Chronic Kidney Disease & Renal Failure Flashcards
1
Q
What homeostatic functions are performed by the kidneys (3)?
A
- Electrolyte balance
- Acid-base balance
- Volume homeostasis
2
Q
What endocrine functions are performed by the kidneys (2)?
A
- Erythropoietin synthesis
- 1-alpha hydroxylase (Vitamin D)
3
Q
What are the excretory functions of the kidneys (4)?
A
- Nitrogenous waste
- Middle sized molecules
- Hormones, peptides
- Salt and Water
4
Q
What are the functions of the kidney regarding glucose metabolism (2)?
A
- Gluconeogenesis
- Insulin clearance
5
Q
What is Chronic Kidney Disease (CKD)?
A
- CKD is defined as abnormalities of kidney structure or function, present for >3 months
6
Q
What are the clinical signs of CKD (3)?
A
- Albuminuria / proteinuria
- Haematuria
- Electrolyte abnormalities detected by imaging
7
Q
Disruptions to the homeostatic balance of the kidneys can manifest as what (4)?
A
- Hyperkalaemia
- Reduced bicarbonate - decreases pH and manifests as metabolic acidosis
- Increased phosphate
- Salt and water imbalance
8
Q
Why does metabolic acidosis occur in kidney failure?
A
- Reduced excretion of hydrogen ions from the distal convoluted tubule into the filtrate, manifests as acid retention
9
Q
What can acidosis cause (2)?
A
- Anorexia
- Muscle catabolism
10
Q
Why does hyperkalaemia occur in kidney failure?
A
- Reduced potassium excretion
11
Q
What are the symptoms of hyperkalaemia (3)?
A
- Cardiac arrhythmias
- Neural muscular activity
- Vomiting
12
Q
What features on an ECG suggest hyperkalaemia (6)?
A
- Peaked T waves
- P-waves: Broadens, reduced amplitude
- QRS widening
- Heart block
- Asystole
- VT / VF
13
Q
What is the treatment for hyperkalaemia?
Drive it in, drive it out and into the gut
A
- Drive into cells
- Sodium bicarbonate
- Insulin dextrose (caution) – carries hypoglycaemic risk. Insulin is a potassium drive (short term solution)
- Drive out of the body
- Diuretics/dialysis
- Gut absorption
- Potassium chelating agents
14
Q
How does insulin dextrose treat hyperkalaemia?
A
- Insulin induces a potassium drive (short-term solution)
15
Q
What is used to treat hyperkalaemia in an acute setting?
A
- Sodium bicarboante - neutralises the hydrogen ions, such that potassium can re-enter the cells
16
Q
Why is there an increased cardiovascular risk with chronic kidney disease?
A
- There is an increased cardiovascular risk, since cardiac ventricular myocyte contraction is directly related to extracellular concentrations of calcium (arrythmias) + increased calcification risk
- Predictor of end stage renal failure is CKD
- Outcome for a patient with CKD → Cardiovascular disease
17
Q
What are the standard cardiovascular risk (3)?
A
- Hypertension
- Diabetes
- Lipid abnormalities
18
Q
What are the symptoms associated with kidney failure and reduced secretion of sodium chloride (3)?
A
- Hypertension
- Oedema
- Pulmonary Oedema
19
Q
Why is salt and water loss evident in tubulointestinal disorders?
A
- Damage in the concentrating mechanism of the juxtamedullary interstitial → water reabsorption decreased
20
Q
What is the immediate treatment in a patient with hypovolaemia?
A
- Give fluids
21
Q
What is the immediate treatment for a patient with hypervolaemia?
A
- Fluid restriction, consider diuretics/dialysis
22
Q
What are the endocrine imbalances that occur in kidney dysfunction (3)?
A
- Increased PTH
- Anaemia - reduced EPO production
- Hypocalcaemia- reduced calcitriol synthesis
23
Q
What type of hyperparathyroidism is linked with chronic kidney failure?
A
- Tertiary hyperparathyroidism
24
Q
Why does anaemia occur in kidney dysfunction?
A
- Reduced erythropoeitin production
25
Why is there parathyroid hyperplasia associated with kidney dysfunction?
* There is a **reduction of calcitriol synthesis**, due to insufficient activity of renal 1-alpha hydroxylase, manifesting as **chronic hypocalcaemia,** this **increases PTH secretion** to potentiate **bone resorption**
26
Which veins should be used when taking blood or IV lines for patients with renal failure?
* **Dorsal venous** structures
27
Where should taking blood be avoided in patients with renal failure?
* Avoid taking blood or inserting IV lines into the veins of the **antecubital fossa or cephalic vein at wrist level**
28
What is a fistula in terms of CKD?
* A fistula is created by connecting **an artery directly to the vein** – vein swells for ease of access
29
Why should transfusions be avoided in patients with renal failure?
* **Transfusions will sensitise anaemia** (haemolytic anaemia, as foreign antigens are detected, and antibodies are formed) → **Autoimmune mediated rejection of transplanted kidney**
30
What is the long term management for CKD (4)?
* **Erythropoietin injections** to correct anaemia
* **Diuretics** to correct salt-water overload
* **Phosphate binders**
* **1-25 Vitamin D supplements**
31
What home therapy is available for CKD?
* **Haemodialysis**
* **Peritoneal dialysis** / assisted programmes → The peritoneum behaves as a semipermeable membrane and a dialysate is delivered with specific concentrations (hyperosmolar to generate drive, fluid into the peritoneal cavity)
32
What is haemodialysis?
* The **process of blood purification** in individuals with dysfunctional kidneys (glomerular filtrations is impaired)
* Extracorporeal **removal of waste products** – urea and freely filtered creatinine from the blood
* There is **counter current motion** between the blood and dialysate
* Filtration occurs **between the semi-permeable membrane**
* The specific components of diastyle are determined by the nephrologist, dependent on the individual – monitored
33
How long does haemodialysis last typically during the week?
* **3-4.5 hours** treatment **3 times per week**
* Allows 4 treatment free days per week
34
Which type of haemolysis is concerned with dietary constraints?
* **Haemodialysis** - strictly dietary constraints and salt / water intake restrictions
35
What is peritoneal dialysis?
* A type of dialysis that **incorporates the peritoneum as the membrane through which fluid and dissolve substances are exchanged with the blood**
* **Dialysate within the peritoneal cavity** (between the visceral and parietal peritoneum)
* **Removes excess fluid** – correct electrolyte problems and removes toxins in individuals with renal failure
* Solution is introduced through a **permanent tube** in lower abdomen and then removed
36
Which type of dialysis is performed at home?
* Pertioneal dialysis
37
What is the access advantage with peritoneal dialysis (2)?
* **Can travel easily** – machine packs into wheelie suitcase and fluids delivered by the companies internationally
* **Daytime exchanges can be done anywhere** – at work etc just need to be able to wash hands
38
What type of infection risk is associated with peritoneal dialysis (2)?
* Chance of **infection** due to catheter
* **Peritonitis**
39
What are the main factors to consider when doing a live kidney donor transplant (8)?
* **Family history** of kidney disease
* **Age**
* **Two** **healthy kidneys**
* **Financial stability**
* **Mental health** history
* Future **pregnancy**
* **Kidney match**
* **Comorbidities**
40
How is a kidney match made (3)?
* **Blood type** compatibility
* **HLA typing**
* **Serum cross** match
41
During kidney transplantation, the renal artery of the transplanted kidney is connected to which artery?
* **External iliac artery** of the recipient rather than the abdominal aorta
42
Which vein is the renal vein of the transplanted kidney connected to?
* **External iliac vein**
43
What is not recommended in patients with a kidney transplant (6)?
* No **live vaccines**
* No **alcohol**
* No **recreational drugs**
* No **NSAIDs** / Herbal medicines
* No **smoking**
* **Dietary restrictions:**
* No seville oranges or tacrolimus
* No raw eggs, raw meat, undercooked fish or unpasteurised cheese
44
What calculation is used, to estimate GFR in patients?
* **Modification of Diet in Renal Disease (MDRD)**
* **CKD Epidemiology Collaboration (CKD-EPI)**
45
Which GFR-CKD classification is recommended by NICE and why?
* NICE guidelines to use **CKD-EPI** (At high GFR, it is more accurate)
46
What GFR parameter defines CKD?
* GFR **\< 60** mL / minute / 1.73m2
47
What factors affect creatinine within patients with renal failure (4)?
* Muscle mass
* Age
* Race
* Sex
48
Why is urea a poor indicator of GFR?
* Confounded by:
* **Diet**
* **Catabolic state**
* **GI bleeding** (bacterial breakdown of blood in gut)
* **Drugs**
* **Liver function**
49
What is the most appropriate radionucleotide studies in patients with renal failure?
EDTA
