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Year 3 Renal > CKD + Renal failure > Flashcards

CKD + Renal failure Flashcards

1
Q

Presentation of renal failure

A 
Critical illness
Uraemia
Hyperkalaemia
Acidosis
Oedema and ↑BP
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2
Q

Ix of Renal failure

A 
Bloods: FBC, U+E, LFT, glucose, clotting, Ca, ESR
ABG: hypoxia (oedema), acidosis, ↑K+
GN screen: if cause unclear
Urine: dip, MCS
ECG: hyperkalaemia
CXR: pulmonary oedema
Renal USS: Renal size, hydronephrosis
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3
Q

Rx Life-Threatening Complications

A

Hyperkalaemia
Pulmonary oedema

  • Consider need for rapid dialysis
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4
Q

CKD

A

Kidney damage ≥3mo indicated by ↓ function
Symptoms usually only occur by stage 4 (GFR<30)
ESRF is stage 5 or need for RRT

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5
Q

CKD stages

A

Stage 1 - eGFR >90 with haematuria or proteinuria

Stage 2 - 60-89 with haematuria or proteinuria

Stage 3a - 45-59
Stage 3b - 30-44
Stage 4 - 16-29
Stage 5 <15

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6
Q

Common causes of chronic renal failure

A

DM
HTN

Other:
SLE
PCKD
Myeloma
Glomerulonephritis
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7
Q

Mechanism of osetomalasia

A
  • ↓ vit D activation → ↓ Ca → ↑ PTH
  • Phosphate retention → ↓ Ca and ↑ PTH (directly)
  • ↑ PTH → activation of osteoclasts ± osteoblasts
  • Also acidosis → bone resorption
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8
Q

Mx of bone disease

A

Phosphate binders
Vit D analogues
Ca supplements

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9
Q

Types of dialysis

A

Haemodialysis

Peritoneal dialysis

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10
Q

Indications for renal replacement therapy

A 
Hyperkalaemia refractory to medication 
Metabolic acidosis 
Fluid overload 
Uraemic pericarditis 
Uraemic encephalopathy 
Intoxication
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11
Q

Mx

A
  1. Treat underlying disease
  2. Reduce cardiovascular risk
  3. Reduce progression
  4. Treat complications
  5. Plan for future
    - refer for fistula - dilaysis
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12
Q

Peritoneal dialysis

A

Home based therapy
Solutes move from blood across peritoneal membrane into dialysate fluid

Advantages:

  • can travel
  • don’t have to go to hospital frequently
  • can work around pt’s life

Disadvantages:

  • need to be able to use
  • risk of peritonitis
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13
Q

Haemodialysis

A

Pumps blood from patient through dialyser and back to pt

Advantages:

  • efficient
  • does not rely on pt

Disadvantages:

  • can’t travel
  • frequent hospital visits
  • Muscle cramps
  • infection and bacteraemia risk
  • fistula needed
  • fistula may stenose
  • anaemia - due to haemolysis
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14
Q

Reduce cardiovascular risk

A 
Start on statin
Control BP
Improve control of diabetes
Advise weight loss
Advise exercise
STOP SMOKING
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15
Q

Reduce progression of CKD

A

Reduce proteinuria- ACEi/ARB
Monitor blood tests
Control BP

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16
Q

Polycystic Kidney Disease Mx

A

Control BP
Tolvaptan (Vasopression receptor-2 antagonist)
Genetic counselling and testing

17
Q

Tertiary Hyperparathyroidism

A

Occurs when PTH release continues despite raised serum Calcium levels (independently)

  • parathyroid gland nodular hyperplasia
  • advanced CKD
18
Q

Automated peritoneal dialysis

A

Automated cycler machine

performed at night

19
Q

Continuous Ambulatory peritoneal dialysis

A

Usually consisting of 4-5 dialysis exchanges per
day

• Exchanges are performed at regular intervals throughout the day, with a long overnight dwell

20
Q

Renal transplant

A

Advantages
• Near normal lifestyle
• Better mortality/morbidity

Disadvantages
• Criteria for tx
• Lifelong immunosuppression 
• Risk of rejection
• Risk of malignancies over time
• Risk of infection 
• Long waiting times for cadaveric organ
21
Q

Contraindications for kidney transplantation

A
  • Active infection or malignancy
  • Severe heart disease not suitable for correction
  • Severe lung disease
  • Reversible renal disease
  • Uncontrolled substance abuse, psychiatric illness
  • On-going treatment non-adherence
  • Short life expectancy
22
Q

Living Related Donor Transplantation

A

Elective procedure with a selected donor

Time to transplantation can happen in months

Better outcomes

23
Q

Deceased Donor Transplantation

A

Patients receive a kidney with little time for preparation

  • Time to transplantation - years
  • Survival of kidney allograft and patients - low compared to live donor

Year 3 Renal (6 decks)

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