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3 - Urinary > deck_1665842 > Flashcards

deck_1665842 Flashcards

1
Q

Define chronic kidney failure

A

• The progressive and irreversible loss of renal function over a period of months to years

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2
Q

What is the underlying pathology of chronic kidney failure?

A

• Function renal tissue is replaced by extra-cellular matrix, which gives rise to glomerulosclerosis and tubular intersitial fibrosis

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3
Q

What does a diseased kidney do?

A

• Shrinks • Fibrosis

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4
Q

What does chronic kidney failure result in?

A

• Progressive loss of both the excretory and hormone functions of the kidney • Proteinuria and systemic hypertension develops

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5
Q

Give 8 causes of chronic kidney disease

A

I gave GOD HIV • Immunologic ○ Glomerulonephritis • Infection ○ Pyelonephritis • Genetic ○ Polycystic Kidney Disease (PCK) ○ Alport’s Syndrome • Obstruction and reflux nephropathy • Hypertension • Vascular • Systemic Disease ○ Diabetes ○ Myeloma • Cause unknown

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6
Q

What are the three most common causes of chronic kidney disease

A

• Diabetes mellitus • Hypertension • Glomerulonephritis

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7
Q

What do most patients with CKD have?

A

• Diabetes • Hypertension • Ischaemic Heart Disease

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8
Q

What is polycystic kidney disease?

A

• Multiple cysts appear on the kidney

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9
Q

What is Alport syndrome?

A

• Hereditary nephritis caused by an x-linked mutation • Proliferating and sclerosing kidney disease

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10
Q

How is Chronic Kidney Disease classified?

A

• By amount of GFR fall and kidney disease

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11
Q

How many stages of chronic kidney disease are there?

A

5

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12
Q

What is stage 1 of chronic kidney disease? GFR, description, clinical diagnosis, %population

A

• >90 GFR • Kidney damage with normal or increased GFR • Need other evidence of kidney damage3.3% population

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13
Q

What is stage 2 of chronic kidney disease? GFR, description, clinical diagnosis, %population

A

• 60-89% GFR • Kidney damage with mild GFR fall • Need other evidence of kidney dmage • 3% population

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14
Q

What is stage 3 of chronic kidney disease? GFR, description, clinical diagnosis, %population

A

• 30-59% fall in GFR • Moderate fall in GFR • Symptoms +/-6% population

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15
Q

What is stage 4 kidney disease?

A

• 15-29% • Severe fall in GFR • Symptoms ++ • 0.2% population

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16
Q

What is stage 5 kidney disease

A

•

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17
Q

What is the incidence of CKD?

A

• 85% have diabetes, hypertension or ischaemic heart disease • More common in the elderly, ethnic minorities and the socially disadvantaged

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18
Q

Why don’t most patients with CKD end up needing dialysis?

A

High cardiovascular mortality at all stages of CKD

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19
Q

Give four systems affected by CKF

A

• CVS • Haematological • Musculoskeltal • CNS

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20
Q

What does CKF cause in the CVS system?

A

• Atherosclerosis • Cardiomyopathy • Pericarditis

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21
Q

What does CKF cause in haemotologically

A

○ Decreased erythropoietin ○ Resistance to erythropoietin ○ Decreased RBC survival Blood loss

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22
Q

Where is erythropoietin produced?

A

The interstitial fibroblasts in the kidney, in close assocaiation with peritublar capillaries.

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23
Q

What does CKF cause in the bone?

A

• Renal bone disease

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24
Q

Give two forms of renal bone disease

A

• Decreased GFR means less phosphate is excreted, increasing serum conc. Then forms complexes with free Ca2+, reducing effective serum conc. Stimulated PTH release, causing overactivity of osteoclasts - Osteitis Fibrosa Cystica • Less Vitamin D hydroxylated to Calcitriol, causing hyperparathyroidism and osteomalacia

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25
Q

Where does hydroxylation of vitamin D occur?

A

• First step in the liver - prohormone calcifedolSecond step in the kidney

26
Q

Give three CNS symptoms of CKD

A

• Neuropathy • Seizures • Coma

27
Q

Give three general symptoms of CKD?

A

• Tiredness • BreathlessnessRestless legs

28
Q

How likely is a patient to require dialysis compared to their changes of having a CVS event?

A

• More likely to have CVS event than to require dialysis

29
Q

What is a normal range of GFR?

A

• 80-120 ml/min

30
Q

How can you compare current GFR of patient to normal GFR?

A

• % of normal GFR • Use inulin clearance of 24hr creatinine clearance

31
Q

What is inulin clearance?

A

• Extract inulin • Infuse inulin into patient until steady plasma state • Measure it’s presence in the urine over a given rate

32
Q

What is 51Cr EDTA?

A

• Measure radioactivity • Expensive • Radioactive

33
Q

What is creatinine clearance?

A

• Patient collects urine over 24hrs • Delivered to lab, blood sample taken

34
Q

What is eGFR and what must be taken into account when finding it?

A

• Estimated GFR used to assess creatinine clearance • Must take into account age, sex, gender and ethnicity

35
Q

Why is creatinine clearance not a perfect marker of renal function?

A

• Someone with a GFR of 40% normal can still have a normal creatinine level • Only accurate in adults and not useful in acute renal failure

36
Q

What is creatinine?

A

• Muscles produce creatine, which is converted to creatinine in blood • Levels determined by muscle mass and kidney function

37
Q

Why is age taken into account when measuring creatinine?

A

• Lower muscle mass when old

38
Q

Why is gender taken into account when measuring creatinine?

A

Females have lower muscle bulk

39
Q

Why is ethnicity taken into account when measuring creatinine?

A

• Some ethnicitys have a higher muscle mass

40
Q

Give three ways of imaging the kidney

A

• Ultrasound to look at size and hydronephrosis • CT • MRI

41
Q

Give three ways of assessing cause of CFK

A

• Autoantibody screen • Complement • Immunoglobulin A • CRP

42
Q

What does treatment of CFK aim to do?

A

• Delay progression

43
Q

Give five modifiable risk factors of CKF

A

• Lifestyle ○ Smoking ○ Obesity ○ Exercise • Treat diabetes • Blood pressure • ACE inhibitor • Statins

44
Q

When is Renal Replacement Therapy indicated?What are the two types?

A

• When native renal function declines to a level where it can no longer support health •

45
Q

Give five indications for dialysis

A

• Uraemic symptoms • Acidosis • Pericarditis • Fluid overload • Hyperkalaemia

46
Q

What are two types of dialysis

A

• Haemodialysis • Peritoneal dialysis

47
Q

What is haemodialysis

A

• Requires the creation of an arteriovenous fistula • Vascular access used to connect patient to dialysis machine, which contains highly purified water across a semi-permeable membrane, allowing for blood filtering

48
Q

What is an arteriovenous fistulae?

A
  • A connection between an artery and vein • Difference in pressure means vein dilates and developes a muscular wall, which provides vascular access
49
Q

Why is an AV fistula required?

A

• Increases strength of vein • Increases blood flow through vein

50
Q

What is used to keep blood flowing smoothly in dialysis

A

An anti-clotting agent

51
Q

Give three advantages of haemodialysis

A

• Effective (survivors >25 years • 4/7 days free from treatment • Dialysis dose easily prescribed

52
Q

Give five disadvantages of haemodialysis

A

• Fluid/diet restriction • Limits holidays • Access problems • CVS instability • High capital cost

53
Q

What is peritoneal dialysis?

A

• Requires peritoneal membrane, blood flow and peritoneal dialysis fluid • Peritoneal dialysis fluid placed in peritoneal cavity and dialysis occurs across the peritoneal membrane • Fluid then drained away and disposed of

54
Q

Give 5 advantages of peritoneal dialysis

A

• Low technology • Home technique • Easily learned • Allows mobility • CVS stability

55
Q

Give 6 disadvantages of peritoneal dialysis

A

• Frequent exchanges • No long term survivors yet • Peritonitis • Frequent treatment failure • Limited dialysis dose range • High revenue cost

56
Q

Who is considered for a kidney transplant?

A

• All patients with progressive CKD or end-stage renal failure

57
Q

Give four sources of kidney transplants

A

• Cadaver donors • Non-heart beating donors • Living related donors • Altruistic donors • Kids from the backstreet of Nepal you tempted into a backstreet with the promise of free money. Sarah.

58
Q

Where is a kidney put when it is transplanted?

A

• Iliac fossa • Allows it to be easily connected to iliac vessels and the bladder

59
Q

Give five advantages of kidney transplantation

A

• Restores near normal renal function • Allows mobility and rehabilitation • Improved survival • Good long term resultsCheaper than dialysi

60
Q

Give five disadvantages of kidney transplantation

A

• Not all are suitable • Limited donor supply • Operative morbiditiy and mortality • Life long immunosupression • Still left with progressive CKD

3 - Urinary (39 decks)

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