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Health.1 > CKD > Flashcards

CKD Flashcards

1
Q

consequence of impaired kidney func
concept of CKD
what does CKD mean for patient?

A
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2
Q

renal function: 3 functions of the kidneys

A
  • Homeostasis; regulates and maintains.
  • > elimination of waste
  • > water homeostasis
  • > acid base homeostasis; need to pass enough H+ ions to prevent acidosis
  • > electrolyte homeostasis
  • > BP control
  • Excretion of drugs and drug metabolites
  • Metabolic/ Endocrine -> synthesis of hormones
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3
Q

what 3 hormones synthesised in kidney?

A

Vitamin D, Erythipoietin, Renin

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4
Q

what electrolytes does kidney control (homeostasis)?

A

K, Phosphate, Ca

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5
Q

How would you measure kidney function?

- what influences this?

A 
serum creatinine (traditional measure)
- influenced by gender, ethnicity, age, body mass, diet, excercise
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6
Q

relationship on graph between plasma conc and GFR?

A
  • as kidney function declines, the creatinine levels increase (GFR increases)
  • not sensitive to small changes
  • non-linear relationship to kidney function
  • doesn’t take long-term changes into account
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7
Q

How would you estimate the GFR?

A
  • calculate from creatinine, age, gender, ethnicity
  • better reflection of kidney function
  • best measure for use in stable renal function
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8
Q

Is CKD irreversible or reversible?

A

irreversible and tends to progress

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9
Q

Stages of CKD?

A

CKD 1-5

CKD 5- worst, shows kidney failure of levels of 0-15 eGFR

CKD 4- Severe decrease in GFR ; 15-29; feeling tired and insulin doses and drug tablets

CKD 3- moderate CKD; 30-59

CKD2- kidney damage but mild; 60-89

CKD 1- kidney damage but normal GFR; >90

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10
Q

What occurs with CKD 5?

A
  • end stage renal failure
  • insufficient renal function to sustain life/health
  • death
  • there are renal replacement therapies are essential to prevent progression of kidney failure
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11
Q

3 possible treatments for CKD5?

A

end stage renal failure

  • > haemodialysis
  • > peritoneal dialysis
  • > kidney transplantation
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12
Q

Who has CKD?

A
  • common
  • most of it unrecognised
  • diabetes and renovascular disease lead to CKD and most common
  • more common with older age
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13
Q

What are the risk factors for CKD?

A
  • increased age
  • hypertension (highest risk)
  • diabetes
  • smoking
  • poor education
  • drugs (NSAIDs)
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14
Q

6 possible Causes of CKD

A
  • systemic diseases; diabetes, hypertension, atherosclerotic disease !!!
  • immune mediated diseases; IPA nephropathy
  • infectious diseases; HIV, HBV, HCV, TB
  • genetic diseases; polycystic kidneys
  • arterial disease; atherosclerosis
  • obstruction; tumours, stones, fibrosis
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15
Q

With chronic glomerulonephritis, what happens to the glomeruli and tubules?

A

sclerosed glomeruli and atrophied tubules

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16
Q

What is the pathology of CKD? 3 steps

A
  • thickening of BM; cap walls become weak, bleed and leak protein; slow blood flow
  • mesangial expansion
  • > hyperglycaemia stimulates increased matrix production by mesengial cells
  • > stimulation of TGF-beta release
  • glomerulosclerosis
  • > due to intraglomerular hypertension or ischaemic damage
  • high levels of sugarcane also make vessels to become narrow and clogged
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17
Q

Explain the vascular disease- renal artery stenosis

A
  • low blood flow
  • consequence of poor diet and diabetes
  • both or one of the arteries leading to the kidneys becomes narrowed
  • cant use an ACE inhibitor
  • we want to constrict the afferent arterial to maintain BP and glomerular pressure
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18
Q

List the complications of CKD

A
  • anaemia
  • hypertension
  • disturbed calcium
  • CVD
  • Bone disease
  • immune suppression
  • bleeding tendency
  • treatment complications
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19
Q

4 types of obstructions that may occur?

A

stones
benign prostate
tumours: intrinsic/ extrinsic
fibrosis: narrow blood vessels

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20
Q

obstructio may cause hydronephrosis, what is it?

A

enlargement + swelling of kidney as build up of urine

21
Q

why is anaemia a complication of CKD

A

lack of erythrop. production, loss of Fe absorption -> Fe deficiency

22
Q

hyeprtension in CKD caused by result of?

A

RAAS system inactivation problem-

if not able to pass fluids properly -> urine poorly func kidneys = inc BP

23
Q

What does the failure of fluid homeostasis lead to? (2)

A

inability to concentrate urine

  • > loss of diurnal rhythm of urine excretion
  • > limited rate of water excretion
  • osmotic diuresis of surviving glomeruli

inability to excrete water load

  • > dilutational hyponatraemia
  • > oedema
  • > hypertension
24
Q

What is the treatment for fluid overload?

A
  1. diuretics (remove as much urine as possible, using working parts of kidney)
  2. salt restriction
  3. fluid restriction

if doesnt work then dialysis and transplant

25
Q

What do electrolytes such as sodium do and cause?

A
  • loss of nephrons reduces ability to excrete salt and water
  • major cause of hypertension and fluid overload; damage to vessels and blood flow- heart struggles to pump blood around, enlarged
  • sodium must be within normal range
  • high or low sodium leads to confusion, fits, coma
26
Q

What do electrolytes such as potassium do and cause?

A
  • enormous functional reserve to excrete potassium
  • severe hyperkalaemia when GFR <10ml/min
  • due to:
  • > excessive load
  • > interference with potassium excretion; acidosis with volume contraction and diabetic nephropathy
27
Q

What ECG changes are seen with hyperkalaemia?

A
  • tall T waves
  • long QRS interval
  • long PR interval
  • cardiac arrest

-> alterations in membrane excitability

28
Q

what is the treatment to prevent hyperkalaemia and hypernatraemia?

A
  • salt restriction
  • K+restriction
  • dialysis and transplants if all else fails; drugs that act as K+ binders (less effective than insulin dextrose) - bring K+ back into cells. dont fix but help manage hyperkal, risk of arrhythmias
29
Q

whats meds should be stopped when trying to prevent hyperkalaemia and hypernatraemia?

A

ACEi and ARBS: increase K+.
dont remove K+ well: aldosterone antagonists.
K sparing diuretics: spironolactone

30
Q

State the equation for the carbonic acid buffer system and how this system works

A

CO2 + H20 - H2CO3 - H+ + HCO3-

  • increasing H+ due to failure to excrete acid leads to increase in HCO3- and so increase in CO2 and H20
    the CO2 is removed by lungs to maintain pH
    there is an accumulation of H+ acid
31
Q

What are the effects of acidosis?

A
  • increased respiratory drive; breathless
  • chest pain
  • confusion
  • bone pain
  • demineralisation of bone
32
Q

What is the treatment for metabolic acidosis?

A
  • sodium bicarbonate
    IV/ caps/ tabs

OR… dialysis/transplant if fails

33
Q

What do Vitamin D, renin and erythropoietin control?

A

Vitamin D- Ca metabolism

Erythropoietin- Hb production

Renin- control of blood production

34
Q

what is hypertension? and what mechanisms occur?

A
  • high BP
  • accelerates decline of kidney function
  • contributes to CV risk

mechanisms:

  • sodium retention
  • volume expansion
  • RAS activation
  • sympathetic nervous system activity
  • endothelial dysfunction
35
Q

What is the treatment for hypertension?

A
  • salt restriction
  • diuretics
  • RAS blockade
  • other antihypertensive med
36
Q

What happens when excretory function reaches failure?

A

accumulation of toxic waste products

  • > creatinine rises only after significant renal damage
  • > nitrogenous waste retention occurs
  • > urate retention then occurs
  • > phosphate retention then will occur -> skin itching
37
Q

what is the treatment for uraemia?

A

dialysis or transplantation

38
Q

why is protein restriction not used as treatment for uraemia?

A

due to it causing malnutrition which weakens the individual further

39
Q

what happens when drugs fail to be excreted?

A
  • many drugs are usually excreted by the kidney but the metabolism of these drugs will be impaired by renal failure
  • toxicity due to accumulation of the drug will lead to:
insulin-> hypoglycaemia
opiates-> narcosis
anitbiotics-> encephalopathy
sedatives-> respiratory arrest
digoxin-> cardiac arrythmias
40
Q

treatment to prevent drug toxicity?

A

modify presc according to renal function

  • adjust the dose when needed
  • adjust the frequency when and if needed

Genatmicin etc. dec doses to prevent toxicity

41
Q

explain the purpose of dialysis?

A

dialysis removes the waste products and excess body fluids from the individual when the kidneys are failing to excrete these substances

42
Q

explain what is narcosis

A

it is when a patient is in a state of unconsciousness or arrested activity due to narcotics or chemicals in the body

43
Q

What three diseases show the greatest risk of harm when a patient has all of them?

A

CKD, CVD, diabetes

44
Q

Why does CKD progress?

A

major modifiable risk factors

  • > uncontrolled underlying disease
  • > hypertension
  • > proteinuria
  • > smoking
45
Q

What is the treatment for the CKD?

A
  • control underlying diseases
  • treat hypertension
  • ACEi/ARB
  • stop smoking
46
Q

4 main things that may cause harm in CKD patients?

A

K+ !!!! ALWAYS CHECK
acid
fluid
confusion/urea

47
Q

CKD is the progressive loss of?

A

excretory renal function

  • water
  • electrolytes
  • acid
  • metabolites
  • drugs

secretory renal function

  • EPO
  • Vit D
48
Q

treatment of CKD (5)?

A
  • if possible treat underling cause
  • healthy lifestyle
  • stop smoking
  • good BP control
  • reduce protein excretion

Health.1 (12 decks)

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