Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Urinary > Lecture 20 - CKD > Flashcards

Lecture 20 - CKD Flashcards

1
Q

Adult polycystic kidney disease

A

Autosomal dominant
PKD 1 and 2 gene

Renal cysts develop with age
Diagnosed with USS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Secondary complications of renal cysts

A 
Pain
Infection
Bleeding into cyst 
Renal stones - stasis 
Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Management of APCKD

A

Treat hypertension - ACE inhibitors to block RAAS

Diet:
Drink water - flushing
Low salt
Normal protein intake

Tolvaptan - ADH antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tolvaptan

A

ADH antagonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Normal GFR

A

90 - 120 ml/min/1.73m^2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CKD

A

Irreversible and progressive loss of renal function over a period of months to years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why does renal injury cause CKD?

A

Renal injury causes renal tissue to be replaced by ECM

- glomerulosclerosis and tubular intersitital fibrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CVS complications

A

Stroke
Vasculitis
MI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Incidence of CKD

A

Prevalent in

  • elderly
  • ethnic minorities
  • social deprivation
  • multi morbidities
  • FHx stage 5 CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CKD macroscopic changes

A

Scarring - fibrosis

Loss of cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Caused of CKD

A 
Diabetic nephropathy
Hypertension 
Pyelonephritis
Renal vascular disease
Glomerulonephritis - rare 
APCKD
Myeloma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Investigations of CKD

A 
Blood pressure
Urine dipstick 
GFR
Blood tests 
USS 
Kidney biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CKD staging

A

1 - eGFR - greater than 90 with proteinuria/haematuria

  1. eGFR 60-90 - proteinurian and haematuria
  2. eGFR 30 - 60
  3. eGFR 15 - 30
  4. eGFR less than 15 = ESRF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Serum immunoglobulin screen detects what?

A

Myeloma

  • can do a protein electrophoresis and serum free light chain measurement
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What blood tests

A
  • U + E
  • FBC
  • CRP
  • PTH
  • Iron
  • LFTs - albumin
  • ANCA - ANCA vasculitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Imaging

A

MRI - mass
CT - stone or mass
MR angiogram - renal stenosis
USS - hydronephrosis and kidney size

17
Q

Prevention of CKD

A

Lifestyle modification:

  • Stop smoking
  • Lose weight
  • Exercise
  • Control diabetes
18
Q

Treatment of CKD

A

Anti- hypertensives - ACE inhibitors and Ang II receptor blockers

Diuretics - ferusomide

Fluid restriction

19
Q

CKD GFR

A

Decreases GFR so can only excrete 1- 2 L of urine a day

Risk of overloading so must restrict fluid intake

20
Q

CKD nocturia

A

Decreased counter current multiplication therefore smaller concentration gradient

  • Smaller glomerular filtrate (less water filtered) but same solute
  • Decreased ADH response (normally active at night) therefore get nocturia as less water absorbed by aquaporins in the DCT
21
Q

Hyperkalaemia

A

Lower eGFR - less K+ excreted

  • Stop ACE inhibitors and Ang II receptor blockers as hyperkalemia causes supra ventricular tachycardia
  • Avoid K+ sparring drugs e.g. spironolactone
  • Altered diet to avoid foods with less K+ e.g. spinach
22
Q

CKD acidosis

A

Less HCO3- produced

Treat with oral NaHCO3 - flatulence

23
Q

Causes of anaemia in CKD

A

Vit B12 deficiency

CKD mineral and bone disorder

Bone suppression by hyperuraemia

Absolute iron deficiency - high hepcidin due to:

  • reduced hepicidin clearance
  • inflammation

Decreased EPO production

24
Q

Hepcidin

A

Inhibits functional iron release from iron stores

25
Q

Treatment of anaemia

A

Check iron stores first to check functional iron

  • If low, give IV or oral iron
  • Re-check Hb when iron is okay
  • If still low, give synthetic EPO or erythpoietin starting agent
26
Q

Mineral bone disease

A
  1. Kidney secretes phosphate less and less activated vit D
  2. Build up of phosphate in blood and less calcium absorbed from the gut
  3. Stimulates PTH
  4. Increased bone resorption and increased osteoclastic activity
  5. Mineral bone disease
27
Q

Treatment of mineral bone disease

A

Phosphate binders
Low phosphate diet
Vitamin D

28
Q

CKD and drugs

A

Impaired kidney function therefore reduced elimination of drugs.

More side effects e.g. rhabdomyolysis with statins

Alter dose

29
Q

Effects of accumulation of waste products

A

Nausea and vomiting
Reduced appetite and weight loss
Puritis
Malaise

30
Q

When is dialysis required?

A

GFR = 8-10ml/min

31
Q

Symptoms of ESRD dialysis

A

Difficulty sleeping
Malaise
Fatigue
Difficulty concentrating

32
Q

Types of dialysis

A

Haemodialysis

Peritoneal dialysis

33
Q

Advantages and disadvantages to haemodialysis

A

Advantages:

  • Less responsibility
  • Days off

Disadvantages:

  • Time travelling to hospital
  • Tied to dialysis times
  • Restricted fluid and food intake
34
Q

Advantages and disadvantages to peritoneal dialysis

A

Advantages:

  • Can do at home - independence
  • More bespoke to times patient wants
  • Better large molecule clearance
  • Patients feel better and require fewer medications and diet restrictions
  • Easy to travel

Disadvantages:

  • Require someone at home with them
  • Frequent daily exchanges
  • More responsibility
  • Decreased compliance
  • Increased risk of peritonitis
35
Q

What can CKD cause

A
  • hyperuricaemia - less urea cleared
  • Anaemia
  • Hypertension
  • Mineral bone disease
  • Hyperkaleamia
  • Metabolic acidosis
  • Dilutional hyponaturaemia
36
Q

Why do patients get hypertension

A
  1. Impaired kidney therefore decreases filtrate as decreased eGFR.
  2. Macula densa cells detect low Na+ in DCT indicating low BP
  3. Stimulated renin release from JGAin cortical nephrons
  4. Stimulates RAAS causing hypertension
37
Q

How to treat hyperkalaemia

A

Dextrose and insulin
Low K+ diet
Calcium gluconate

38
Q

Pontine demyelination

A

If dilutional hyponaturaemia treated too fast

Urinary (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions