Renal Flashcards
What symptoms should you ask about in a CKD history?
Restless Legs Anaemia Sx Fatigue Pruritis Bone Pain Uraemic Fetor Weight Breathlessness Appetite Gout Peripheral Neuropathy
Causes of CKD
Hypertension Infection Diabetes Drugs Exotic - SLE Nephritis
Why do you place cannulas far apart as possible in diaylsis?
To avoid recirculation loop
What are the disadvantages of central venous dialysis?
Causes more a recirculation loop cause dual lumen next to each other
Higher infection and thrombosis rates
Inadaquete flow rates
Risks of pneumothorax, air embolous, arterial puncture
What causes the thrill over the fistula?
Arterial blood flow
Which vessels are usually connected?
Radiocephalic then when both have failed brachiocephalic
Features of CAPD
Tenckhoff catheter Less expensive than haemodialysis More convenient eg holidays Easy technique Mainly have to stop due to peritonitis Eventual fibrosis of peritoneal membrane 3l of fluid 4x/day with half hour exchanges
What is removed during CAPD?
Urea Creatinine Potassium Phosphate - all along conc gradient w/ isotonic fluid Water removed with hypertonic fluid
Problems with CAPD?
Social Anorexia Peritonitis Malaise
Investigations for severity of CKD
Urine microscopy - infection, casts
FBC - anaemia of chronic disease
U+E - eGFR (vague indicator of disease severity)
Cr clearance
24hr urinary protein
Serum urate + phosphate - retained
Calcium, Alk phos - low calc and high ALP suggests renal bone disease
Indications for dialysis
Progressive decline in renal function Symptomatic uraemia Volume overload Co-morbid: pericarditis, bone disease, hyperkalaemia (All despite treatment)
Causes of CKD
HTN Infection Diabetes Drugs Exotic (lupus, vasculitis) Nephritis
AV fistula
Arterial blood causes thrill Usually cephalic, if radiocephalic thromboses then use brachiocephalic In order to access high pressure high flow arterial blood without scarring up artery from repeated stabs
Av fistula: Complications
Infection Stenosis Thrombosis Bleeding Steal syndrome - distal tissue ischemia from bypassing circulation)
AV fistula: Counseling
Body image - long sleeves Avoid tight clothing/watches Don’t shave arm Don’t let anyone take BP or blood Avoid trauma
CKD: Signs
Pigmentation Pruritis Pulmonary edema Peripheral neuropathy Parathyroid overactivity Painful big toe (gout) Pericarditis
Renal bone disease: Types
Osteoporosis Hyperparathyroidism Osteomalacia Osteosclerosis
Renal bone disease: Symptoms
A symptomatic Low back pain Brachydactyly Acronecrosis
Symptoms of Uraemia
Pruritis Lethargy Anorexia Nausea/vom Cramps Mental/visual change Thirst
Diet changes for CKD
Low phosphate (beans,nuts,greens) Low potassium (bananas, coffee, chocolate) Low fluids (1l/day)
Temporary/Emergency access for dialysis
Uncuffed central venous catheter
only short term eg AKI
Semi permenant access for dialysis
e.g when waiting for fistula formation
tunnelled cuffed catheter TCC dual lumen placed in superior vena cava/right atrium
Complications of haemodialysis
Headache, muscle cramps, itching
Hypotension
Hypokalaemia
Disequilibrium syndrome - if urea falls too quickly osmotic pressure on brain side of BBB relatively high → cerebral edema
Fluid imbalance
Infection, stenosis, thrombosis
Aneurysm
Amyloid
Which factors are considered when calculating eGFR?
CAGE
Cr
Age
Gender
Ethnicity
Factors which can affect eGFR (Cr)
Pregnancy
Muscle Mass
Red Meat
eGFR kidney disease
>90 = stage 1 CKD = only with other kidney path
60-90 = stage 2 only with other kidney path
30-59 = stage 3 = moderate
15-29 = stage 4 = severe
<15 = stage 5 = transpant/dialysis
What is the definition of an AKI?
26+ rise Cr in 48h
50% rise Cr in 7 days
drop in UO to 0.5ml/kg/hr for 6hrs (8hrs kids)
