CKD and renal failure Flashcards
what does presentation of kidney failure depend on?
rate deterioration
cause kidney function
what are the usual blood results in kidney failure?
- Urea- high
- Creatinine- high
- Sodium- depends on patient
- Potassium high
- Haemoglobin- low
what are the signs of hypovolemia?
low BP
high pulse
JVP not visible
hands cold -> vasoconstriction to preserve blood flow to core (+clammy)
low CRT
what is a sign of kidney disease on xray with contrast?
contrast travelling up ureter into right kidney causing reflux
valve system incompetent causing infection into kidney causing pyelonephritis and scarring
what is the primary test for kidney disease?
ultrasound
shrunken kidneys= irreversible
look for obstruction
what are the results of kidney failure on salt and water balance?
causes reduction in secretion salt and water -> hypertension, oedema, pulmonary oedema
but: Hypovolemia may be the cause of acute kidney injury
what disorder may salt and water loss also be seen other than kidney disease?
tubulointerstitial disorders- damage to concentrating mechanism
what is the effect of acidosis in kidney failure?
increased H+ into cells
causes K+ to move out of cells -> hyperkalemia
this acidosis also causes anorexia and muscle catabolism
how do you treat hyperkalaemic acidosis?
give sodium bicarbonate to treat acidosis and this hyperkalaemia
what are the causes of hyperkalaemia?
- Decreased distal tubule potassium secretion
- Acidosis
what are the symptoms of hyperkalaemia?
- Based on chronicity
- Cardiac arrhythmias
- Neural and muscular activity disrupted
- Vomiting
what are the ECG changes seen in hyperkalaemia?
- Peaked T waves
- P wave:
- Broadens
- Reduced amplitude
- Disappears
- QRS widens
- Heart block
- Asystole
- VT/VF
what are the effects of kidney failure on endocrine functions?
reduced erythropoietic -> anaemia (less stimulus to bone marrow)
vitamin D reduction -> reduced intestinal calcium absorption -> hypocalcaemia and hyperparathyroidism
increased CVD risk
what is a predictor of end-stage renal failure?
CKD
but patient with CKD more likely to die from CVD than end-stage renal failure
higher CKD stages= higher risk CVD= higher risk mortality after CVD event
what factors contribute to CV risk?
hypertension
diabetes
lipid abnormalities
inflammation
oxidative stress
mineral/bone metabolism disorders
how is hypovolaemia treated?
give fluids
how is hypervolaemia treated?
trial of diuretics (check urine output)/ dialysis
this will decrease pulmonary oedema
how is hyperkalaemia treated?
- Drive into cells
- Sodium bicarbonate
- Insulin dextrose (caution- risk hypoglycaemia)
- Drive out of body
- Diuretics (furosemide)/ dialysis
- Gut absorption
- Potassium binders
what is the long term conservative management for kidney failure?
- erythropoietin injections to correct anaemia
- diuretics to correct salt water overload
- phosphate binders
- 1.25 vit d supplements
- symptom management
what home therapies can be used long term for kidney failure?
hemodialysis
peritoneal dialysis/ assisted programs
how often is hemodialysis done?
4 hours, 3 times a week
what is always the aim in kidney failure?
transfusion
what should be avoided in patient with kidney failure?
- avoid transfusion as create sensitization and increase transplant failure risk
- avoid inserting IV/taking blood from antecubital fossa or cephalic vein (wrist) as required for dialysis- this is their lifeline! use back of hands!
what estimates are used to assess GFR?
serum creatinine conc
via:
MDRD or CKD-EPI
