RENAL 3 + 4 Flashcards
Is chronic kidney disease progressive or long- term?
slowly, progressive irreversible loss of renal function over a period of years
what are the initial manifestations of chronic renal disease?
biochemical abnormalities>Loss of excretory , metabolic and endocrine functions of the kidney
what is another word for renal failure?
(Uremia)/ CKD
what are the two ways in which chronic kidney disease can be characterised?
Kidney damage: indicated by persistentproteinuria, haematuria or anatomical abnormality
•Decreased kidney function: indicated by a glomerular filtration rate (GFR) of less than60ml/min/ 1.73m2which persists for more than3 months
how many stages of chronic kidney disease are there?
5 stages 1-5, 5 being the worst
how often should you measure your GFR?
1&2- 12 monthly
3a&3b - 6 monthly
4-3 monthly
5- 6 weekly
what is more sensitive ACR or PCR?
ACR- ACR is more sensitive than PCR and is recommended choice forpatients with diabetes.
what are the units of ACR and PCR?
Units of ACR & PCR – mg (of protein) per mmol (of creatinine).
when does a sample of ACR need to be rechecked?
Early morning sample is taken and ACR value of between 3 and70mg/mmol warrants a subsequent morning sample for confirmed diagnosis.
which figure will be greater -ACR or PCR?
PCR value will always be greater than ACR as there are proteins other than albumin in urine.
what is one of the main causes of chronic renal failure?
Diabetes mellitus
what can early treatment of CKD help?
Early treatment of CKD and its complications can delay or prevent progression to ESRD
•Annual SrCr checks recommended forestimation of GFR, urine dipstick for patients known to have a high risk of developing CKD.
what early detection can be used for CKD?
- Inulin – excreted unchanged in the urine,provides accurate GFR assessment.Expensive, time consuming
- Serum creatinine (SrCr)Simple to measure, InexpensiveRoutinely used to assess renal function*Not always accurate and can beinfluenced by many factors.
What method do you use for the estimation of creatine clearance?
Cockcroft and Gault formula
Estimating renal function or calculating drug doses inpatients with renal impairment who are elderly or at extremes of muscle mass
what is the constant ceratine for males and females?
Constant = 1.23 for men; 1.04 for women
when do you need to make dose adjustments for in creatine clearance?
- Direct-acting oral anticoagulants (DOACs)
- Patients taking nephrotoxic drugs (examples include vancomycin andamphotericin B)
- Elderly patients (aged 75 years and older)
- Patients at extremes of muscle mass (BMI <18 kg/m2 or >40 kg/m2)
- Patients taking medicines that are largely renally excreted and have anarrow therapeutic index, such as digoxin and sotalol
how would you investigate CKD?
•Identify the underlying disease
–History
–Examination–Test of:
•Biochemistry•Immunology•Radiology•Biopsy
what are the reversible factors you look for in the nvestigation and management of CKD?
- Hypertension
- Reduced renal perfusion–
- Urinary tract obstruction
- Urinary tract infection
- Other infections : Increased catabolism or ureaproduction
- Nephrotoxic medications
what is the aim of management of CKD?
Attempt to prevent further renal damage
•Attempt to limit adverse effects of loss ofrenal function
•Institute renal replacement
what are the early stages of CKD like?
asymptomatic-As kidney function worsens patients will accumulate uraemic toxins and develop symptoms such as- nausea/vom
what happens in CKD stages 4/5?
Hyperkalaemia
–Uraemia
–Anaemia
–Impaired Vitamin D metabolism leading tohyperparathyroidism which in turn affects boneturnover
what are the 3 key interventions?
- Glycaemic control (for diabetics)
- Blood pressure control
- Reducing proteinuria
what will progression of CKD depends on?
depends on the cause
is Hyperglycaemia an independent risk factor for nephropathy?
yes
what effect does glycemic control have?
Glycaemic control has been shown to reducethe development of microalbuminuria andtherefore reduces the progression of diabeticrenal disease.
•Angiotensin converting enzyme inhibitorsand angiotensin II receptor blockers havebeen shown to have renoprotective effects inearly and late nephropathy caused by type 2diabetes, by reducing microalbuminuria.
what effect does intervention of blood pressure have?
Control of blood pressure has been demonstrated toslow the progression of CKD in several trials.
•Aim to keep blood pressure below 140/90mmHg
•In Diabetes and CKD or if ACR is > 70mg/mmol aim to keep blood pressure below 130/80mmHg
what is primary and secondary prevention of cardiovascular risk?
Offer statin for primary prevention depending on calculated cardiovascular risk
•Offer statin for secondary prevention regardless of baseline lipid
•Aspirin should only be offered as secondaryprevention.
what drugs are used to aid management of CKD?
Loop diuretics, to increase urine volume andNa+excretion
•Acetazolamide, to correct metabolic alkalosisassociated with the vomiting due to renalfailure.
•Antihypertensive drugsto control thehypertension associated with chronic renalfailure.•They reduce the rate of decline in renalfunction
.•ACEIs, ARBs
what do Antiemetics do?
control the nausea and vomiting experienced by many patients inlate renal failure.
what does Recombinant human erythropoietin do?
treat the anemia that develops following the lossof a major source of erythropoietin from peritubular cells in the renal cortex.
how do we control Hyperphosphataemia?
Dietary restriction of food with high phosphatecontent (milk, cheese and egg)
•Use of phosphate binding drugs (calcium carbonate& aluminium hydroxide) administered with food
why do we have to take care with drug therapy?
Diminished excretion of drugs primarily excreted via the kidney, may cause drug concentrations to increase dangerously.
•Some drugs are ineffective when renal function deteriorates.
what is the solution used in peritoneal dialysis?
1.5%, 2.5% and 4.25%dextrose conc.
hemodialysis is more efficient than peritoneal dialysis true/ false?
true
what age do they not tend to give transplantations over?
70
what is a frequent effect of a partial or complete urinary tract obstruction?
hydronephrosis - dilation of the renal pelvis
does obstructiions of the urinary tract reduce or increase EGFR
reduce
what are the 3 types of urinary tract obstructions?
extrinsic,
Intramural
Intraluminal
what is the Renal Calculi?
Develop by precipitation of hardly soluble salts in the kidney or the subsequent tubule of the urinary tract
- relation to the impairment of metabolism /filtration and re-absorption
what are the 5 types of renal calculi?
calcium oxalate-Small, smooth or spiky calcium phosphate-Slightly larger more friable uric acid-May be large struvite-staghorn cystine-Pale yellow, may be large
what causes calcium oxalate calculi?
Hyperparathyroidism, hypercalciuria, hypocitraturia, hyperoxaluria, hyperuricosuria
what causes calcium phosphate calculi?
Distal renal tubular acidosis
what causes uric acid calculi?
Low urinary pH, Hyperuricosuria
what causes struvite calculi?
infection with urease-producing microorganisms
what causes cystine calculi?
Cystinuria
what does struvite stones contain?
Contain magnesium- ammonium-phosphate often mixed with significant amount of matrix
what does the matrix entail?
–organic material usually caused by tissue damage
–Urea splitting pathogens promoted growth of infection calculi
what are cystinic stones associated with and why?
Associated with genetic disorder of the amino acid metabolism
•Leads to excretion of large volumes of cystine in urine combined with a urinary pH of 5.5or less
where is the renal papilla located?
In the kidney the renal papilla is the location where the Medullary pyramids empty urine into the renal pelvis
