Renal Disease/Treatments Flashcards
What process does dialysis involve?
diffuse across semi permeable membrane
What does dialysis allow for the infusion of?
bicarbonate
What does dialysis remove toxin wise?
urea, potassium, sodium
What restrictions are placed on patients during dialysis?
fluid, salt, potassium and phosphate intake
phosphate binders taken with meals
What is the gold standard of dialysis access?
fistula
What else could be used as well as fistula?
tunneled venous catheter - but higher risk of infection
What is intradialytc hypotension and why is it a problem?
removing large volumes of water 3 times a week instead of continously is bad - can lead to low BP
What is peritoneal dialysis?
diffusion across peritoneal membrane
What is osmosis of water out driven by during PD?
high glucose concentration
What are the two types of PD?
CAPD (continous)
APD (automated)
What problems may arise with PD?
infection
Hernias (increased abdo pressure)
membrane failure due to fluid overload
What should you do if membrane failure occurs in PD?
switch to HD
What are metabolic complications of dialysis?
photphate retention low vit D hypocalcaemia High PTH anaemia sodium/water retention
What can dialysis do to cardiovascular disease?
accelarate it
What GFR should cause you to start dialysis?
<5
What urea should start dialysis?
> 45
When else should you start dialysis?
resistant hyperkalaemia
unresponsive acidosis
based on symptoms
Why do you need to gradually build up HD treatment?
disequilibrium syndrome may occur
leads to cerebral oedema/ seizures
What is the commonest cause of end stage renal failure?
diabetes
What is the second commonest cause of end stage renal failure?
chronic Glomerulonephritis
What is an important treatable cause of Acute Renal Failure.
Acute glomerulunephritis
Define glomerulonephritis.
Immune-mediated disease of the kidneys affecting the glomeruli
(with secondary tubulointerstitial damage)
In GN what leads to haematuria and/or proteinuria?
disruption of size and charge barrier
In GN, damage to what leads to a proliferative lesion and red cells in urine?
endothelial or mesangial cells
In GN, damage to what leads to a non-proliferative lesion and protein in urine?
podocytes
How is GN diagnosed?
CLINICAL PRESENTATION
BLOOD TESTS
EXAMINATION of URINE
Urinalysis - haematuria, proteinuria
Urine microsopy - RBC (dysmorphic), RBC & granular casts, lipiduria
Urine Protein: Creatinine Ratio / 24 hour urine - quantify proteinuria
KIDNEY BIOPSY
What is involved in nephrItic syndrome?
Acute Renal Failure Oliguria Oedema/ Fluid retention Hypertension Active urinary sediment RBC’s, RBC & Granular Casts
Indicative of a proliferative process
What is involved in nephrOtic syndrome?
Proteinuria 3 g/day (mostly albumin, also globulins) Hypoalbuminaemia (<30) Oedema Hypercholesterolaemia Usually normal renal function
Indicative of a non proliferative process
How is GN classed in terms of primary and secondary?
Primary (Idiopathic): THE MAJORITY
Secondary: caused by eg. infections or drugs associated - malignancies or part of systemic disease eg. ANCA - associated systemic vasculitis, lupus, Goodpastures, HSP
In what other ways can GN be classed?
Proliferative or non-proliferative
Focal/Diffuse (50% glomeruli affected?)
Global/Segmental (all or part glomerulus affected)
Crescentic (presence of crescents - epithelial cell extracapillary proliferation eg. RPGN in vasculitis)
What is the commonest cause of nephrotic syndrome in children?
Minimal Change Nephropathy
What is the commonest cause of nephrotic syndrome in adults (35%)?
FOCAL SEGMENTAL GLOMERULOSCLEROSIS
What is the commonest GN in the world?
IgA Nephropathy
What type of rapidly progressive glomerulonephritis is ANCA positive?
Systemic Vasculitis
Wegener’s granulomatosis
(Granulomatosis with polyangiitis)
Microscopic polyangiitis
What type of rapidly progressive glomerulonephritis is ANCA negative?
Goodpasture’s disease-Anti-GBM
Henoch Scholein Purpura HSP/IgA
Systemic Lupus Erythematosus
