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Digestive and Renal Sciences > Kidney disease and renal failure > Flashcards

Kidney disease and renal failure Flashcards

1
Q

What are the homeostatic functions of the kidney?

A 
elimination of waste
Water homeostasis
Electrolyte homeostasis
acid base homeostasis
Blood pressure control
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2
Q

What are the metabolic/endocrine functions of the kidney?

A

Synthesis of hormones - Vitamin D, Erythropoietin, Renin

Excretion of drugs and drug metabolites.

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3
Q

What diseases can cause the kidneys to stop working?

A

Chronic kidney disease (CKD)

Acute Kidney Injury (AKI)

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4
Q

What are common causes of CKD?

A

Diabetes and or hypertension but also many other causes.

Usually slow and progressive onset and is often irreversible.

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5
Q

What are the common causes of AKI?

A

Rapid onset usually due to a combination of systemic illness and multiple risk factors and medication.

Usually reversible with treatment.

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6
Q

What is likely to develop AKI?

A 
Elderly
Diabetics
Hypertension patients
Heart disease patients
Liver disease Patients
CKD patients
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7
Q

Who is likely to develop CKD?

A

Diabetics
hypertension
Drug users especially NSAIDs
Elderly

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8
Q

What are the risk factors for CKD?

A 
Increased age
Hypertension
Diabetes
Smoking
Poor education
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9
Q

What are some consequences due to a loss of renal function?

A

High mortality rate
Problems with electrolyte and water homeostasis
Acid base homeostasis issues
Endocrine irregular functionality.

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10
Q

what is the average cardiac output?

A

5L/min

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11
Q

What is the average renal blood flow?

A

1.2L/min

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12
Q

What is the average glomerular filtration rate?

A

125L/min (180-185 L/day)

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13
Q

What is the average urine volume?

A

1mL/min

1.5L/day

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14
Q

What controls water and electrolyte homeostasis?

A

ADH and renin-angiotensin system

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15
Q

What happens if salt and water homeostasis fails?

A

Inability to concentrate urine

Inability to excrete water load (oedema)

Sodium retention - hypertension, CNS dysfunction

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16
Q

What happens if potassium homeostasis fails?

A

Enormous functional reserve to excrete potassium

Severe Hyperkalaemia (when GFR <10ml/min)

Alterations in membrane excitability

Cardiac arrythmias

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17
Q

What causes to problems with acid base dysregulation?

A

Failure to excrete acid
Increase in H+
Increase in CO2 produced
Removed by lungs to maintain pH

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18
Q

What happens if acid base homeostasis fails?

A

Systemic acidosis

Symptoms of breathlessness (dyspnoea)

Physiological systems start to fail (enzyme function requires correct pH)

Cardiac muscle concentration is reduced

Acidosis drives Hyperkalaemia

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19
Q

What happens if vitamin D is not activated?

A

Hypocalcaemia
Muscle Spasms
Cardiac Rhythm problems
Hyperparathyroidism

20
Q

What is hyperparathyroidism?

A

Bone fragility

Soft tissue calcifcation

21
Q

What is caused if erythropoietin is not made?

A

Anaemia

22
Q

What are the consequences of anaemia?

A

Impaired quality of life

reduced exercise capacity

impaired cognition

Transfusion requirement

Iron overload

Blood-borne infection

↑ risk of Left Ventricular Hypertrophy

↑ CV disease in patients with CKD

23
Q

What happens if metabolic waste products are not excreted?

A

Accumulation of toxic waste products.

Can lead to confusion and heart problems

May cause Gout

May cause cardiovascular disease

24
Q

Why are the metabolic waste products that would lead to heart problems, gout and confusion when accumulated?

A

Creatine rises after significant renal damage

Retention of nitrogenous waste

Retention of urate

Retention of phosphate

25
Q

What is the role of the kidneys in drug metabolism?

A

Many drugs excreted by the kidney  Metabolism of drugs may be impaired by renal failure
Increased risk of toxicity due to accumulation of drug

26
Q

What are some complications caused by the loss of kidney function?

A

Anaemia  Hypertension  Disturbed calcium/phosphate homeostasis  Cardiovascular disease 
Bone disease  Abnormal handling of drugs 
Immune suppression  Bleeding tendency
Complications of treatment

27
Q

Why would you give a patient renal replacement therapy?

A

If they have acute or chronic kidney disease

If they are unable to maintain homeostasis functions of the kidney.

Without treatment these are terminal illnessses

28
Q

What are some renal replacement therapies?

A

Dialysis

Conservative (palliative) care

Transplantation replaces all kidney functions

29
Q

What is dialysis?

A

Extracorporeal therapy where fluid and solutes are removed or added to the patients blood.

30
Q

How does dialysis work?

A

Works by separating the patients blood and the dialysis fluid with a semipermeable membrane

31
Q

What is dialysis used to replace?

A

Used to replace the kidneys function of water, electrolyte, acid/base homeostasis and excrete metabolic waste products.

32
Q

What are the types of dialysis?

A

Haemodialysis

Peritoneal

33
Q

Where is peritoneal dialysis done?

A

At home
needs a permanent peritoneal catheter
Can be either continuous or overnight dialysis

34
Q

How long does peritoneal dialysis last for?

A

8-10 years

35
Q

What are the risk factors of peritoneal dialysis?

A

Risk of getting peritonitis

36
Q

How does peritoneal dialysis work?

A

Dialysate is injected into the abdomen through a catheter.
This draws out the metabolic waste, electrolytes and excess fluid from the blood
This fluid is then drained out of the abdomen into a collection bag back through the catheter.

37
Q

How does Haemodialysis work?

A

Preparation of an AV fistula or AV graft to connect a vein and artery together.

Need is placed into the vein and the blood flows out and into a dialysing machine which filters and cleans the blood.

The clean blood is then returned to the body through a needle into the artery.

38
Q

What does haemodialysis require?

A

Needs permanent access to the circulation via an AV fistula, AV graft or central venous catheter.

39
Q

How long does haemodialysis last for?

A

Must be done for 4 hours 3 times per week and can last indefinitely

40
Q

What immunosuppressants are used for a kidney transplantation?

A

Steroids
Calcineurin inhibitors
Azathioprine
Mycophenolate

41
Q

What are the benefits of a kidney transplant?

A

Better life expectancy
Better quality of life (no dialysis)
Replaces all renal functions
First choice treatment for CKD 5 (end stage kidney failure)

42
Q

Who should have a kidney transplant?

A

Everyone with CKD 5 unless they have an absolute contraindication

43
Q

What are absolute contraindications?

A

High peri-operative mortality
Poor life expectancy
Active malignancy

44
Q

Where do the donor kidneys for a transplant come from?

A

Cadaveric donor

Living donor

45
Q

Explain the problem of transplant immunology

A

Organ transferred between non-genetically identical individuals

Rejection of the graft

Driven by an allogenic response

Mechanisms that discriminate self from non-self

46
Q

How can transplant immunological problems be prevented?

A

ABO blood group matching

HLA-A,B,DR matching

Screening for anti donor antibodies in the recipient.

Digestive and Renal Sciences (26 decks)

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