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Genitourinary MBCHB2 > Lecture 13: Clinical renal failure > Flashcards

Lecture 13: Clinical renal failure Flashcards

1
Q

What is kidney failure?

A
  • A reduction in GFR

(Normally 100ml/min)

Acute Kidney Disease
vs
Chronic Kidney injury

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2
Q

Whats the difference between symptoms and signs?

A

Symptoms = What a patient tells out

Signs = What you find upon examinaton

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3
Q

What are the symptoms of kidney failure?

A

Symptoms:

  • Vomiting
  • Loss of appetite
  • Fatigue, weakness, sleep issues
  • CHANGE IN URINE OUTPUT
  • Oedema
  • Persistent itching (high phosphorus)
  • SOB
  • High blood pressure (difficult to control)
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4
Q

What are the signs of renal failure?

A

Blood test:

  • Elevated creatinine
  • Elevated urea as renal failure continues
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5
Q

Why does creatinine elevate in renal failure?

A

Creatinine is a surrogate measure for:

  • How much muscle waste product is produced
  • How well the kidneys get rid of the waste product
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6
Q

What is the gold standard of GFR measurement?

A
  • Insulin clearance
  • Using an isotope Cr-EDTA clearance

But these are impractical for everyday clinical use

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7
Q

What is eGFR and what does it use?

A

eGFR = estiamted GFR and blood test measures creatinine as an indicator of renal function

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8
Q

What factors influence eGFR?

A
  • Weight i.e enhanced muscles mass vs fat b/c muscle mass will increase creatinine
  • Age, muscle mass declines with age
  • Age, GFR declines naturally with age
  • Gender, females have less muscle mass
  • Race, different ethnicities have different muscle mass
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9
Q

Is race widely used in eGFR calculations now?

A

In some calculators yes, but race is very complex and is starting to no longer be used.

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10
Q

How does eGFR compare with GFR?

A

Two people with the same creatinine can have completely different GFRs… so eGFR is largely dependant on creatinine and muscle mass

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11
Q

So what two factors are examined when it comes to kidney function?

A
  • GFR (other methods of being calculated) and Creatinine
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12
Q

What are the two types of renal failure and what do they have in common?

A

Acute Kidney injury
Chronic kidney disease

Both have high creatinine and low GFR

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13
Q

What is acute kidney injury?

A
  • Sudden rapid reduction in GFR
  • Happens over days/weeks
  • Usually reversible

70% due to non-renal causes

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14
Q

What are the potential aetiologies of AKI?

A
  • Pre-renal (insufficient blood)
  • Renal
  • Post renal (Obstructions)
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15
Q

What pre-renal events can lead to AKI?

A

Absolute loss of fluid
i.e Mjr haemorrhage, vomiting, diarrhoea, severe burns

Relative loss of fluids
i.e Congestive HF, distribution shock (i.e fluids not being delivered)

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16
Q

What are the causes of prerenal failure?

A
  • Low BP
  • Not enough blood to kidneys
    • Dehydration, septic shock, haemorrhage, cardiogenic shock , severe renal art. stenosis
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17
Q

What are the main findings for pre-renal AKI?

A 
Low BP
 - Postural drop
Signs of dehydration
- JVP, Tissue tugor (pinch skin, does rebound back)
Signs of sepsis
- Fever etc
Signs of haemorrhage
- Bleeding
Signs of cardiogenic shock
- HF, pulmonary oedema
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18
Q

What happens to urine output in pre-renal AKI?

A
  • Usually low intially

<1L

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19
Q

What is found on a blood test for pre-renal AKI?

A
  • High creatinine
  • K = Hyperkalemia
  • Phosphate = High (itchy skin)
  • Ca: May be low
20
Q

Whats the treatment for pre-renal AKI?

A

Fix underlying problem

  • Rehydrate
  • Treat bleeding
  • Fix heart
  • Antibiotics for sepsis
  • ICU treatment for persistent low BP
21
Q

What happens to pre-renal AKI if it doesnt get better?

A

Potentially leads to acute tubular necrosis

22
Q

Whats acute tubular necrosis (ATN)?

A
  • Mainly due to pre-renal causes
  • Persistant oliguria (low urine) and renal failure after correction of underlying pre-renal condition
  • > High creatinine
  • > Low urine output
  • > High potassium

Necrosis of the tissues, suspected from lack of blood

23
Q

Whats the treatment for ATN?

A
  • Maintain normal BP
  • Treat underlying problem…
  • If kidney keeps getting worse then dialysis (not a cure just keeps people alive)
24
Q

Whats recovery like for ATN?

A
  • 95% get better

Polyuric phase in recovery

  • Tubules cant concentrate
  • Up to 20L urine per day
  • Need IV fluids to recover
25
Q

What are the renal causes of renal failure?

A

ATN:

  • Pre-renal (as listed earlier)
  • Drugs i.e aminoglycosides
  • Toxins

Glomerulonephritis

26
Q

What causes rapidly progressive glomerulonephritis (RPGN)?

A
  • Acute renal failure due to glomerular disease (not drug related)
  • Usually presents with blood and or protein in the urine
  • AKI
  • Diagnosis requires a renal biopsy
27
Q

What are the causes of post renal AKI?

A
  • Kidney stones
  • Tumour
  • Prostate hypertrophy
  • Urinary retention
28
Q

Whats the best way to assess post renal AKI?

A

Ultrasound

29
Q

What is chronic kidney disease?

A
  • Happens over months/years
  • Gradual decline in renal function
  • Irreversible (scarring on kindeys)
30
Q

What is seen with CKD?

A
  • Elevated creatinine
  • Elevated urea
  • Usually NORMAL urine ouput
31
Q

Whats is the goal of treating CKD?

A

Aim to slow down progress

32
Q

What are the causes of CKD?

A
  • Diabetes
  • Glomerulonephritis
  • Hypertension
33
Q

What happens in CKD?

A
  • Gradual increase in creatinine due to underlying disease

- Scarring of glomeruli and interstitium

34
Q

What are the patient symptoms of CKD?

A
  • None in early stages
  • Usually found on blood tests
  • Urine output normal
  • Uraemia: Symptom of kidney failure (Not till GFR has got low)
35
Q

What does uraemia result in?

A
  • Anorexia (B/c so sick doesnt eat)
  • Nausea
  • Vomiting
  • Itchiness
  • SOB
  • Swelling
  • Cold intolerance
  • Seizures
  • Coma
36
Q

What are the signs of CKD?

A
  • No consistent signs early on
  • Most common is hypertension
  • Oedema
  • Pulmonary oedema
  • Raised JVP
37
Q

How is CKD diagnosed?

A

Usually on a routine blood test

  • Urea: Increased
  • Creatinine: Increased
  • eGFR: Decreased
38
Q

What are the stages of CKD and what are some consequences?

A

Stage 1: Normal
Stage 2: Early (Increased PTH)
Stage 3: Moderate (decreased Ca, anaemia, low EPO)
Stage 4: Severe (High phosphate, acidosis, K may rise, malnutrition)
ESRF: Uraemia

39
Q

How else can stage 3 CKD be measured? and what would you expect and why?

A

Blood test

- Low EPO because kidney produces EPO and this drives RBC production thus may also be anaemic

40
Q

How does the failing kidney contribute to bone disease?

A

Kidney converts the stored form of vitamin D to its active form and that regulates Ca + phosphate absorption in the gut

41
Q

What bone disease can kidney failure lead to?

A

Renal oseodystrophy

42
Q

Why does phosphate rise in Kidney failure?

A

Body has a high turn over of phosphate

  • Thus most of what is absorbed in excreted in the kidney.
  • This in kidney failure, less is excreted and serum phosphate increases.
43
Q

Why does PTH increase in early stage CKD?

A

Low Ca and high phosphate stimulate PTH release

44
Q

Describe how all the factors of CKD lead to renal osteodystrophy?

A
  • High serum phosphate
  • Low vit D
  • Low Ca
  • High PTH

=

  • Excessive bone reabsoprtion of Ca
  • Fractures
  • Extra-osseous calcification
  • Vascular calcification
45
Q

What happens to Potassium in CKD?

A

Often high b/c proximal tubule issues

= Arrhythmias

46
Q

What can you do in CKD?

A

Aims of therapy:

  • Prevent disease progression
  • Control complications of renal failure

Chronic -> control of BP (tends to be the aim)

47
Q

What is the most common and best treatment of CKD?

A

Aggressive control of blood pressure

- ACE inhibitor and ARB

Genitourinary MBCHB2 (26 decks)

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