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Medicine, Year 3, Metabolic Medicine > Clinical Topic 2: Chronic Kidney Disease > Flashcards

Clinical Topic 2: Chronic Kidney Disease Flashcards

1
Q

What is the most likely cause of death of CKD patients on Haemodialysis?

A

Ischaemic Heart Disease

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2
Q

What is the appearance of kidneys in Chronic Kidney Disease?

A

Bilateral shrunken kidneys

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3
Q

What is the appreance of kidneys in diabetic nephropathy?

A

Bilateral enlarged / normal kidneys

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4
Q

What is Stage 1, 2, 3a, 3b, 4, 5 Chronic Kidney Disease?

A 
Stage 1: >90
Stage 2: 60 - 89
Stage 3a: 45 - 59
Stage 3b: 30 - 44
Stage 4: 15 - 29
Stage 5: < 15
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5
Q

What factors may inappropriately skew eGFR estimation?

A
  • Pregnancy
  • Increased muscle mass
  • Red meat consumption 12 hours before sample
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6
Q

What are the four features of Diabetic-related Chronic Kidney Disease?

A
  • Mesangial expansion
  • Basement membrane thickening
  • Glomerular schlerosis
  • Podocyte damage
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7
Q

How does Chronic Kidney Disease affect Na+ / H2O balance?

A

↓ in GFR leads to an increase in Na+ / H2O retention, causing ↑ in BP, and ↑ Peripheral Oedema

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8
Q

How does Chronic Kidney Disease affect K+ balance?

A

↓ in GFR leads to an increase in K+ retention, causing hyperkalaemia. Hyperkalaemia can cause muscle weakness → ECG changes, i.e. Tall tented T-waves

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9
Q

How does Chronic Kidney Disease affect acid-base balance?

A

Diminished capacity to excrete H+ to generate bicarbonate, hence metabolic acidosis

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10
Q

How does Chronic Kidney Disease affect Calcium levels and bone health?

A

Loss of nephrons, leads to a ↓reduction in Calcitriol production (active form of Vitamin D). This causes a ↓ in calcium reabsorption from the GIT / kidney, causing Hypocalcaemia. This stimulates the parathyroid glands causing secondary hyperparathyroidism, causing Osteodystrophy / Osteoporosis via bone breakdown

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11
Q

How does Chronic Kidney Disease cause anaemia? What kind of anaemia is it?

A

Normocytic, normochromic anaemia

Decreased EPO production (main cause)

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12
Q

How can you manage hypocalaemia and deteriorating bone health in patients with Chronic Kidney Disease?

A

Vitamin D supplements: Alfacalcidol
Phosphate binders: Calcium carbonate
Calcimimetics

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13
Q

How can you manage anaemia in patients with Chronic Kidney Disease?

A

IV iron
Erythropoetin
Darbepoetin

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14
Q

What is the most common electrolyte abnormality in patients with Chronic Kidney Disease?

A

Hypocalcaemia

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15
Q

What are the effects of advanced uraemia in patients with CKD?

A
  • Uraemia induced platelet dysfunction (bruising, bleeding)
  • Uraemic pericarditis (chest pain, friction rub)
  • Uraemic neuropathy (distal sensorimotor polyneuropathy)
  • Uraemic encephalopathy (headache, confusion, coma, seizures)
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16
Q

What are the four indications for renal replacement therapy?

A
  • Symptoms of uraemia
  • Fluid overload
  • Resistant hyperkalaemia
  • eGFR < 10
17
Q

Due to the theoretical risk of BBV within haemodialysis units, what serology testing is performed and when? What must they also be vaccinated against?

A

Hepatitis B, C and HIV serology every 6-12 months

Must be vaccinated against Hepatitis B

18
Q

What are the three main forms of Renal replacement therapy for CKD patients?

A

Haemodialysis
Peritoneal dialysis
Renal transplantation

19
Q

What is the Renal replacement therapy for AKI patients?

A

Haemofiltration

20
Q

What are some of the complications of Haemodialysis?

A

Loss of venous access

Bacteraemia from line contamination

21
Q

How is access obtained in Haemodialysis?

A

Arteriovenous fistula
Arteriovenous graft
Central catheter

22
Q

What are some of the complications of Peritoneal Dialysis?

A

Bacterial peritonitis

Hyglycaemia (dialysis fluid has high glucose intake)

23
Q

What are some organisms which commonly cause bacterial peritonitis in Peritoneal Dialysis?

A 
Staphylococcus epidermis (most common)
Staph aureus
24
Q

Acute rejection of a renal transplant occurs at what time from transplantation? How is it acutely treated?

A

Within 6 months

Corticosteroids

25
Q

Patients who have received an organ transplant are at risk of what cancer? Why

A

Skin cancer (particularly squamous cell carcinoma) due to long-term use of immunosuppressants

26
Q

Chronic rejection of a renal transplant occurs at what time from transplantation?

A

> 6 months post transplantation

27
Q

Define: Xenograft, Isograft, Autograft, Allograft

A

Xenograft - transplant between different species
Isograft - transplant between twins
Autograft - transplant within same person
Allograft - transplant within same species

28
Q

What are the main antigens which give rise to transplant rejection?

A

ABO blood group
HLA
MHC

29
Q

Hyperacute organ rejection is mediated by what?

A

ABO antigens

30
Q

Acute organ rejection is mediated by what?

A

T-cells

31
Q

What is the normal range for anion gap?

A

10 - 18 mmol/L

Medicine, Year 3, Metabolic Medicine (9 decks)

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