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SBOMs > Kidney > Flashcards

Kidney Flashcards

1
Q

How many adults in the UK have CKD?

A

8%

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2
Q

Costs of CKD to NHS

A 
Dialysis
Transplantation
Antihypertensives
1º care consultations
Anaemia
Admissions to hospital
Excess MI, stroke
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3
Q

How much did CKD cost the NHS in 2009-10?

A

£1.45 billion

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4
Q

What is the commonest cause of renal impairment?

A

Diabetes

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5
Q

Functions of kidney lost in CKD-> symptoms

A

Waste excretion-> build up of toxins, uraemia
Acid base balance-> Metabolic acidosis, hyperkalaemia
Salt/water homeostasis-> Oliguria/polyuria, peripheral oedema
Blood pressure control-> hypertension
Gluconeogensesis, insulin metabolism-> T2DM
Secretion of erythropoetin-> Anaemia
Calcitriol production-> Vit D deficiency, hyperparathyroidism

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6
Q

How is CKD self perpetuating?

A

Sclerosis/fibrosis/atrophy

  • > RAAS activation, aldosterone
  • > Hypertension and mechanical vascular damage
  • > Inflammation
  • > Profibrotic cytokines
  • > Glomerulosclerosis so less functional nephrons
  • > Increased blood flow to remaining nephrons
  • > Intraglomerular hypertension
  • > Intraglomerular sclerosis
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7
Q

Name 2 pro fibrotic cytokines

A

TGF-B

Plasminogen activator inhibitor 1

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8
Q

Treatment of CKD

A

ACEi and ang-II receptor blockers in younger patients
Calcium channel blockers in older patients who already have renal disease so can’t lower kidney perfusion by blocking RAAS

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9
Q

How is the diagnosis of CKD made?

A

2 eGFR estimations 3mg/mmol

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10
Q

Normal eGFR?

A

90 or more

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11
Q

Treatment of anaemia?

A

Parenteral iron
Epo injections
HIF stabilisers (hypoxic induced factor)

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12
Q

What is tumoural calcinosis?

A

Chunks of calcium caused by CKD mineral bone disorders

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13
Q

Why does hyperparathyroidism occur in CKD?

A

Less kidney mass, insufficient Vit D so calcium remains low
PTH remains unsupressed
= secondary hyperparathyroidism

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14
Q

What happens in worsening CKD?

A

Instead of hypocalcaemia due to less Vit D Ca2+ starts being resorbed from bone so hypercalcaemia occurs and hyperphosphataemia too

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15
Q

What is tertiary hyperparathyroidism?

A

Due to upregulation and hypertrophy of parathyroid glands in secondary hyperparathyroidism
Even if corrected, sometimes the glands remain hyperfunctioning

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16
Q

What happens with hyperparathyroidism?

A

Loss of bone mass, increased fractures
Hyperphophataemia
Vascular calcification (CVD, thrombosis, skin necrosis)

17
Q

Treatment of hyperparathyroidism in CKD?

A 
Vitamin D replacement
Dietary phosphate reduction
Phosphate binders (Ca salts)
Calcimimetics
Parathyroidectomy
18
Q

How does CKD cause death?

A 
Pulmonary oedema
Hypertension -> CVD
Nauseated and anorexic
Anaemia
Convulsions (ion imbalance)
Sudden cardiac death
19
Q

What eGFR is end stage renal disease?

A

Less than 5mls/min

20
Q

Types of treatment for end stage CKD?

A

Haemodialysis
Peritoneal dialysis
Renal transplantation

21
Q

What is inserted into blood before the dialysis chamber?

A

Heparin to avoid coagulation

22
Q

How does dialysis work?

A

Semi permeable membrane, countercurrent exchange

23
Q

What are the drawbacks of haemodialysis?

A

Needs to be done each day
Recquires fashioning of AV fistula
Doesn’t correct hormone imbalances or avoid CVD risk

24
Q

What fluid is used for peritoneal dialysis?

A

Glucose solution that draws out nitrogenous waste

25
Q

What are the 4 types of peritoneal dialysis?

A

NIPD (Night time intermittent)
CCPD (continuous cycling)
CAPD (continuous abulatory)
APD (automated)

26
Q

What does a person need to be eligible for kidney transplantation?

A 
Progressive irreversible kidney failure
No current infection
No current malignancy
Prrof of compliance with treatments
Life expectancy without transplant more than 5 years
BMI less than 40
27
Q

3 options for renal tranplantation

A

Cadaveric brain stem death donor
Cadaveric cardiac death donor
Live donation

28
Q

What is looked at for compatibility with kidney transplantation?

A

ABO
HLA
Not affected by same genetic disease
No diabetes/hypertension/malignancy

29
Q

Can kidneys still be transplanted without ABO compatibility?

A

Yes, via plasma exchnage and immunoadsorption
Transplant in immunologically naive state

OR a paired sharing scheme could be used

30
Q

Risk of rejection of kidney transplant with current methods?

A

Less than 10%

31
Q

What is used for immunosuppression to avoid rejection of kidney transplant?

A 
Steroids
Calcineurin inhibitors (Tacrolimus)
Antiproliferative agents (Mycophenolate mofentil)
Induction agent (basiliximab)

SBOMs (18 decks)

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