Renal Failure Flashcards by Anouk Wijeratne

What indicates hypovoleamia?

Cold hands
No visible JVP
Reduced capillary refill
Low BP

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Why would a patient have a high respiratory rate with normal O2 and clear lungs on auscultation?

Respiratory compensation in response to metabolic acidosis

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What is Kussmaul respiration?

Hyperventilation to breathe of CO2

O2 goes up

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What is the state of the kidneys in CKD?

Small shrunken kidneys

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What is interesting about salt and water balance?

Can cause kidney failure

Can be a symptom

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What does kidney failure result in re salt and water?

REDUCE secretion of salt and water leading to:
Hypertension
Oedema
Pulmonary oedema

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When might water loss be seen?

BUT Salt and water loss may be seen in tubulointerstitial disorders – damage to concentrating mechanism
& hypovolemia may be the cause of AKI.

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What do you give to treat hyperkalaemia?

Bicarbonate
To reduce H+
So potassium can return to cell

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What causes hyperkalaemia?

↓ Distal tubule potassium secretion

Acidosis

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What are the symptoms of hyperkalaemia?

Cardiac arrhythmias
Neural and muscular activity
Vomiting

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What do the symptoms of hyperkalemia depend on?

Chronicity

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What are the ECG findings for arrhythmias caused by hyperkalaemia?

Peaked T waves
P wave - broadens 
	- reduced amplitude -	- disappears
QRS widening
Heart block
Asystole
VT/VF

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What does reduced erythropoietin cause?

Anaemia

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What does reduced Vit D result in?

Reduced intestinal calcium absorption

Hypocalcaemia

Hyperparathyroidism

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What is a major predictor of end stage renal failure?

CKD
BUT
Major outcome for a patient with CKD is cardiovascular disease
i.e. a patient with CKD is more likely to die from cardiovascular disease than end stage renal failure

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How do you treat hypovolaemia?

Fluidshttps://www.brainscape.com/decks/11272691/cards/quick#

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How do you treat hypervolaemia?

Diuretics if there is sustained urine ouput

Dialysis

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How do you treat hyperkalaemia?

Drive into cells

sodium bicarbonate
insulin dextrose (caution)

Drive out of the body – diuretics/dialysis

Gut absorption – potassium binders, stay in gut, excreted via faeces

What is the long term conservative management for kidney failure?

erythropoietin injections to correct anaemia
diuretics to correct salt water overload
phosphate binders
1.25 vit d supplements
symptom management

What is the ultimate aim in renal failure?

Transplantation if fit enough

Why would you opt for conservative mangement?

Sometime dialysis would not be hugely beneficial

Dialysis is not very pleasant

What home therapy is available?

Heamodialysis

Peritoneal dialysis/Assisted programmes

What in centre therapy is available?

Haemodialysis

4 hours, 3 times a week

How is a fistula created?

Connect artery to vein

Vein swells up - easy to get needles in to

What should be avoided in kidney patients?

Taking blood or IV lines into the veins in the ante-cubital fossa Avoiding transfusions in transplantable patients

Why do you avoid transfusions?

Sensitisation can risk transplant success

What are the features of using Creatinine to assess GFR?

Affected by muscle mass, age, race, sex etc. | Need to look at the patient when interpreting the result. TREND helpful.

What are the features of using Creatinine clearance to assess GFR?

Difficult for elderly patients to collect an accurate sample | Overestimates GFR at low GFR (as a small amount of creatinine is also secreted into urine)

What are the features of using radionuclide to assess GFR?

EDTA clearance etc Reliable but expensive Used for donated kidneys to check function prior to transplantation

How does haemodilaysis work?

Blood flows into dialyzer Countercurrent movement (blood and dialysate) Via diffusion the blood is cleaned Fresh dialysate is pumped in and used pumped out Doctor can adjust property of dialysate solution according to the patients need

How does peritoneal dialysis work?

Dialysate pumped into peritoneal cavity Peritoneum acts as semi-permeable membrane Diffusion occurs Dialysiate pumped out via catheter

What are the pros and cons of haemodialysis?

Dialysis centre visits (can be performed at home) | 3-4.5 hours of treatment 3x a a week

What are the pros and cons of peritoneal dialysis?

What factors are considered in determining a candidate as a suitable live kidney donor?

``` Patient fitness Good kidney function Psychological assessment Blood type - but you can transplant against blood type Tissues type (HLA, serum crossmatch) Kidney size No blood/protein in urine Financial stability (of work for 4 weeks) Age Future pregnancy Comorbidities Family history of kidney disease ```

What advice should be given to those post transplant?

``` Low salt Hygiene No grapefruit Manage BP Use sunscreen Be mindful of psychiatric disorders Regular fluid intake ```

Why is the old kidney left in situ?

Operative risk of removing is significant

When would you remove the old kidney?

Concern in the native kidney e.g. cancer/TB Polycystic kidneys - too bug

What should be avoided after having a transplant?

Raw eggs/meat Undercooked fish and unpasteurised chsses Seville oranges/marmalade/grapfruit 0 can interact with immunosupressants No live vaccines No smoking No NSAIDS/Herbal meds No alcohol

What should be avoided after having a transplant?

Raw eggs/meat Undercooked fish and unpasteurised chsses Seville oranges/marmalade/grapefruit - can interact with immunosupressants No live vaccines No smoking No NSAIDS/Herbal meds No alcohol

What investigations are done for CKD?

Bloods - high creatinine, low eGFR Urinalysis (haem/protein/albuminuria) Renal US (kidney size)

What is the conservative management for CKD?

Stop nephrotoxic drugs Manage underlying cause Diet - sodium/protein restriction Smoking cessation

What is the medical management for CKD?

ARB or ACEi Loop diuretic e.g. fureosmide Statin if hyperlipidaemia

What is interventional management of CKD?

Renal replacement therapy - Haemodialysis - Peritoneal dialysis - Kidney transplant