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Y2 - Urinary > Lecture 12 - Chronic Kidney Disease > Flashcards

Lecture 12 - Chronic Kidney Disease Flashcards

1
Q

What is CKD?

A

A progressive deterioration of renal function over months to years

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2
Q

What is used to measure Chronic Kidney Disease (CKD)?

A

eGFR

Can see change in renal function over time

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3
Q

Why is CKD considered irreversible?

A

Renal tissue is replaced by extracellular matrix (scar tissue) in response to damage

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4
Q

What is the point of treatment of CKD if it cant be reversed?

A

Slows down the deterioration

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5
Q

What eGFR is considered normal/high?

A

Anything over 90ml/min

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6
Q

How many stages of CKD are there?

A

5

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7
Q

What are the 5 stages of kidney failure?

A

CKD S1: eGFR > 90 but other CKD symptoms
CKD S2: eGFR 60 - 89
CKD S3: eGFR 30 - 59
CKD S4: eGFR 15 - 29
CKD S5: eGFR <15

CKD S5 = Kidney failure

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8
Q

What may be suggestive of Chronic Renal Failure?

A

Small kidneys with thin cortices (small cortex)

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9
Q

What part of the kidney undergoes atrophy/shrinking in CKD?

A

Cortex

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10
Q

Go to the last slide and label the kidney:

A

1 = renal pelvis
2 = major calyces (calyx)
3 = minor calyces
4 = renal cortex
5 = renal medulla
6 = ureter
7 = renal pyramid
8 = renal column
9 = renal papilla
10 = renal lobe

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11
Q

What can causes Chronic Kidney Disease (CKD)?

A

Diabetes Mellitus
Hepatorenal syndrome (failing liver causes failing kidney)
Hypertension
Recurrent AKI
Chronic pyelonephritis
Chronic glomerulonephritis
Polycystic kidneys

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12
Q

What is meant by a primary cause of CKD?

A

The conditions directly affect the kidneys leading to CKD

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13
Q

What are some primary causes of CKD?

A

Polcystic Kidney disease
Acute tubular necrosis
Recurrent pyelonephritis
Glomeruloneprhitis

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14
Q

What are some secondary causes of CKD?

A

Diabetes Mellitus
Hypertension
Renovascular disease
Autoimmune

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15
Q

What is a key process that is thought to occur in Diabetic nephropathy that eventually leads to the CKD?

A

Hyperfilitration

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16
Q

Describe how the hyperfiltration DM leads to diabetic neuropathy (CKD):

A

High plasma glucose levels
Lots of glucose reabsorbed back into blood
Lots of Na+ reabsorbed as a result

Leads to levels of Na+ in filtrate being lower (detected by Macula densa cells in DCT)

RAAS activated to increase Na+ reabsorption and consequently increases BP ad therefore GFR

This increased BP/GFR means that damage to the glomerulus is likely causing CKD

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17
Q

What types of drugs /treatment can be given to regulate blood pressure reducing CKD detoriation?

A

Antihypertensives like ACEi and aldosterone receptor antagonists

Diuretics (furosemide)

Fluid restriction (prevents fluid overload)

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18
Q

What is the max blood pressure target for a patient with non diabetic CKD?

A

120 - 139/90 mmHg

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19
Q

What is the max blood pressure for patients with CKD with proteinuria or diabetes?

A

120 - 129/80 mmHG

Lower more strict target for diabetics with CKD

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20
Q

What are some indicators of CKD?

A

Microalbuminuria
Haemoturia

Albumin:creatinine ratio increased (since albumin levels in urine should be 0)

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21
Q

What are some complications of CKD?

A

Anaemia

Oedema

Bone mineral disease

Accelerated atherosclerosis/vascular disease

Metabolic acidosis

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22
Q

Why does CKD often lead to anaemia?

A

Kidney produces Erythropoietin (EPO)

CKD = reduced EPO production
Less EPO = less erythropoiesis
= less RBC cells made = anemia

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23
Q

How can CKD lead to oedma?

A

Decreased GFR may lead to not enough water being removed (fluid overload?)

Albumin escaping to be excreted in urine, plasma oncotic pressure low so fluid remains in interstitium

24
Q

What important role does the kidney have in Calcium absorption/metabolism?

A

Converts inactive vitamin D to its active Vit D form

25
What is the function of active Vit D?
Stimulates Ca2+ absorption in the small intestine
26
Describe how CKD causes bone mineral diseases like non-bone calcification and weak fragile:
CKD means less active Vit D available and less phosphate removed by kidney Les active Vit D = less Ca2+ absorbed by gut Less Ca2+ means parathyroid makes more PTH More PTH means increased osteoclast activity some more bone resorption This leads to Ca2+ being released in blood which can then calcify with phosphate in non bony locations Also lack of Active Vit D means impaired bone mineralisation
27
What are some symptoms of Uraemia?
Confusion Palpitations Anxiety Depression Leg swelling High BP Anaemia SOB Nausea Muscle weakness
28
How may a patient present on blood investigations with CKD?
Anaemia Hypocalcaemia Hyperphosphatemia Hyperparathyroidism Hypertension
29
How could you treat a patient with Anaemia and hypertension in CKD?
Anemia = IV iron and EPO Hypertension = ACEi, diuretics or B-blockers
30
What is an example of a ACE inhibitor that can be given for hypertension in CKD? What about diuretic? What about B-blocker?
ACEi = ramipril Diuretic = furosemide B-blocker = atenolol or bisoprolol
31
How is the Hyperphosphatemia managed in CKD? How is the hypocalcaemia and hyperparathyroidism managed in CKD?
Hyperphosphatemia = phosphate binders and dietary advice Hypocalcaemia and hypperparathyroidism = active Vitamin D
32
What is the end stage management for CKD?
Renal transplant Dialysis
33
What is the eGFR value indicating End Stage renal failure?
eGFR < 15
34
Briefly outline the process of a renal transplant:
Healthy kidney removed with the renal artery, vein and ureter and its inserted into the Iliac artery’s of the patient Unhealthy kidneys left in place
35
What are the 2 types of dialysis?
Haemodialysis Peritoneal dialysis
36
How does a dialyser work in Haemodialysis?
Has a conc gradient so that the waste products in the blood are removed
37
Why are anticoagulants important in Haemodialysis?
Prevents the blood clotting
38
What are the advantages of Haemodialysis?
Go to hospital and professionals sort it Days where you dont have to do it Is effective
39
What a re the disadvantages of Haemodialysis?
Have to follow dialysis times May struggle to insert Haemodialysis line into body Food/fluid restrictions
40
What is peritoneal dialysis?
Where a catheter is inserted into he peritoneal cavity inserting fluid in cavity Peritoneal membrane acts a semi permeable membrane filtering the waste contents of the blood into the fluid which is then drained into a bag
41
What are the advantages to peritoneal dialysis?
Do it at home (independance) Less fluid/food restrictions than Haemodialysis Easy to travel May preserve renal function better at start
42
What are the disadvantages of Peritoneal dialysis?
Frequent daily exchanges/overnight Responsibility of doing it yourself May get peritonitis Less long term survival data
43
What is the most commmon inherited nephropathy?
Polycystic kidney disease
44
What age does polycystic kidney disease present in?
30 - 40yrs
45
What complications do present with in Polycystic Kidney disease?
Hypertension Acute loin pain Haematuria Bilateral palpable kidneys
46
Why can polycystic kidney disease lead to development of CKD?
The cysts can develop anywhere in the kidney compressing the parenchyma which impairs the renal function
47
What is meant by parenchyma?
Functional tissue
48
What type of inheritance is most common in Polycystic kidney disease?
Autosomal dominant
49
Where else can cysts develop in patients with polycystic kidney disease?
Liver
50
How do the kidneys appear on CT with polycystic kidney disease?
Very large kidneys Many cysts
51
What can happen to the large yellow filled cysts in polycystic kidney disease if they get knocked?
Haemorrhaging into the cysts may occur
52
What cells line the cysts in poly cystic kidney disease?
Cuboidal epithelium
53
Why may a patient with Polycystic Kidney disease present with Haematuria?
Enlarged kidneys not protected by rib cage Bash may occur Leads to cysts rupturing so haemorrhage enters urine
54
What causes morbidity in polycycstic kidney disease?
The hypertension caused by reduced parenchyma in kidney (reduced fluid excretion) Which can lead to MI and cerebrovascular disease
55
How is PKD treated that progresses to CKD?
Control BP May need dialysis and renal translpmant if endstage renal failure develops
56
What are berry aneurysms?
When the walls of the blood vessels are weaker so the bulge outwards like a berry, blood collect here which can then lead to rupture /burst of the blood vessel

Y2 - Urinary (24 decks)

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