CKD And Renal Failure Flashcards
What are the roles of kidneys?
Balance electrolytes and acid-base
Volume homeostasis
Activate Vit D
Gluconeogenesis
Insulin clearance
Excrete waste, salt, water, hormones, proteins
Erythropoiesis
What lab findings would you see in someone that has kidney failure?
Hyperkalaemia
Hyponatraemia
Metabolic Acidosis (low carbonate)
Decrease Ph
Hyperphosphatase
Increased urea
Increased creatinine
Hypocalcaemic
Increased PTH
Anaemia
Decreased GFR
Why are some patients with kidney failure hypervolaemic vs hypovolaemic
What 3 things will a hypervolaemic kidney failure present with
Normally its hypervolaemic (high bp)- normally it reduces secretion of salt and water = oedema and pulmonary oedema
But if it’s affecting the kidney tubules- site of excretion it will cause hypovolaemic
Why does KF cause hyperkalaemia?
How does hyperkalaemia present on examination and on ECG?
Decreased tube secretion of H+ ions, H+ and K+ ions are swapped with an antiporter, so more K+ is retained and sent to the blood
Muscle spasms
Vomiting
Cardiac arrhythmias- broad p wave- can even disappear and wide QRS complex, asystole,
Peaked T waves
Is a patient with CKD more likely to die of renal failure or CVD?
CVD
How do you manage kidney failure in the following:
Hypervolaemia
Hypovolaemia
Hyperkalaemia (2)
Long term management
Should you give a transplant patient blood transfusion?
Hypervolaemic- give diuretics - to try to make them pee
Hypovolaemic- give fluids
Hyperkalaemia- sodium bicarbonate to drive K+ into cells or to drive potassium out of BODY use diuretics
Long term management: erythropoietin for anaemia
Diuretics for salt water imbalance
1-25 vit D supplements
Haemodialysis
Peritoneal dialysis
Transplants- NO BLOOD TRANFUSION AS THEY SENSITISE PATIENT TO FOREIGN ANTIGENS = TRANSPLANT FAILURE
How do you assess GFR?
What method is a poor indicator?
Can track the trend of creatinine
Radionuclide studies good but expensive
Creatinine clearance can be checked but not good for elderly patients and overestimates GFR
Insulin clearance but only for research
UREA IS A POOR INDICATOR
What does a reduced amount of erythropoiesis and reduced 1-25 Vit D levels cause in KF?
What risk can these two factors increase?
Anaemia
Reduced calcium absorption = hypocalcaemia
Hyperparathyroidism = increased PTH
Increased cardiovascular risk
Why is there tachypnoea in CKD?
What is this process called?
The increased retention of H+ ions causes an increase in CO2
This causes respiratory rate increase- respiratory compensation
Kaussmal Respiration
How would an ABG of someone with AKI compare to someone with CKD?
AKI would show milder metabolic acidosis with still resp compensation but less extreme
How does AKI present vs CKD?
Comment on their US findings and volaemic state
AKI: recent nausea, reduced urinary output, metabolic acidosis, normovolaemia, normal sized kidneys
CKD: pale, cold hands, decreased capillary refill, high BP, tachpnoea, shrunken kidneys
