Chronic Renal Failure Flashcards
What are the common symptoms of patients suffering from chronic kidney failure?
Often asymptomatic until late stage renal disease
Oedema Polyuria Lethargy Pruritis Anorexia N&V HTN Insomnia
What are some complications of chronic renal failure?
Blood:
- Anaemia (reduced renal erythropoietin synthesis)
- Coagulopathy
Bone disease:
- osteoporosis
- osteomalacia
- osteosclerosis
Fluid:
- Pulmonary oedema
- Hypertension
Cardiac:
-Left ventricular hypertrophy
Heart failure
Neurological:
-Uraemic encepalopathy
Endocrine:
- Glucose intolerance due to peripheral insulin resistance
- electrolyte disturbances
What is autosomal dominant polycystic kidney disease?
Autosomal dominant condition
Leads to presence of cysts on the kidneys impairing their function
Describe the pathophysiology of diabetic nephropathy?
Poor glycaemic control leading to basement membrane thickening and increased capillary permeability
Leads to increased albumin secretion in the urine
What are the initial investigations you would do for a patient with CKD?
Observations- including BP and urine dip
Bloods -FBC (anaemia) -CRP -U&Es ( 2 tests 3 months apart to confirm) -LFTs -Ca -PTH -Vit D -Phosphate -Glucose
CXR- pulmonary oedema
Renal USS for obstruction
Describe the different classifications of CKD based on eGFR?
1- >90 and signs of kidney damage on other tests
2- 60-89 and signs of kidney damage on other tests
3A- 45-59 and moderate kidney damage
3B- 30-44 and moderate kidney damage
4- 15-29 and severe renal impairment
5- <15, dialysis or transplant required
What are some of the signs you may find on examination?
Pallor Yellowness Excoriations HTN Oedema Pericardial rub= rare
What is the effect of CKD on the blood?
Leads to impaired EPO production which causes a drop in RBC and leads to anaemia
Must measure Fe levels and correct Fe levels first
Tx with erythropoietin supplementation
Those on haemodialysis often require IV iron
What is the effect of CKD on the bone
CKD leads to secondary hyperparathyroidism which leads to increased osteoclastic activity
Tx with Vit D replacement and decrease dietary phosphate
If osteoporosis then bisphosphonates
What are the indications for dialysis?
Uraemia:
Pericarditis
Encephalopathy
Pulmonoary oedema
Refractive hyperkalaemia (greater than 6.5mmol)
Overdose of salicyalates or ethylene glycol
What are the different types of dialysis?
Haemodialysis
Hemofiltration
Peritoneal dialysis
What are the causes of CKD?
Diabetic nephropathy Chronic glomerulonephritis Chronic pyelonephritis HTN Polycystic kidney disease
What is the management of CKD?
Slow progression of disease
- optimise glycaemic control in diabetes
- BP monitoring
- ACEi first line for HTN and proteinuria (>70mmol or >30 and haematuria)
Reduce CVD risk
-statin and low dose aspirin
Reduce risk of complications
- lose weight
- stop smoking
- exercise
- dietary advice
Treat complications
- tx anaemia
- bisphosphanates for osteoporosis
- Vit D for renal bone disease
Ultimately renal transplant required
When should referral to secondary care be made?
eGFR <30 ACR>70 Accelerated progression -eGFR 15ml/min in 1 yr -Uncontrolled HTN despite 4 anti hypertensives
What is haemodialysis?
Most common form
Regular filtration a few times a week
AV fistula must be formed 8wks prior
-often in lower arm
Can have haemodynamic instability during dialysis
