Kidney Flashcards
How many adults in the UK have CKD?
8%
Costs of CKD to NHS
Dialysis Transplantation Antihypertensives 1º care consultations Anaemia Admissions to hospital Excess MI, stroke
How much did CKD cost the NHS in 2009-10?
£1.45 billion
What is the commonest cause of renal impairment?
Diabetes
Functions of kidney lost in CKD-> symptoms
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
How is CKD self perpetuating?
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
Name 2 pro fibrotic cytokines
TGF-B
Plasminogen activator inhibitor 1
Treatment of CKD
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
How is the diagnosis of CKD made?
2 eGFR estimations 3mg/mmol
Normal eGFR?
90 or more
Treatment of anaemia?
Parenteral iron
Epo injections
HIF stabilisers (hypoxic induced factor)
What is tumoural calcinosis?
Chunks of calcium caused by CKD mineral bone disorders
Why does hyperparathyroidism occur in CKD?
Less kidney mass, insufficient Vit D so calcium remains low
PTH remains unsupressed
= secondary hyperparathyroidism
What happens in worsening CKD?
Instead of hypocalcaemia due to less Vit D Ca2+ starts being resorbed from bone so hypercalcaemia occurs and hyperphosphataemia too
What is tertiary hyperparathyroidism?
Due to upregulation and hypertrophy of parathyroid glands in secondary hyperparathyroidism
Even if corrected, sometimes the glands remain hyperfunctioning
What happens with hyperparathyroidism?
Loss of bone mass, increased fractures
Hyperphophataemia
Vascular calcification (CVD, thrombosis, skin necrosis)
Treatment of hyperparathyroidism in CKD?
Vitamin D replacement Dietary phosphate reduction Phosphate binders (Ca salts) Calcimimetics Parathyroidectomy
How does CKD cause death?
Pulmonary oedema Hypertension -> CVD Nauseated and anorexic Anaemia Convulsions (ion imbalance) Sudden cardiac death
What eGFR is end stage renal disease?
Less than 5mls/min
Types of treatment for end stage CKD?
Haemodialysis
Peritoneal dialysis
Renal transplantation
What is inserted into blood before the dialysis chamber?
Heparin to avoid coagulation
How does dialysis work?
Semi permeable membrane, countercurrent exchange
What are the drawbacks of haemodialysis?
Needs to be done each day
Recquires fashioning of AV fistula
Doesn’t correct hormone imbalances or avoid CVD risk
What fluid is used for peritoneal dialysis?
Glucose solution that draws out nitrogenous waste
What are the 4 types of peritoneal dialysis?
NIPD (Night time intermittent)
CCPD (continuous cycling)
CAPD (continuous abulatory)
APD (automated)
What does a person need to be eligible for kidney transplantation?
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
3 options for renal tranplantation
Cadaveric brain stem death donor
Cadaveric cardiac death donor
Live donation
What is looked at for compatibility with kidney transplantation?
ABO
HLA
Not affected by same genetic disease
No diabetes/hypertension/malignancy
Can kidneys still be transplanted without ABO compatibility?
Yes, via plasma exchnage and immunoadsorption
Transplant in immunologically naive state
OR a paired sharing scheme could be used
Risk of rejection of kidney transplant with current methods?
Less than 10%
What is used for immunosuppression to avoid rejection of kidney transplant?
Steroids Calcineurin inhibitors (Tacrolimus) Antiproliferative agents (Mycophenolate mofentil) Induction agent (basiliximab)
