Progressive renal disease

Question 1

What percentage of the UK population likely to have chronic kidney disease stage 3 or worse

Answer 1

5%

Question 2

Give examples of diseases which may cause kidney function to worsen

Answer 2

accelerated hypertension
vasculitis
membranous nephropathy 
IgA nephropathy 
post streptococcal
AKI
amyloidosis
lupus
diabetic nephropathy

Question 3

Understand the consequences of worsening kidney function

Answer 3

oedema
hyperkalaemia leading to arrhythmias
anaemia
leads to hyperparathyroidism
bone disease

Question 4

Explain strategies that can slow the rate of decline

Answer 4

Blood pressure control

Diabetic control

Reducing proteinuria
(blocking renin angiotensin system, statins)

Stop smoking

Weight loss/exercise

Remove nephrotoxic drugs / avoid renal insults
(lithium, non steroidal anti-inflammatory drugs)

Specific treatments

Question 5

Have an understanding of the options available to patients as kidney function approaches end stage

Answer 5

Supportive/end of life care

Transplantation

Haemodialysis

Peritoneal dialysis

Question 6

how do ACEi treat renal failure

Answer 6

ACEi opens up efferent arteriole, reduced pressure in the glomerulus, reducing workload

Question 7

How do NSAIDs damage the kidneys

Answer 7

NSAIDs block PGs which would keep the afferent arteriole open, without the PGs, i.e. with NSAIDs, the pressure in the afferent arteriole decreases. This leads to renal failure.

Question 8

what is peritoneal dialysis

Answer 8

Abdomen is filled up with low toxin fluid and left for some time, toxins diffuse out of cells and into fluid. Fluid is then drained out.

Question 9

2 advantages of peritoneal dialysis

Answer 9

Avoids surgery

Can be used at home