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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
Q

What is the function of active Vit D?

A

Stimulates Ca2+ absorption in the small intestine

26
Q

Describe how CKD causes bone mineral diseases like non-bone calcification and weak fragile:

A

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
Q

What are some symptoms of Uraemia?

A

Confusion
Palpitations
Anxiety
Depression
Leg swelling
High BP
Anaemia
SOB
Nausea
Muscle weakness

28
Q

How may a patient present on blood investigations with CKD?

A

Anaemia
Hypocalcaemia
Hyperphosphatemia
Hyperparathyroidism
Hypertension

29
Q

How could you treat a patient with Anaemia and hypertension in CKD?

A

Anemia = IV iron and EPO

Hypertension = ACEi, diuretics or B-blockers

30
Q

What is an example of a ACE inhibitor that can be given for hypertension in CKD?

What about diuretic?

What about B-blocker?

A

ACEi = ramipril

Diuretic = furosemide

B-blocker = atenolol or bisoprolol

31
Q

How is the Hyperphosphatemia managed in CKD?

How is the hypocalcaemia and hyperparathyroidism managed in CKD?

A

Hyperphosphatemia = phosphate binders and dietary advice

Hypocalcaemia and hypperparathyroidism = active Vitamin D

32
Q

What is the end stage management for CKD?

A

Renal transplant

Dialysis

33
Q

What is the eGFR value indicating End Stage renal failure?

A

eGFR < 15

34
Q

Briefly outline the process of a renal transplant:

A

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
Q

What are the 2 types of dialysis?

A

Haemodialysis

Peritoneal dialysis

36
Q

How does a dialyser work in Haemodialysis?

A

Has a conc gradient so that the waste products in the blood are removed

37
Q

Why are anticoagulants important in Haemodialysis?

A

Prevents the blood clotting

38
Q

What are the advantages of Haemodialysis?

A

Go to hospital and professionals sort it

Days where you dont have to do it

Is effective

39
Q

What a re the disadvantages of Haemodialysis?

A

Have to follow dialysis times

May struggle to insert Haemodialysis line into body

Food/fluid restrictions

40
Q

What is peritoneal dialysis?

A

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
Q

What are the advantages to peritoneal dialysis?

A

Do it at home (independance)

Less fluid/food restrictions than Haemodialysis

Easy to travel

May preserve renal function better at start

42
Q

What are the disadvantages of Peritoneal dialysis?

A

Frequent daily exchanges/overnight

Responsibility of doing it yourself

May get peritonitis

Less long term survival data

43
Q

What is the most commmon inherited nephropathy?

A

Polycystic kidney disease

44
Q

What age does polycystic kidney disease present in?

A

30 - 40yrs

45
Q

What complications do present with in Polycystic Kidney disease?

A

Hypertension
Acute loin pain
Haematuria
Bilateral palpable kidneys

46
Q

Why can polycystic kidney disease lead to development of CKD?

A

The cysts can develop anywhere in the kidney compressing the parenchyma which impairs the renal function

47
Q

What is meant by parenchyma?

A

Functional tissue

48
Q

What type of inheritance is most common in Polycystic kidney disease?

A

Autosomal dominant

49
Q

Where else can cysts develop in patients with polycystic kidney disease?

A

Liver

50
Q

How do the kidneys appear on CT with polycystic kidney disease?

A

Very large kidneys

Many cysts

51
Q

What can happen to the large yellow filled cysts in polycystic kidney disease if they get knocked?

A

Haemorrhaging into the cysts may occur

52
Q

What cells line the cysts in poly cystic kidney disease?

A

Cuboidal epithelium

53
Q

Why may a patient with Polycystic Kidney disease present with Haematuria?

A

Enlarged kidneys not protected by rib cage
Bash may occur
Leads to cysts rupturing so haemorrhage enters urine

54
Q

What causes morbidity in polycycstic kidney disease?

A

The hypertension caused by reduced parenchyma in kidney (reduced fluid excretion)
Which can lead to MI and cerebrovascular disease

55
Q

How is PKD treated that progresses to CKD?

A

Control BP

May need dialysis and renal translpmant if endstage renal failure develops

56
Q

What are berry aneurysms?

A

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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