Chronic Kidney Disease and Renal Failure

Question 1

What is the homeostatic function of kidneys in health?

Answer 1

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

Question 2

What is the excretory function of kidneys in health?

Answer 2

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

Question 3

What is the endocrine function of kidneys in health?

Answer 3

1. Erythropoietin

2. 1-alpha hydroxylase vitamin D

Question 4

What is the glucose metabolism function of kidneys in health?

Answer 4

1. Gluconeogenesis

2. Insulin clearance

Question 5

What happens to the homeostatic function in kidney failure?

Answer 5

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

Question 6

What happens to the excretory function in kidney failure?

Answer 6

1. Increase urea
2. Increase creatinine
3. Decrease insulin requirement

Question 7

What happens to the endocrine function in kidney failure?

Answer 7

1. Decrease calcium
2. Anaemia
3. Increase parathyroid hormone

Question 8

What happens as the kidney fails?

Answer 8

Increase cardiovascular risk

Question 9

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

Answer 9

1. Hypertension
2. Oedema
3. Pulmonary oedema

Question 10

What are the causes of hyperkalaemia?

Answer 10

1. Decrease distal tubule potassium secretion

2. Acidosis

Question 11

What are the symptoms of hyperkalaemia?

Answer 11

1. Cardiac arrhythmias
2. Neural and muscular activity
3. Vomiting

Question 12

What are the ECG changes in hyperkalaemia?

Answer 12

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

Question 13

What does reduced erythropoietin lead to?

Answer 13

Anaemia

Question 14

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

Answer 14

1. Reduced intestinal calcium absorption
2. Hypocalcaemia
3. Hyperparathyroidism

Question 15

What does chronic renal failure lead to?

Answer 15

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

Question 16

What can CKD predict?

Answer 16

• End stage renal failure

- But more likely to die from cardiovascular

Question 17

What is the standard cardiovascular risk for kidney failure?

Answer 17

• Hypertension
• Diabetes
• Lipid abnormalities

Question 18

What are the additional cardiovascular risks for kidney failure?

Answer 18

• Inflammation
• Oxidative stress
• Mineral/bone metabolism disorder

Question 19

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

Answer 19

1. Hypovolemic: give fluids

2. Hyervolaemic: trial of diuretics/dialysis

Question 20

What is the initial management for kidney failure and hyperkalamia?

Answer 20

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

Question 21

What is long term conservative treatment for kidney failure?

Answer 21

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

Question 22

What is long term home therapy for kidney failure?

Answer 22

• Haemodialysis

- Peritoneal dialysis/assisted programmes

Question 23

What is long term in centre therapy for kidney failure?

Answer 23

• Haemodialysis, 4 hours 3 x a week

- Transplantation ?

Question 24

When should you avoid transfusions?

Answer 24

1. In transplantable patients with kidney disease

2. Transfusions lead to sensitisation which leads to transplant failure

Question 25

How do you use Urea to assess GFR?

Answer 25

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

Question 26

How do you use creatinine to assess GFR?

Answer 26

* Affected by muscle mass, age, race, sex etc. | * Need to look at the patient when interpreting the result. TREND helpful.

Question 27

How do you use radionucelide studies to assess GFR?

Answer 27

* EDTA clearance etc | * Reliable but expensive

Question 28

How do you use creatinine clearance to assess GFR?

Answer 28

* 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)

Question 29

How do you use insulin clearance to assess GFR?

Answer 29

•Laborious - used for research purposes only

Question 30

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

Answer 30

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

Question 31

What does hyponatremia not always equal?

Answer 31

Reduced total body sodium