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1B Urology and Renal Medicine > CKD and renal failure > Flashcards

CKD and renal failure Flashcards

1
Q

what does presentation of kidney failure depend on?

A

rate deterioration

cause kidney function

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2
Q

what are the usual blood results in kidney failure?

A
  • Urea- high
  • Creatinine- high
  • Sodium- depends on patient
  • Potassium high
  • Haemoglobin- low
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3
Q

what are the signs of hypovolemia?

A

low BP

high pulse

JVP not visible

hands cold -> vasoconstriction to preserve blood flow to core (+clammy)

low CRT

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4
Q

what is a sign of kidney disease on xray with contrast?

A

contrast travelling up ureter into right kidney causing reflux

valve system incompetent causing infection into kidney causing pyelonephritis and scarring

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5
Q

what is the primary test for kidney disease?

A

ultrasound

shrunken kidneys= irreversible

look for obstruction

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6
Q

what are the results of kidney failure on salt and water balance?

A

causes reduction in secretion salt and water -> hypertension, oedema, pulmonary oedema

but: Hypovolemia may be the cause of acute kidney injury

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7
Q

what disorder may salt and water loss also be seen other than kidney disease?

A

tubulointerstitial disorders- damage to concentrating mechanism

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8
Q

what is the effect of acidosis in kidney failure?

A

increased H+ into cells

causes K+ to move out of cells -> hyperkalemia

this acidosis also causes anorexia and muscle catabolism

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9
Q

how do you treat hyperkalaemic acidosis?

A

give sodium bicarbonate to treat acidosis and this hyperkalaemia

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10
Q

what are the causes of hyperkalaemia?

A
  • Decreased distal tubule potassium secretion
  • Acidosis
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11
Q

what are the symptoms of hyperkalaemia?

A
  • Based on chronicity
  • Cardiac arrhythmias
  • Neural and muscular activity disrupted
  • Vomiting
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12
Q

what are the ECG changes seen in hyperkalaemia?

A
  • Peaked T waves
  • P wave:
    • Broadens
    • Reduced amplitude
    • Disappears
  • QRS widens
  • Heart block
  • Asystole
  • VT/VF
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13
Q

what are the effects of kidney failure on endocrine functions?

A

reduced erythropoietic -> anaemia (less stimulus to bone marrow)

vitamin D reduction -> reduced intestinal calcium absorption -> hypocalcaemia and hyperparathyroidism

increased CVD risk

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14
Q

what is a predictor of end-stage renal failure?

A

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

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15
Q

what factors contribute to CV risk?

A

hypertension

diabetes

lipid abnormalities

inflammation

oxidative stress

mineral/bone metabolism disorders

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16
Q

how is hypovolaemia treated?

A

give fluids

17
Q

how is hypervolaemia treated?

A

trial of diuretics (check urine output)/ dialysis

this will decrease pulmonary oedema

18
Q

how is hyperkalaemia treated?

A
  • Drive into cells
    • Sodium bicarbonate
    • Insulin dextrose (caution- risk hypoglycaemia)
  • Drive out of body
    • Diuretics (furosemide)/ dialysis
  • Gut absorption
    • Potassium binders
19
Q

what is the long term conservative management for kidney failure?

A
  • erythropoietin injections to correct anaemia
  • diuretics to correct salt water overload
  • phosphate binders
  • 1.25 vit d supplements
  • symptom management
20
Q

what home therapies can be used long term for kidney failure?

A

hemodialysis

peritoneal dialysis/ assisted programs

21
Q

how often is hemodialysis done?

A

4 hours, 3 times a week

22
Q

what is always the aim in kidney failure?

A

transfusion

23
Q

what should be avoided in patient with kidney failure?

A
  • 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!
24
Q

what estimates are used to assess GFR?

A

serum creatinine conc

via:

MDRD or CKD-EPI

25
Q

why is urea not useful for assessing GFR?

A

confounded by diet, catabolic state, GI bleeding, drugs, liver function

26
Q

why is creatinine not useful for assessing GFR?

A

affected by muscle mass, age, race, sex

need to look at patient when interpreting result

trend helpful

27
Q

why is radionuclide studies not useful for assessing GFR?

A

look at EDT clearance

reliable but expensive

28
Q

why is creatinine clearance not useful for assessing GFR?

A

difficult for elderly patients to collect accurate sample

overestimates GFR at low GFR (as small amount creatinine is also secreted into urine)

29
Q

why is insulin clearance not useful for assessing GFR?

A

laborious- used for research purposes only

30
Q

what values ACR are abnormal? (albumin : creatinine ratio)

A

<3 normal to mildly increasing

3-30 moderately increased

>30 severely increased

31
Q

what values of GFR are abnormal?

A

>90- normal and high

60-89- mild reduction related to normal range for young adult

45-59- mild moderate reduction

30-44- moderate severe reduction

15-29- severe reduction

<15 kidney failure

32
Q

what is the relationship between ACR and GFR?

A

the more abnormal the higher the risk of progressing to end-stage renal failure on both sides

1B Urology and Renal Medicine (6 decks)

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