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Urinary System > Lecture 11.1: Chronic Kidney Disease and Renal Dialysis > Flashcards

Lecture 11.1: Chronic Kidney Disease and Renal Dialysis Flashcards

1
Q

What is CKD/Chronic Kidney Failure?

A

Abnormalities of kidney structure or function, present for ≥3 months, with implications for health

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2
Q

What are common Symptoms of CKD? (When is not Asymptomatic) (10)

A
  • 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
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3
Q

What Signs might be observed/should you look out for upon Examination of a patient with CKD? (13)

A
  • Pallor
  • Cachexia
  • Cognition Impaired
  • Dehydrated
  • Tachypnoea
  • Peripheral Oedema
  • Hypertension
  • Diabetes Mellitus
  • Previous AVF/PD
  • PCK
  • Peripheral Neuropathy
  • Distended Bladder
  • Surgical Scars
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4
Q

What can Cause CKD? (9)

A
  • 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
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5
Q

What happens to Glomerular Filtration Rate in CKD?

A

A glomerular filtration rate less than 60 mL/minute/1.73 m²

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6
Q

What markers of kidney damage can be found in CKD? (5)

A
  • Albuminuria/proteinuria
  • Urine sediment abnormalities
  • Electrolyte abnormalities due to tubular
    disorders
  • Abnormalities detected by histology
  • Structural abnormalities detected by imaging
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7
Q

What are the Main Functions of the Kidney? (5)

A
  • Acid-base balance
  • Electrolyte and fluid balance
  • Remove toxins and waste products
  • Control B.P.
  • Produce erythropoietin/renin/calcitrol
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8
Q

Refer to slide 6 in lecture for CKD Classification

A
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9
Q

What are Frequent Complications of Renal Disease? (4)

A

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

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10
Q

How can CKD lead to CVD? (4 general steps)

A
  • Chronic kidney disease promotes hypertension
    and dyslipidaemia
  • Inflammatory mediators are often elevated
  • Renin-angiotensin system is frequently
    activated
  • Which contributes to accelerated
    atherosclerosis
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11
Q

What Drugs are used to manage CVD (in CKD)? (5)

A
  • Aspirin
  • Statins
  • ACE inhibitors (ACEi) or
  • Angiotensin receptor blockers (ARBs)
  • β-blockers
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12
Q

What other factors are important to control in CVD? (2)

A
  • Glycaemia
  • Blood Pressure
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13
Q

How can CKD lead to Neuropathy (Central and Peripheral)?

A

Levels of electrolytes in the body to become unbalanced, which negatively affects nerve cell function and causes the nerves to work abnormally

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14
Q

What are Consequences of Central and Peripheral Neuropathy? (4)

A
  • Stroke
  • Cognitive Dysfunction
  • Encephalopathy
  • Through to autonomic and peripheral
    neuropathies (cramps, numbness and pins and
    needles)
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15
Q

What is Peripheral Neuropathy as a result of kidney disease is referred to as?

A

Uremic Neuropathy (demyelination)

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16
Q

How is Peripheral Neuropathy managed (in CKD)? (1)

A

Renal replacement therapy

17
Q

Why can CKD lead to a Mineral Bone Disorder? (4 general steps)

A
  • 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)
18
Q

How are Mineral Bone Disorders managed (in CKD)? (3)

A
  • 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
19
Q

Why can CKD cause Anaemia?

A
  • 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
20
Q

What cells in the Kidney produce the hormone Erythropoietin?

A

Interstitial Cells

21
Q

How is Anaemia managed (in CKD)?

A
  • Supplements (iron)
  • Recombinant human erythropoiesis stimulating
    agents (ESAs)
  • S/C or IV
  • Improves QOL (exercise tolerance, cognition)
22
Q

Why should blood transfusions be avoided in CKD caused Anaemia?

A

Avoids blood transfusion as it minimises sensitisation to HLA antigens (in the case of future kidney transplants)

23
Q

What Investigations should be done to Diagnose CKD? (4)

A
  • U&Es, eGFR, FBC
  • Markers of kidney damage (electrolytes, ACR
    Levels)
  • Structure – imaging (u/sd, CT)
  • Biopsy - histology
24
Q

What are ACR Levels?

A

Urine Albumin/Creatinine

25
Q

What is Dialysis?

A

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

26
Q

What is another name for Dialysis?

A

Renal Replacement Therapy

27
Q

What are the 2 Main Types of Dialysis?

A
  • Haemodialysis (via arterio-venous fistula)
  • Peritoneal Dialysis (via peritoneal dialysis
    catheter)
28
Q

How is Peritoneal Dialysis done?

A
  • Via peritoneal dialysis catheter
  • Peritoneal cavity: between parietal & visceral
    peritoneum (cf pleura)
  • Peritoneum acts as semi permeable membrane
29
Q

What are possible complications of Peritoneal Dialysis?

A

Bacterial peritonitis (Fever, pain, cloudy dialysate)

30
Q

How Haemodialysis done?

A
  • Via arterio-venous fistula (a connection, made
    by a vascular surgeon, of an artery to a vein)
  • Provides good blood flow for dialysis
31
Q

What is Maintained in Dialysis? (3)

A
  • Maintain euvolaemia (weigh patient)
  • Maintain electrolytes eg low K in dialysate
  • Dialysate bicarbonate diffuse into blood correct
    acidosis
32
Q

How often does Dialysis need to be done?

A

4 hour treatments 3x a week

33
Q

What are some Key Factors to be considered in Kidney Transplants? (3)

A
  • Donor Types/Match: HLA Typing (Human
    Leukocyte Antigen)
  • If patient is fit for transplant
  • Immunosuppressants given after transplant
34
Q

Pros of Kidney Transplant (3)

A
  • Improved patient survival
  • Correct symptoms and metabolism (Uraemia,
    Anaemia, Vit D)
  • Improved QOL (Better life- work, sex,
    pregnancy)
35
Q

Cons of Kidney Transplant (3)

A
  • Organ Rejection
  • Expensive
  • Long Waiting List

Urinary System (15 decks)

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