Lecture 11.1: Chronic Kidney Disease and Renal Dialysis Flashcards
What is CKD/Chronic Kidney Failure?
Abnormalities of kidney structure or function, present for ≥3 months, with implications for health
What are common Symptoms of CKD? (When is not Asymptomatic) (10)
- Feeling more tired
- Puffiness around eyes
- Trouble concentrating/sleeping
- Poor appetite
- Dry, itchy skin
- Muscle cramping at night
- Swollen feet and ankles
- Urination frequency change
- Frothy urine (proteinuria)
- Haematuria
What Signs might be observed/should you look out for upon Examination of a patient with CKD? (13)
- Pallor
- Cachexia
- Cognition Impaired
- Dehydrated
- Tachypnoea
- Peripheral Oedema
- Hypertension
- Diabetes Mellitus
- Previous AVF/PD
- PCK
- Peripheral Neuropathy
- Distended Bladder
- Surgical Scars
What can Cause CKD? (9)
- Type 1 or type 2 diabetes
- High blood pressure
- Glomerulonephritis
- Interstitial Nephritis
- Polycystic kidney disease
- Other inherited kidney diseases
- Prolonged obstruction of the urinary tract, from
conditions such as enlarged prostate, kidney
stones and some cancers - Vesicoureteral reflux, a condition that causes
urine to back up into your kidneys - Recurrent kidney infection, also called
pyelonephritis
What happens to Glomerular Filtration Rate in CKD?
A glomerular filtration rate less than 60 mL/minute/1.73 m²
What markers of kidney damage can be found in CKD? (5)
- Albuminuria/proteinuria
- Urine sediment abnormalities
- Electrolyte abnormalities due to tubular
disorders - Abnormalities detected by histology
- Structural abnormalities detected by imaging
What are the Main Functions of the Kidney? (5)
- Acid-base balance
- Electrolyte and fluid balance
- Remove toxins and waste products
- Control B.P.
- Produce erythropoietin/renin/calcitrol
Refer to slide 6 in lecture for CKD Classification
What are Frequent Complications of Renal Disease? (4)
1) Cardiovascular disease: 5-10X more likely to
die
2) Peripheral neuropathy and myopathy
3) Renal mineral and bone disorder: bone
pain/disturbed Vitamin D, Calcium, PTH and
phosphate metabolism
4) Renal anaemia: reduced erythropoietin
How can CKD lead to CVD? (4 general steps)
- Chronic kidney disease promotes hypertension
and dyslipidaemia - Inflammatory mediators are often elevated
- Renin-angiotensin system is frequently
activated - Which contributes to accelerated
atherosclerosis
What Drugs are used to manage CVD (in CKD)? (5)
- Aspirin
- Statins
- ACE inhibitors (ACEi) or
- Angiotensin receptor blockers (ARBs)
- β-blockers
What other factors are important to control in CVD? (2)
- Glycaemia
- Blood Pressure
How can CKD lead to Neuropathy (Central and Peripheral)?
Levels of electrolytes in the body to become unbalanced, which negatively affects nerve cell function and causes the nerves to work abnormally
What are Consequences of Central and Peripheral Neuropathy? (4)
- Stroke
- Cognitive Dysfunction
- Encephalopathy
- Through to autonomic and peripheral
neuropathies (cramps, numbness and pins and
needles)
What is Peripheral Neuropathy as a result of kidney disease is referred to as?
Uremic Neuropathy (demyelination)
How is Peripheral Neuropathy managed (in CKD)? (1)
Renal replacement therapy
Why can CKD lead to a Mineral Bone Disorder? (4 general steps)
- Decreased Calcitriol produced by Kidney (Vit D
– absorb Ca in gut) - Thus low calcium, high phosphate in blood
serum - Results in high PTH secretion
- Increase in calcium released from bones by
osteoclasts (pain, shape change due to excess
bone breakdown)
How are Mineral Bone Disorders managed (in CKD)? (3)
- Gut phosphate binders / diet / dialysis
- Calcitriol (1,25 (OH) Vitamin D) analogues:
increase calcium absorption and suppress
PTH - Calcimimetic agents (Cinacalcet): reduce
calcium by acting on calcium sensing
receptors in parathyroid to reduce PTH
Why can CKD cause Anaemia?
- Kidney releases Erythropoietin
- Erythropoietin stimulates red bone marrow
- Leads to enhanced erythropoiesis (RBC
production) - If interstitial cells in the kidney damaged no
erythropoietin produced and none of this can
occur
What cells in the Kidney produce the hormone Erythropoietin?
Interstitial Cells
How is Anaemia managed (in CKD)?
- Supplements (iron)
- Recombinant human erythropoiesis stimulating
agents (ESAs) - S/C or IV
- Improves QOL (exercise tolerance, cognition)
Why should blood transfusions be avoided in CKD caused Anaemia?
Avoids blood transfusion as it minimises sensitisation to HLA antigens (in the case of future kidney transplants)
What Investigations should be done to Diagnose CKD? (4)
- U&Es, eGFR, FBC
- Markers of kidney damage (electrolytes, ACR
Levels) - Structure – imaging (u/sd, CT)
- Biopsy - histology
What are ACR Levels?
Urine Albumin/Creatinine
What is Dialysis?
Kidney dialysis is the process of removing excess water, solutes, and toxins from the blood in people whose kidneys can no longer perform these functions naturally
What is another name for Dialysis?
Renal Replacement Therapy
What are the 2 Main Types of Dialysis?
- Haemodialysis (via arterio-venous fistula)
- Peritoneal Dialysis (via peritoneal dialysis
catheter)
How is Peritoneal Dialysis done?
- Via peritoneal dialysis catheter
- Peritoneal cavity: between parietal & visceral
peritoneum (cf pleura) - Peritoneum acts as semi permeable membrane
What are possible complications of Peritoneal Dialysis?
Bacterial peritonitis (Fever, pain, cloudy dialysate)
How Haemodialysis done?
- Via arterio-venous fistula (a connection, made
by a vascular surgeon, of an artery to a vein) - Provides good blood flow for dialysis
What is Maintained in Dialysis? (3)
- Maintain euvolaemia (weigh patient)
- Maintain electrolytes eg low K in dialysate
- Dialysate bicarbonate diffuse into blood correct
acidosis
How often does Dialysis need to be done?
4 hour treatments 3x a week
What are some Key Factors to be considered in Kidney Transplants? (3)
- Donor Types/Match: HLA Typing (Human
Leukocyte Antigen) - If patient is fit for transplant
- Immunosuppressants given after transplant
Pros of Kidney Transplant (3)
- Improved patient survival
- Correct symptoms and metabolism (Uraemia,
Anaemia, Vit D) - Improved QOL (Better life- work, sex,
pregnancy)
Cons of Kidney Transplant (3)
- Organ Rejection
- Expensive
- Long Waiting List
