CKD and Renal Failure

Question 1

What are the 4 main functions of the kidney?

Answer 1

Homeostasis
Endocrine
Excretory
Glucose metabolism

Question 2

What are the endocrine functions of the kidney?

Answer 2

Erythropoietin synthesis

Have 1 alpha hydroxylase for the synthesis of vitamin D

Question 3

What are the homeostatic functions of the kidney?

Answer 3

Electrolyte balance
Acid-base balance
Volume homeostasis

Question 4

What are the excretory functions of the kidney?

Answer 4

Nitrogenous waste
Hormones
Peptides
Middle sized molecules 
Salt
Water

Question 5

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

Answer 5

Carry out some gluconeogenesis

Insulin clearance

Question 6

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

Answer 6

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

Question 7

What does loss of kidney endocrine function lead to?

Answer 7

Low calcium
Anaemia
High PTH

Question 8

What does loss of kidney excretory function lead to?

Answer 8

High urea
High creatinine
Low insulin requirement

Question 9

Why is insulin requirement low in those with kidney failure?

Answer 9

Kidneys get rid of insulin

Question 10

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

Answer 10

Cardiovascular risk

Question 11

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

Answer 11

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

Question 12

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

Answer 12

High urea
High creatinine
High potassium
Sodium levels vary
Low haemoglobin

Question 13

What is important to remember in hyponatremia?

Answer 13

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

Question 14

Why might kidney failure patients not have anemia?

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

It falls, tis causes hypertension, oedema, pulmonary oedema

Question 17

What imbalance does acidosis contribute to?

Answer 17

Hyperkalaemia

Question 18

Why is bicarbonate given to patients with kidney failure?

Answer 18

Mainly to treat hyperkalemia, but also to resolve the acidosis

Question 19

What is the main issue with having a hyperkalemia?

Answer 19

It leads to cardiac arrhythmia which can eventually be deadly

Question 20

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

Answer 20

First sign is peaking of T waves
P waves then disappear
QRS complex widens
Heart block, asystole, VT/VF may occur

Question 21

Aside from arrhythmia what effects does hyperkalemia have?

Answer 21

Neural and muscular activity is disrupted

Vomiting

Question 22

Why does anaemia arise in kidney failure?

Answer 22

Reduced erythropoietin

Question 23

What are CKD patients most likely to die of?

Answer 23

Cardiovascular disease, not end stage renal failure

Question 24

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

Answer 24

Reduced calcium absorption
Hypocalcaemia
Hyperparathyroidism

Question 25

How is fluid balance treated in kidney failure?

Answer 25

Hypovolemic give fluids

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

Question 26

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

Answer 26

What is their volume status

Are they peeing?

Question 27

What are the 3 ways to treat hyperkalemia?

Answer 27

Drive into cells via sodium bicarbonate or insulin dextrose (with caution due to risk of hypoglycaemia!!)
Drive out of body via diuretics and dialysis
Gut absorption via potassium binders

Question 28

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

Answer 28

Transplant if the patient is healthy

Question 29

What does conservative management for CKD involve?

Answer 29

Erythropoietin injections to correct anemia
Diuretics to correct salt water overload
Phosphate binders (to prevent itching)
1.25 vit d supplements
Symptom management eg anti-nausea

Question 30

When is conservative management used in CKD?

Answer 30

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

Question 31

What are the 2 ways dialysis can be offered?

Answer 31

Home therapy or centre therapy

Question 32

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

Answer 32

They need their veins for dialysis, to help don’t take blood from their cubital fossa take it from the back of their hand and dont insert IV there

Question 33

Why should you avoid transfusion in CKD patients?

Answer 33

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

Question 34

How is anaemia ideally treated in CKD patients?

Answer 34

IV iron or erythropoietin

Question 35

What are some methods of assessing GFR?

Answer 35

Urea
Creatinine
Radionuclide studies
Creatinine clearance
Inulin clearance

Question 36

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

Answer 36

eGFR (estimate of GFR)

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

Question 37

On what basis are CKD patients classified?

Answer 37

GFR

Albumin: creatinine