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BRS Year 2 > CKD and Renal Failure > Flashcards

CKD and Renal Failure Flashcards

1
Q

What are the 4 main functions of the kidney?

A

Homeostasis
Endocrine
Excretory
Glucose metabolism

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2
Q

What are the endocrine functions of the kidney?

A

Erythropoietin synthesis

Have 1 alpha hydroxylase for the synthesis of vitamin D

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3
Q

What are the homeostatic functions of the kidney?

A

Electrolyte balance
Acid-base balance
Volume homeostasis

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4
Q

What are the excretory functions of the kidney?

A 
Nitrogenous waste
Hormones
Peptides
Middle sized molecules 
Salt
Water
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5
Q

What are the functions of the kidney in relation to glucose metabolism?

A

Carry out some gluconeogenesis

Insulin clearance

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6
Q

What does loss of kidney homeostatic function lead to in terms of potassium, bicarbonate, pH, phosphate, salt and water?

A 
High potassium
Low bicarbonate
Low pH (patients become acidotic when H+ cannot be removed)
High phosphate
Salt and water imbalance
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7
Q

What does loss of kidney endocrine function lead to?

A

Low calcium
Anaemia
High PTH

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8
Q

What does loss of kidney excretory function lead to?

A

High urea
High creatinine
Low insulin requirement

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9
Q

Why is insulin requirement low in those with kidney failure?

A

Kidneys get rid of insulin normally. In kidney failure clearance is decreased so less requirement

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10
Q

What is the main systemic risk that increases in kidney failure?

A

Cardiovascular risk

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11
Q

When assessing a patient with kidney failure what question is it really important to adress?

A

What their fluid status is- are they hypovolemic, hypervolemic or euvolemic? hypovolemic = low fluid volume

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12
Q

In hypovolemic kidney failure what will happen to levels of urea, creatinine, potassium, sodium, haemoglobin?

A 
High urea
High creatinine
High potassium
Sodium levels vary (depending on hydration)
Low haemoglobin
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13
Q

What is important to remember in hyponatremia?

A

Hyponatraemia does not mean there is low total sodium in the body, it may just mean there is extra fluid
This is why assessing volume status is so important

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14
Q

Why might kidney failure patients not have anemia?

A

If they present early on eg due to toxin from food causing kidney failure then there may not be effects in the bone marrow

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15
Q

Why might patients with kidney failure not have high potassium levels?

A

If they have diarrhoea or are vomiting they may be getting rid of the excess potassium

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16
Q

In kidney failure what happens to secretion of salt and water? What are the effects of this?

A

It falls, this causes hypertension, oedema, pulmonary oedema

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17
Q

What imbalance does acidosis contribute to?

A

Hyperkalaemia

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18
Q

Why is bicarbonate given to patients with kidney failure?

A

Mainly to treat hyperkalemia, but also to resolve the acidosis

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19
Q

What is the main issue with having a hyperkalemia?

A

It leads to cardiac arrhythmia which can eventually be deadly

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20
Q

What is seen on the ECG of someone with chronic kidney disease when they have arrhythmia?

A 
First sign is peaking of T waves
P waves:
- broaden
- reduced amplitude
-disappears
QRS complex widens
Heart block, asystole, VT/VF may occur
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21
Q

Aside from arrhythmia what effects does hyperkalemia have?

A

Neural and muscular activity is disrupted

Vomiting

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22
Q

Why does anaemia arise in kidney failure?

A

Reduced erythropoietin

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23
Q

What are CKD patients most likely to die of?

A

Cardiovascular disease, not end stage renal failure

24
Q

What does reduced vitamin D cause in patients with kidney disease?

A

Reduced calcium absorption
Hypocalcaemia
Hyperparathyroidism

25
Q

How is fluid balance treated in kidney failure?

A

Hypovolemic give fluids

Hypervolemic- trail of diuretics/dialysis (dialysis if they aren’t peeing)

26
Q

When deciding how to treat fluid balance in kidney failure what 2 questions do we need to address?

A

What is their volume status

Are they peeing?

27
Q

What are the 3 ways to treat hyperkalemia?

A

Drive into cells via sodium bicarbonate or insulin dextrose (with caution due to risk of hypoglycaemia!! Only done if K+ is >6.6mmol/L)
Drive out of body via diuretics and dialysis
Gut absorption via potassium binders

28
Q

What is the main method of long term management of CKD?

A

Transplant if the patient is healthy

29
Q

What does conservative management for CKD involve?

A

Erythropoietin injections to correct anemia
Diuretics to correct salt water overload
Phosphate binders (to prevent itching- bind phosphate in stomach so you can excrete it)
1.25 vit d supplements
Symptom management eg anti-nausea

30
Q

When is conservative management used in CKD?

A

In old patients, dialysis is an unpleasant process and often conservative treatment will help their symptoms in a much easier way

31
Q

What are the 2 ways dialysis can be offered?

A

Home therapy or centre therapy

32
Q

Why is it important to save veins of CKD patients and how do doctors do this?

A

They need their veins for dialysis and a fistula to do so (blood from art. to vein to increase size of vein)
To help don’t take blood from their cubital fossa (long term catheter can scar and stenose vein) take it from the back of their hand and don’t insert IV there

33
Q

Why should you avoid transfusion in CKD patients?

A

If they are transplantable, transfusion can sensitise them and reduce success of future transplant

34
Q

How is anaemia ideally treated in CKD patients?

A

IV iron or erythropoietin

35
Q

What method is commonly used to asses GFR? Why is ti good

A

eGFR (estimate of GFR)

Good as it takes into account age and sex but you have to account for ethnicity afterwards

36
Q

On what basis are CKD patients classified?

A

GFR

Albumin: creatinine

37
Q

Why does tachypnea with normal oxygen sats and clear lungs occur?

A

Respiratory compensation for metabolic acidosis

Trying to get rid off CO2 to increase pH

38
Q

What equation represents changes in pH?

A

CO2 + H20 >/< H2CO3 >/< HCO3- + H+

Inc. RR (kasmuraal respiration) = dec. CO2

39
Q

What are 2 big indicators of renal failure?

A

High Urea

High creatinine

40
Q

What is a clinical symptom of hyperphosphatemia?

A

Itching

41
Q

What might you see on an ultrasound for renal failure?

A

Shrunken kidneys

42
Q

What are complications of renal failure?

A

Hyperkalaemia
Hyponatraemia
Metabolic acidosis
Anaemia

43
Q

What are indicators of hypovolaemia?

A

Low blood pressure

Slow capillary refill time

44
Q

What might we see in normovolaemic kidney failure?

A

Inc. urea
Inc. creatinine
Normal K/Na/Hb

45
Q

What would we see on an ultrasound for acute renal failure?

A

Normal sized kidneys with no obstruction

46
Q

What else may be the cause of salt and water loss?

A

Tubulointerstitial disorders- damage to conc. mechanisms

AKI: leads to hypovolemia

47
Q

What causes metabolic acidosis?

What can this lead to?

A

Reduced excretion of H+ ions

Can lead to anorexia and muscle catabolism

48
Q

What are causes of hyperkalemia?

A

Dec. distal tubule potassium secretion

Acidosis

49
Q

What can kidney failure reduce the metabolism off?

A

Erythropoietin

1-25 vit D levels

50
Q

What factors contribute to hyperparathyroidism?

A

Chronic renal failure -> phosphate retention + low 1-25 vit D
-> hypocalcaemia
all lead to: hyperparathyroidism

51
Q

What are standard cardiovascular risks?

A

Hypertension
Diabetes
Lipid abnormalities

52
Q

What are additional cardiovascular risks?

A

Inflammation
Oxidative stress
Mineral/bone metabolism

53
Q

What does home therapy for CKD include?

A

Haemodialysis

Peritoneal dialysis/ assisted programmes

54
Q

What does in centre therapy for CKD include?

A

Haemodialysis, 4hrs, 3 times a week

55
Q

What are methods of assessing GFR? How effective are they?

A

Urea: poor indicator- confounded by diet, catabolic state, GI bleeding etc.
Creatinine: affected by muscle mass, age, sex etc. Need to look at patient and trent
Radionuclide studies: cr- EDTA clearance, reliable but expensive
Creatinine clearance: Difficult to patients to collect accurate sample. Overestimates GFR at low GFR (small amount of creatine secreted)
Insulin clearance: labrous- used for research only

56
Q

What are 2 methods used to estimate GFR?

A

Modification of diet in renal disease (MDRD)

CKD epidemiology collaboration (CKD- EPI) - NICE guidance to use this

BRS Year 2 (110 decks)

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