CKD + Renal failure Flashcards
Presentation of renal failure
Critical illness Uraemia Hyperkalaemia Acidosis Oedema and ↑BP
Ix of Renal failure
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
Rx Life-Threatening Complications
Hyperkalaemia
Pulmonary oedema
- Consider need for rapid dialysis
CKD
Kidney damage ≥3mo indicated by ↓ function
Symptoms usually only occur by stage 4 (GFR<30)
ESRF is stage 5 or need for RRT
CKD stages
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
Common causes of chronic renal failure
DM
HTN
Other: SLE PCKD Myeloma Glomerulonephritis
Mechanism of osetomalasia
- ↓ vit D activation → ↓ Ca → ↑ PTH
- Phosphate retention → ↓ Ca and ↑ PTH (directly)
- ↑ PTH → activation of osteoclasts ± osteoblasts
- Also acidosis → bone resorption
Mx of bone disease
Phosphate binders
Vit D analogues
Ca supplements
Types of dialysis
Haemodialysis
Peritoneal dialysis
Indications for renal replacement therapy
Hyperkalaemia refractory to medication Metabolic acidosis Fluid overload Uraemic pericarditis Uraemic encephalopathy Intoxication
Mx
- Treat underlying disease
- Reduce cardiovascular risk
- Reduce progression
- Treat complications
- Plan for future
- refer for fistula - dilaysis
Peritoneal dialysis
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
Haemodialysis
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
Reduce cardiovascular risk
Start on statin Control BP Improve control of diabetes Advise weight loss Advise exercise STOP SMOKING
Reduce progression of CKD
Reduce proteinuria- ACEi/ARB
Monitor blood tests
Control BP
Polycystic Kidney Disease Mx
Control BP
Tolvaptan (Vasopression receptor-2 antagonist)
Genetic counselling and testing
Tertiary Hyperparathyroidism
Occurs when PTH release continues despite raised serum Calcium levels (independently)
- parathyroid gland nodular hyperplasia
- advanced CKD
Automated peritoneal dialysis
Automated cycler machine
performed at night
Continuous Ambulatory peritoneal dialysis
Usually consisting of 4-5 dialysis exchanges per
day
• Exchanges are performed at regular intervals throughout the day, with a long overnight dwell
Renal transplant
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
Contraindications for kidney transplantation
- 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
Living Related Donor Transplantation
Elective procedure with a selected donor
Time to transplantation can happen in months
Better outcomes
Deceased Donor Transplantation
Patients receive a kidney with little time for preparation
- Time to transplantation - years
- Survival of kidney allograft and patients - low compared to live donor
