Progressive Kidney Disease Flashcards

1
Q

Demographics-wise, how has chronic kidney disease progressed?

A
  • Major public health issue
  • # of patients requiring renal replacement therapy in the form of dialysis or transplantation is increasing at about 6-8% per annum
  • 4.9% of the UK population likely to have chronic kidney disease stage 3 or worse
  • Greatest increase is in the elderly population (65+)
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2
Q

What is chronic kidney disease?

A
  • Progressive loss in kidney function
  • Over a period of months or years
  • The symptoms of worsening kidney function are not specific, and might include feeling generally unwell and experiencing a reduced appetite
  • Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders
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3
Q

What is the most accurate and least accurate way to measure kidney disease?

A
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4
Q

Most people don’t notice any symptoms until the disease becomes advanced. What are symptoms of CKD?

A
  • feel more tired and have less energy
  • have trouble concentrating
  • have a poor appetite
  • have trouble sleeping
  • have muscle cramping at night
  • have swollen feet and ankles
  • have puffiness around your eyes, especially in the morning
  • have dry, itchy skin
  • need to urinate more often, especially at night.
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5
Q

What are risk factors for chronic kidney disease?

A
  • have diabetes
  • have high blood pressure
  • have a family history of kidney failure
  • are older
  • belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.
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6
Q

What are the stages of kidney disease?

A
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7
Q

What is rapid deterioration defined as?

A
  • a fall in GFR of 5mL/min/1.73m2 in 1 year or
  • a fall of 10mL/min/1.73m2 over 5 years
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8
Q

What are the categories of causes of acute kidney injury?

A
  • prerenal (70%) - caused by decrease prerenal perfusion, often bc of volume depletion
  • intrinsic - caused by process within the kidneys
  • postrenal - caused by inadequate drainage of urine distal to the kidneys

http://www.aafp.org/afp/2012/1001/p631.html

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9
Q

What are pre-renal processes that can cause kidney function to worsen?

A
  • Hypovolaemia - haemorrhage/diarrhoea/vom
  • Reduced perfusion - septic shock, cardiac failure
  • Drugs - ACE inhibitors, NSAIDs
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10
Q

What are intrinsic causes of renal disease?

A
  • glomerular (glomerulonephritis, systemic disease)
  • tubular (acute tubular necrosis)
  • interstitial (interstitial nephritis)
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11
Q

What are post-renal causes of renal disease?

A
  • Hydroureter
  • Hydronephrosis
  • Typically from obstruction of urinary flow
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12
Q

What are the functions of the kidney?

A
  • Excretes waste substances
  • Important for acid-base balance
  • Vitamin D activation
  • Blood pressure control
  • Red blood cell production
  • Helps regulate water balance
  • Regulates minerals in extracellular fluid

*be able to explain the processes and underlying physiology of these functions

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13
Q

What are the consequences of worsening kidney function?

A
  • Fluid retention
  • Hyperkalaemia -> cardiac arrhythmias
  • Secondary hyperparathyroidism and bone disease
  • Renal anaemia
  • CKD increases cardiovascular risk
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14
Q

How does worsening kidney function lead to secondary hyperparathyroidism and bone disease?

A
  • decreased kidney function
  • decreased glomerular filtration rate
  • decreased phosphate excretion
  • therefore there is phosphate retention
  • elevated serum phosphate suppresses calcitriol production
  • reduced calcitriol (AKA activated Vit D3)
  • consequent reduced calcium absorption at gut
  • hypocalcaemia
  • this directly increases PTH
  • longterm leads to secondary hyperparathyroidism + bone disease
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15
Q

How does worsening kidney function cause anaemia?

A
  • Reduced erythropoietin produced by kidney
  • Functional iron deficiency
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16
Q

Explain strategies that can slow the rate of decline

A
  • Blood pressure control
  • Diabetic control
  • Reducing proteinuria (blocking RAAS, statins)
  • Stop smoking
  • Weight loss/exercise
  • Remove nephrotoxic drugs/avoid renal insults (lithium, NSAIDs)
  • Pregnancy - in most cases, CKD may worsen during pregnancy
17
Q

How do NSAIDs and ACE inhibitors lower GFR?

A
  • Both lower pressure in glomerulus
  • NSAIDs inhibit prostaglandins -> cause afferent constriction
  • ACE inhibitors block Ang II -> cause efferent dilation
  • Both actions lower pressure and lower GFR
    • Reduces progression to end stage renal failure
    • Reduces proteinuria
    • Reduces cardiovascular events
18
Q

What are the options available to patients as kidney function approaches end stage?

A
  • End of life care
  • Transplantation
  • Haemodialysis
  • Peritoneal dialysis
19
Q

What are the clinical advantages of transplantation over other renal failure therapies?

A
  • Fewer fluid and diet restrictions than when receiving dialysis
  • No dialysis schedule -> can work full time
  • Improved quality of life
  • Free from restrictions
  • Lead a more normal life