Renal Disease/Treatments Flashcards

1
Q

What process does dialysis involve?

A

diffuse across semi permeable membrane

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2
Q

What does dialysis allow for the infusion of?

A

bicarbonate

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3
Q

What does dialysis remove toxin wise?

A

urea, potassium, sodium

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4
Q

What restrictions are placed on patients during dialysis?

A

fluid, salt, potassium and phosphate intake

phosphate binders taken with meals

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5
Q

What is the gold standard of dialysis access?

A

fistula

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6
Q

What else could be used as well as fistula?

A

tunneled venous catheter - but higher risk of infection

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7
Q

What is intradialytc hypotension and why is it a problem?

A

removing large volumes of water 3 times a week instead of continously is bad - can lead to low BP

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8
Q

What is peritoneal dialysis?

A

diffusion across peritoneal membrane

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9
Q

What is osmosis of water out driven by during PD?

A

high glucose concentration

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10
Q

What are the two types of PD?

A

CAPD (continous)

APD (automated)

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11
Q

What problems may arise with PD?

A

infection
Hernias (increased abdo pressure)
membrane failure due to fluid overload

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12
Q

What should you do if membrane failure occurs in PD?

A

switch to HD

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13
Q

What are metabolic complications of dialysis?

A
photphate retention
low vit D
hypocalcaemia
High PTH
anaemia
sodium/water retention
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14
Q

What can dialysis do to cardiovascular disease?

A

accelarate it

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15
Q

What GFR should cause you to start dialysis?

A

<5

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16
Q

What urea should start dialysis?

A

> 45

17
Q

When else should you start dialysis?

A

resistant hyperkalaemia
unresponsive acidosis
based on symptoms

18
Q

Why do you need to gradually build up HD treatment?

A

disequilibrium syndrome may occur

leads to cerebral oedema/ seizures

19
Q

What is the commonest cause of end stage renal failure?

A

diabetes

20
Q

What is the second commonest cause of end stage renal failure?

A

chronic Glomerulonephritis

21
Q

What is an important treatable cause of Acute Renal Failure.

A

Acute glomerulunephritis

22
Q

Define glomerulonephritis.

A

Immune-mediated disease of the kidneys affecting the glomeruli
(with secondary tubulointerstitial damage)

23
Q

In GN what leads to haematuria and/or proteinuria?

A

disruption of size and charge barrier

24
Q

In GN, damage to what leads to a proliferative lesion and red cells in urine?

A

endothelial or mesangial cells

25
Q

In GN, damage to what leads to a non-proliferative lesion and protein in urine?

A

podocytes

26
Q

How is GN diagnosed?

A

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

27
Q

What is involved in nephrItic syndrome?

A
Acute Renal Failure
Oliguria
Oedema/ Fluid retention
Hypertension
Active urinary sediment
RBC’s, RBC & Granular Casts

Indicative of a proliferative process

28
Q

What is involved in nephrOtic syndrome?

A
Proteinuria  3 g/day (mostly albumin, also globulins)
Hypoalbuminaemia (<30)
Oedema 
Hypercholesterolaemia
Usually normal renal function

Indicative of a non proliferative process

29
Q

How is GN classed in terms of primary and secondary?

A

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

30
Q

In what other ways can GN be classed?

A

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)

31
Q

What is the commonest cause of nephrotic syndrome in children?

A

Minimal Change Nephropathy

32
Q

What is the commonest cause of nephrotic syndrome in adults (35%)?

A

FOCAL SEGMENTAL GLOMERULOSCLEROSIS

33
Q

What is the commonest GN in the world?

A

IgA Nephropathy

34
Q

What type of rapidly progressive glomerulonephritis is ANCA positive?

A

Systemic Vasculitis
Wegener’s granulomatosis
(Granulomatosis with polyangiitis)
Microscopic polyangiitis

35
Q

What type of rapidly progressive glomerulonephritis is ANCA negative?

A

Goodpasture’s disease-Anti-GBM
Henoch Scholein Purpura HSP/IgA
Systemic Lupus Erythematosus