
  1. Drive into cells: sodium bicarbonate and insulin dextrose (caution)
  2. Drive out of body: diuretic/dialysis
  3. Gut absorption: potassium binders
21
Q

What is long term conservative treatment for kidney failure?

A
  1. erythropoietin injections to correct anaemia
  2. diuretics to correct salt water overload
  3. phosphate binders
  4. 1.25 vit d supplements
  5. symptom management
22
Q

What is long term home therapy for kidney failure?

A
  • Haemodialysis

- Peritoneal dialysis/assisted programmes

23
Q

What is long term in centre therapy for kidney failure?

A
  • Haemodialysis, 4 hours 3 x a week

- Transplantation ?

24
Q

When should you avoid transfusions?

A
  1. In transplantable patients with kidney disease

2. Transfusions lead to sensitisation which leads to transplant failure

25
Q

How do you use Urea to assess GFR?

A
  • Poor indicator

* Confounded by diet, catabolic state, GI bleeding (bacterial breakdown of blood in gut), drugs, liver function etc.

26
Q

How do you use creatinine to assess GFR?

A
  • Affected by muscle mass, age, race, sex etc.

* Need to look at the patient when interpreting the result. TREND helpful.

27
Q

How do you use radionucelide studies to assess GFR?

A
  • EDTA clearance etc

* Reliable but expensive

28
Q

How do you use creatinine clearance to assess GFR?

A
  • Difficult for elderly patients to collect an accurate sample
  • Overestimates GFR at low GFR (as a small amount of creatinine is also secreted into urine)
29
Q

How do you use insulin clearance to assess GFR?

A

•Laborious - used for research purposes only

30
Q

What can salt and water loss may also be due to?

A
  1. may be seen in tubulointerstitial disorders – damage to concentrating mechanism
  2. and hypovolemia may be the cause of AKI
31
Q

What does hyponatremia not always equal?

A

Reduced total body sodium

Z YEAR 2 BRS GASTRO (15 decks)

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