Chronic Kidney disease & Renal Failure

Question 1

What are the Homeostatic functions of the kidneys?

Answer 1

Electrolyte balance
Acid-Base balance
Volume homeostasis

Question 2

What are the excretory functions of the Kidney?

Answer 2

Nitrogenous waste, hormones, peptides, salt and water, middle sized molecules.

Question 3

What are the endocrine functions of the Kidney?

Answer 3

Erythropoetin, 1 alpha-hydroxylase vitamin D

Question 4

What is the role of the Kidney in Glucose metabolism?

Answer 4

Gluconeogenesis, Insulin clearance

Question 5

What happens when the homeostatic function of the kidney is disturbed?

Answer 5

Increased Potassium & Phosphate.
Decreased, Bicarbonate, pH.
Salt and water imbalance.
Acidosis, Hyponatremia, Volume depletion.

Question 6

What happens when the endocrine function of the kidney is disturbed?

Answer 6

Decreased Calcium.
Anaemia.
Increased Parathyroid hormone (hyperparathyroidism).

Question 7

What happens when the excretory function of the kidney is disturbed?

Answer 7

Increased Urea & Creatinine.

Decreased Insulin requirement.

Question 8

What disease does Kidney failure increase the risk of?

Answer 8

Cardiovascular disease.

Question 9

Why are some patients confused about their kidney failure, especially when their diabetes has gone away?

Answer 9

Diabetes, over a long period of time can cause kidney failure. However, because they are sustaining more of their endogenous insulin due to kidney failure the diabetes can sort of cure itself.

Question 10

How does Kidney failure present?

Answer 10

Presentation can be either from the consequences of renal failure or the disease that is causing Renal Failure.

Question 11

What is the normal creatinine level?

Answer 11

50-110 μmol/L

Question 12

What is tachypnea?

Answer 12

fast, shallow breaths.

Question 13

Why would a patient be tachypneic with normal oxygen sats and clear lungs?

Answer 13

you are trying to increase bicarbonate, so you need to shift the equation to the left and to do this you try to drop pCO2 through an increased respiratory rate.

Question 14

What is the normal range for Urea?

Answer 14

3-7 mmol/L

Question 15

What is the normal range for Sodium?

Answer 15

135-145 mmol/L

Question 16

What is the normal range for potassium?

Answer 16

3-5 mmol/L

Question 17

What is the normal range for haemoglobin?

Answer 17

12-16 g/100ml

Question 18

What does kidney failure do to salt and and water secretion?

Answer 18

Reduced. This leads to Hypertension, Oedema, Pulmonary oedema.

Question 19

What can salt and water loss also be a symptom of?

Answer 19

tubulointerstitial disorders - damage to concentrating mechanism, can happen after kidney transplant or obstruction, Hypovolemia may also be the cause.

Question 20

What happens in acidosis associated with kidney failure?

Answer 20

Reduced excretion of H+ ions,
Retention of acid bases,
K+ leaves cells,
Anorexia, Muscle Catabolism.

Question 21

What are the causes of hyperkalaemia?

Answer 21

Acidosis, Reduced distal tubule potassium secretion.

Question 22

What are the symptoms of hyperkalaemia?

Answer 22

Cardiac arrhythmias,
Neural & muscular activity,
Vomiting (body trying to get rid of excess K+).

Question 23

What changes can be seen on the ECG of a patient with hyperkalaemia and kidney failure?

Answer 23

Peaked T waves,
P wave - broadens, reduced amplitude, disappears.
QRS widening
Heart block
Asystole
Ventricular tacychardia, fibrilation.

Question 24

What is the relationship between renal failure, CKD and Cardiovascular disease?

Answer 24

Major predictor of end stage renal failure is CKD, but major outcome for a patient with CKD is cardiovascular disease. a patient with CKD is more likely to die due to cardiovascular disease than renal failure.

Question 25

What are the risks for a renal patient?

Answer 25

Standard Cardiovascular - Hypertension, Diabetes, Lipid abnormalities.
Additional risks - Inflammation, Oxidative stress, Mineral/bone metabolism disorder.

Question 26

What it the treatment for Hypervolemia?

Answer 26

trial of diuretics/dialysis.

Question 27

What is the treatment for Hypovolemia?

Answer 27

give fluids.

Question 28

What is the treatment for Hyperkalaemia?

Answer 28

Drive into cells - Sodium bicarbonate, insulin dextrose (caution - hypoglycaemia).
Drive potassium out of body - diuretics/dialysis.
Gut absorption - Potassium binders.

Question 29

What is the conservative treatment for Kidney failure?

Answer 29

• erythropoietin injections to correct anaemia
• diuretics to correct salt water overload
• phosphate binders
• 1.25 vit d supplements
• symptom management

Question 30

What are home therapies for Kidney failure?

Answer 30

• haemodialysis
• peritoneal dialysis/assisted programmes
  in centre therapies also available.

Question 31

What should be avoided in a patient set for a transplant?

Answer 31

Blood transfusions, can lead to sensitisation and transplant failure.

Question 32

What are the best ways of assessing GFR?

Answer 32

Creatinine trend can be helpful, radionuclide study can be expensive, EGFR equation used instead. Serum creatinine is the main component in the equation.

Question 33

What is the problem with the EGFR equation?

Answer 33

difference between estimated and actual GFR is reduced as GFR gets better.

Question 34

What is the relationship between protein in urea and end stage renal failure?

Answer 34

as protein urea increases, the higher your risk for progressing to end stage renal failure is.

Question 35

What is a fistula?

Answer 35

connection between an artery and a vein, vein enlarges so you can insert cannula easier.