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Y2 Urology & Renal Medicine > CKD & renal failure > Flashcards

CKD & renal failure Flashcards

1
Q

What are the 4 functions of the kidneys?

A

Excretion
Homeostasis
Endocrine
Glucose metabolism

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2
Q

What are the homeostatic functions of the kidneys? (3)

A

Electrolyte balance
Acid-base balance
Volume homeostasis

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3
Q

What is excreted by the kidneys? (5)

What can be seen in renal failure?

A

Nitrogenous waste
Middle molecules
Salt and water
Peptides
Hormones

High urea and creatinine, low insulin requirement

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4
Q

What endocrine functions do the kidneys perform?

What can be seen in renal failure?

A

Erythropoietin
1-alpha-hydroxylase (Vitamin D)

Low calcium, high PTH, anaemia

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5
Q

What functions do the kidneys do in glucose metabolism?

A

Gluconeogenesis
Insulin clearance

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6
Q

What is the most common presentation of a patient with kidney failure?

What are the exceptions?

A

Hypertension
Oedema
(Pulmonary oedema)

Acute: vomiting can lead to hypovolaemia
Chronic: tubulointerstitial causes instead of glomerular, can lose salt & water

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7
Q

What is oedema caused by?

A

Excess extracellular fluid
Excess water and salt
More water excess than salt

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8
Q

What are the two ways that hyperkalaemia occurs in kidney failure?

A
  1. decreased K+ secretion in distal tubule
  2. decreased H+ secretion, acidosis leading to H+ and K+ swapping, K+ becomes extracellular
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9
Q

What are the symptoms of hyperkalaemia?

A

Cardiac arrythmias
Neural and muscular activity
Vomiting

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10
Q

What are some ECG changes that can be seen in hyperkalaemia?

A

Peaking T waves
Loss of P waves
Widened QRS
Heart block
Asystole
V tach/fib

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11
Q

How does CKD affect PTH levels?

What condition is this?

A
  1. Phosphate retention & decreased 1-alpha-hydroxylation (decreased 1,25 Vit D)
  2. Hypocalcaemia
  3. Increased PTH

Secondary hyperparathyroidism, can progress to tertiary

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12
Q

What is the initial management for kidney failure?

A
  1. Fluid balance - give IV fluids or diuretics
  2. Reduce K+
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13
Q

What are the 3 ways to reduce hyperkalaemia?

A
  1. Drive into cells - sodium bicarbonate, dextrose
  2. Drive out of body - diuretics/dialysis
  3. Reduced gut absorption - potassium binders
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14
Q

What are some long-term management options for kidney failure?

A

Transplant
Dialysis
Conservative treatment

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15
Q

What are some conservative treatments for kidney failure? (4)

A

Erythropoietin injections
Diuretics
Phosphate binders
1,25 Vit D supplements

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16
Q

What is the kidney failure risk equation used for? What patients are applicable?

What information is needed from the patient?

A

Risk prediction tool for kidney replacement therapy in the next 2 or 5 years

Patients with stable CKD, stages 3A to 5, with stable eGFR

Age, sex, eGFR, urine albumin-creatinine ratio

17
Q

Methods of assessing GFR

A

Urea
Serum creatinine
Radionuclide studies (EDTA)
Creatinine clearance
Inulin clearance

18
Q

What can affect serum urea levels?

A

Diet
Catabolic state
GI bleeding
Drugs
Liver function

19
Q

What can affect serum creatinine levels?

A

Muscle mass
Age
Sex (higher in males)
Race

20
Q

Why is creatinine clearance not used anymore to assess GFR?

A

Difficult for elderly patients to collect accurate samples
Overestimates GFR at low GFR

21
Q

What factors should be considered when selecting a live kidney donor? (8)

A

Age
Mental health
2 healthy kidneys
FHx of kidney disease
Kidney match to patient (HLA, serum, blood type)
Comorbidities
Future pregnancy
Financial stability

22
Q

What conditions are post-kidney-transplant patients more at risk for?

What can be done to counteract them?

A

Psychiatric disorders - being mindful & seek help
Cancer - sunscreen, regularly check skin & breasts
Cardiovascular disorders - active lifestyle, measure BP
Diabetes - active lifestyle, low sugar diet

23
Q

Dietary considerations for post-kidney-transplant patients

What immunosuppressant is often used?

A

Regular fluid intake
Low salt and sugar diet
Avoid raw eggs, meat, fish and unpasteurised cheese
Avoid foods that interact with immunosuppressant e.g. Seville oranges, grapefruit

Tacrolimus

24
Q

Drugs/medication considerations for post-transplant patients

A

Avoid NSAIDs
Stop smoking & alcohol & recreational drugs
Avoid live vaccines
Keep taking immunosuppressants
Keep getting flu jabs

25
Q

Difference between haemodialysis and peritoneal dialysis?

How many days of the week?

A

Peritoneal dialysis uses patient’s peritoneum as the filter

Haemodialysis - 3 days a week at center. Peritoneal - every day at home

Y2 Urology & Renal Medicine (3 decks)

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