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Phase 1b - Urology & Renal Medicine > Chronic Kidney Disease & Renal Failure > Flashcards

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
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2
Q

What endocrine functions are performed by the kidneys (2)?

A
  • Erythropoietin synthesis
  • 1-alpha hydroxylase (Vitamin D)
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3
Q

What are the excretory functions of the kidneys (4)?

A
  • Nitrogenous waste
  • Middle sized molecules
  • Hormones, peptides
  • Salt and Water
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4
Q

What are the functions of the kidney regarding glucose metabolism (2)?

A
  • Gluconeogenesis
  • Insulin clearance
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5
Q

What is Chronic Kidney Disease (CKD)?

A
  • CKD is defined as abnormalities of kidney structure or function, present for >3 months
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6
Q

What are the clinical signs of CKD (3)?

A
  • Albuminuria / proteinuria
  • Haematuria
  • Electrolyte abnormalities detected by imaging
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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
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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
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9
Q

What can acidosis cause (2)?

A
  • Anorexia
  • Muscle catabolism
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10
Q

Why does hyperkalaemia occur in kidney failure?

A
  • Reduced potassium excretion
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11
Q

What are the symptoms of hyperkalaemia (3)?

A
  • Cardiac arrhythmias
  • Neural muscular activity
  • Vomiting
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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
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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
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14
Q

How does insulin dextrose treat hyperkalaemia?

A
  • Insulin induces a potassium drive (short-term solution)
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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
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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
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17
Q

What are the standard cardiovascular risk (3)?

A
  • Hypertension
  • Diabetes
  • Lipid abnormalities
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18
Q

What are the symptoms associated with kidney failure and reduced secretion of sodium chloride (3)?

A
  • Hypertension
  • Oedema
  • Pulmonary Oedema
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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
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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
Q

Why is there parathyroid hyperplasia associated with kidney dysfunction?

A
  • 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
Q

Which veins should be used when taking blood or IV lines for patients with renal failure?

A
  • Dorsal venous structures
27
Q

Where should taking blood be avoided in patients with renal failure?

A
  • Avoid taking blood or inserting IV lines into the veins of the antecubital fossa or cephalic vein at wrist level
28
Q

What is a fistula in terms of CKD?

A
  • A fistula is created by connecting an artery directly to the vein – vein swells for ease of access
29
Q

Why should transfusions be avoided in patients with renal failure?

A
  • Transfusions will sensitise anaemia (haemolytic anaemia, as foreign antigens are detected, and antibodies are formed) → Autoimmune mediated rejection of transplanted kidney
30
Q

What is the long term management for CKD (4)?

A
  • Erythropoietin injections to correct anaemia
  • Diuretics to correct salt-water overload
  • Phosphate binders
  • 1-25 Vitamin D supplements
31
Q

What home therapy is available for CKD?

A
  • 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
Q

What is haemodialysis?

A
  • 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
Q

How long does haemodialysis last typically during the week?

A
  • 3-4.5 hours treatment 3 times per week
    • Allows 4 treatment free days per week
34
Q

Which type of haemolysis is concerned with dietary constraints?

A
  • Haemodialysis - strictly dietary constraints and salt / water intake restrictions
35
Q

What is peritoneal dialysis?

A
  • 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
Q

Which type of dialysis is performed at home?

A
  • Pertioneal dialysis
37
Q

What is the access advantage with peritoneal dialysis (2)?

A
  • 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
Q

What type of infection risk is associated with peritoneal dialysis (2)?

A
  • Chance of infection due to catheter
  • Peritonitis
39
Q

What are the main factors to consider when doing a live kidney donor transplant (8)?

A
  • Family history of kidney disease
  • Age
  • Two healthy kidneys
  • Financial stability
  • Mental health history
  • Future pregnancy
  • Kidney match
  • Comorbidities
40
Q

How is a kidney match made (3)?

A
  • Blood type compatibility
  • HLA typing
  • Serum cross match
41
Q

During kidney transplantation, the renal artery of the transplanted kidney is connected to which artery?

A
  • External iliac artery of the recipient rather than the abdominal aorta
42
Q

Which vein is the renal vein of the transplanted kidney connected to?

A
  • External iliac vein
43
Q

What is not recommended in patients with a kidney transplant (6)?

A
  • 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
Q

What calculation is used, to estimate GFR in patients?

A
  • Modification of Diet in Renal Disease (MDRD)
  • CKD Epidemiology Collaboration (CKD-EPI)
45
Q

Which GFR-CKD classification is recommended by NICE and why?

A
  • NICE guidelines to use CKD-EPI (At high GFR, it is more accurate)
46
Q

What GFR parameter defines CKD?

A
  • GFR < 60 mL / minute / 1.73m2
47
Q

What factors affect creatinine within patients with renal failure (4)?

A
  • Muscle mass
  • Age
  • Race
  • Sex
48
Q

Why is urea a poor indicator of GFR?

A
  • Confounded by:
    • Diet
    • Catabolic state
    • GI bleeding (bacterial breakdown of blood in gut)
    • Drugs
    • Liver function
49
Q

What is the most appropriate radionucleotide studies in patients with renal failure?

A

EDTA

Phase 1b - Urology & Renal Medicine (11 decks)

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