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
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