Renal failure Flashcards
What are the two causes of kidney failure?
Chronic kidney disease
Acute kidney injury
What is chronic kidney disease?
Slow progressive and irreversible
Commonly due to diabetes mellitus or hypertension
What is acute kidney injury?
Rapid onset (hours to days)
Systemic illness and medication
Reversible with treatment
How is kidney function measured?
Serum creatinine
Estimated glomerular filtration rate
What are the three stages of acute kidney injury?
Stage 1: 50-100% increase in creatinine
Stage 2: 100-200% increase
Stage 3: over 200% increase
Who suffers from chronic kidney disease?
Diabetes mellitus Hypertension NSAIDs Elderly Genetic
What are risk factors for chronic kidney disease?
Increased age Hypertension Diabetes Smoking Poor education
Who develops acute kidney injury?
Older people Diabetes mellitus Hypertension Heart disease Liver disease Chronic kidney disease
What are the complications of loss of kidney function?
Anaemia Hypertension Disturbed calcium/phosphate homeostasis Cardiovascular disease Bone disease Immune suppression Bleeding tendency
What happens if salt and water homeostasis fails?
Inability to concentrate urine
Inability to excrete water leading to oedema
Sodium retention leading to hypertension and CNS dysfunction
What happens if potassium homeostasis fails?
Hyperkalaemia
Alterations in membrane excitability
Cardiac arryhthmia
What if acid base homeostasis fails?
Systemic acidosis
Dyspnoea
Enzyme function failure
Reduced cardiac function
What hormones are produced by the kidneys?
Vitamin D
Erythropoietin
Renin
What are symptoms of vitamin D not being produced?
Hypocalcaemia Muscle spasm Cardiac rhythm problems Hyperparathyroidism Bone fragility Soft tissue calcification
What happens if erythropoietin is not made?
Anaemia Reduced exercise capacity Impaired cognition Transfusion requirement Iron overload
What happens if metabolic waste products aren’t excreted?
Accumulation of toxic waste products Retention of nitrogenous waste Percarditis Gout (retention of urate) Cardiovascular disease (retention of phosphate)
Which drugs will not be metabolised if renal failure occurs?
Insulin Opiates Antibiotics Sedatives Digoxin
When is renal replacement therapy used?
Chronic kidney disease stage 5
Acute kidney disease stage 3
What is renal replacement therapy?
Dialysis
Transplantation
Conservative care
What is dialysis?
Extracorporeal therapy where fluid and solutes are removed or added to the patients blood
Not as good as own kidneys
What is peritoneal dialysis?
Peritoneum is filled and then drained
Needs a permanent peritoneal catheter
Lasts 8-10 years
Risk of peritonitis
What are the two types of dialysis?
Haemodialysis
Peritoneal dialysis
What is haemodialysis?
4 hours three times per week
Lasts indefinitely
Why have a kidney transplant?
Better life expectancy
Better quality of life
Replaces all renal function
Describe a kidney transplant
Usually in iliac fossa
Outside peritoneum
Iliac vessels
Native kidneys left in situ
Where do kidneys come from?
Cadaveric donor
Living donor
What is required for a successful kidney transplantation?
Matching blood and tissue type
Immunosuppressants
