Chronic kidney injury Pt 1 Flashcards
CKD definition
progressive loss of renal function over time
what is CKD clinically based on
GFR and creatinine
diagnosis of CKD requires
decline in kidney function over 3 months and
evidence of kidney damage or GFR <60
End stage kidney disease=
when kidney function is insufficient to maintain life without RRT
main causes of CKD (5)
- diabetes
- hypertension
- PKD
- GN
- recurrent UTIs
signs/symptoms of CKD
hypertension azotaemia hyperkalaemia metabolic acidosis anaemia hypocalcaemia
what type of anaemia in CKD
normochromic normocytic due to lack of EPO
metabolic acidosis causes
SOB
hypocalcemia due to
vitamin D deficiency
stage G1 =
> 90
stage 2=
60-89
stage 3a
45-59
stage 3b
30-44
stage 4
15-29
stage 5
<15
management of CKD stage 1/2 without uremia
ACEi or ARB
statin
diuretics
Calcium channel blocker
name 2 non-dihydropyridine calcium channel blockers
Diltiazem
Verapamil
danger of ACEi and spironolactone
hyperkalaemia
additions for management of stage 3/4
- Ezetimibe
- additional antihypertensives- thiazides, spironolactone, beta blockers
- EPO stimulating agent
- iron supplements
- calcitriol
- oral bicarbonate
calcitrol=
active 1,25 vitamin D therapy
treatment of stage 5 ESRD
dialysis or kidney transplant
when is oral bicarbonate indicated
when bicarbonate levels lower than 15mmol/L
Azotaemia in CKD due to
impaired function of the kidney urea is not effectively filtered and removed
3 consequences of raised urea
pruitus
encephalopathy
N&V
only way to treat uremia
dialysis
why anaemia in CKD
lack of EPO
treatment of anaemia in CKD
IV EPO stimulating agent
Bp target for people with CKD
<130/80
why oedema in CKD
due to proteinuria and blood hypoalbuminemia decreasing blood osmolarity
treatment of oedema
IV furosemide
what can high doses of IV furosemide cause
ototoxicity
why hyperlipidemia in CKD
bi-product of synthesis of albumin is low-density lipoprotein
treatment of hyperlipidemia =
statins with or without ezetimibe
bone metabolism in the kidney
hydroxylation of inactive 25(OH) vit D to active 1,25(OH)2 vit D
in CKD what happens to bone metabolism
Vit D deficiency means less absorption of calcium from gut therefore increased PTH stimulating osteoclast to release calcium from bone
whats it called when kidney function is effected by an obstruction in urinary flow
obstructive nephropathy
hydronephrosis=
dilation of the renal pelvis
common causes of obstructive uropathy (4)
- renal calculi
- BPH
- prostate cancer
- bladder tumours
what is often related to unilateral obstrutive uropathy
renal calculi
what is often related to obstructive nephropathy
BPH
pathophysiology of obstructive nephropathy
back-flow of urine causes increased pressure and a hydronephrosis resulting in reduced renal blood flow, decreased GFR, ischaemia and increased RAAS
end result of obstructive nephropathy in the kidney
atrophy and apoptosis of renal tubules, interstitial tissue fibrosis via macrophage infiltration
high pressure within the tubules in obstructive nephropathy causes
reabsorption of Na, water and urea
lab results of obstructive nephropathy
hypernatremia
low urinary Na
high BUN: cr ratio
high urine osmolarity
risk factors for obstructive uropathy (7)
BPH constipation medications urolithiasis parkinson's MS malignancy- prostatic, bladder, cervical and colon
physical side effects of haemodialysis (5)
- fatigue
- insomnia
- bone and joint pain
- loss of libido
- dry mouth and anxiety
physical complications of peritoneal dialysis (6)
- peritonitis
- abdominal pain
- weight gain
- fever and rigors
- N&V
- increased risk of umbilical hernia
why is delirium seen in dialysis patients
electrolyte imbalances
average waiting list for kidney transplant
> 3 years
2 types of dialysis
haemodialysis
peritoneal
more efficient dialysis=
haemodialysis
times /week of haemodialysis
3 days
times/ week of peritoneal dialysis
everyday
what are antibodies
glycoproteins part of the immunoglobulin superfamily
what is the antigen-binding fragment (Fab) composed of
one constant and one paratope variable domain
what determines the Fab region
idiotype
what is a paratope
the variable antigen-binding site on the Fab domain
what is the fragment crystallisable region (Fc domain)
the constant tail region of the antibody
what does the Fc domain interact with
immune effect cells to coordinate the appropriate response to antigen
what determines the heavy domain
isotype
what does the isotype/ Fc domain determine
the function of an antibody
what antibodies do Naive B cells express
IgM and IgD
how are other antibodies formed
by class switching after antigen exposure in the germinal centre of the lymph nodes
first antibody expressed during B cell development=
IgM
structure of IgM and function
- pentameric connected by central J chain
- major antibody in primary immune response -complement cascade as well
most abundant immunoglobulin in serum =
IgG
what does IgG do
helps bacterial immobilisation and neutralise toxin and viruses
only antibody that can cross the placenta=
IgG
IgA is secreted in the
respiratory and intestinal tract- mucosal immunity
shape of IgA
2 monomeric proteins connected by J chain
antibody present in the lowest concentration in the blood plasma=
IgE
main antibody for allergic reactions=
IgE -induce mast cells, eosinophils and langerhan cells
main categories of antibody action=
neutralisation
agglutination
precipitation
complement activation
aggulatination=
many antibodies bind to foreign cells forming aggregating clumps inducing phagocytosis by macrophages
precipitation=
many antibodies bind to serum-soluble antigens forming a precipitant which recruits macrophages and phagocytosis
what can an activated B cell differentiate into (2)
plasma cell
memory cell
