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Year 2 Uro > Renal Failure > Flashcards

Renal Failure Flashcards

1
Q

What are the homeostatic functions of the kidney?

A

Electrolyte balance
Acid-base balance
Volume homeostasis

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2
Q

What are the endocrine functions of the kidney?

A

Erythropoietin

1 alpha hydroxylase

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3
Q

What are the excretory functions of the kidney?

A 
Nitrogenous waste
Hormones
Peptides
Middle sized molecules”
Salt and water
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4
Q

How is the kidney involved in glucose metabolism?

A

Gluconeogenesis

Insulin clearance

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5
Q

What happens when the homeostatic function is compromised?

A 
Increase potassium
Decreased bicarb
Decreased pH
Increased phosphate
Salt and water imbalance
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6
Q

What happens when the excretory function is compromised?

A

Increased urea
Increased creatinine
Decreased insulin requirement

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7
Q

What happens when the endocrine function is compromised?

A

Decreased calcium
Anaemia
Increased PTH - tertiary hyperparathyroidism possible

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8
Q

Overall what does Kidney failure increase risk of?

A

Cardiovascular problems

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9
Q

What is the clinical presentation related to?

A

Rate of deterioration

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10
Q

What is the most important thing to asses with renal failure?

A

Blood volume

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11
Q

What indicates hypovoleamia?

A

Cold hands
No visible JVP
Reduced capillary refill
Low BP

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12
Q

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

A

Respiratory compensation in response to metabolic acidosis

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13
Q

What is Kussmaul respiration?

A

Hyperventilation to breathe of CO2

O2 goes up

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14
Q

What is the state of the kidneys in CKD?

A

Small shrunken kidneys

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15
Q

What is interesting about salt and water balance?

A

Can cause kidney failure

Can be a symptom

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16
Q

What does kidney failure result in re salt and water?

A

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

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17
Q

When might water loss be seen?

A

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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18
Q

What do you give to treat hyperkalaemia?

A

Bicarbonate
To reduce H+
So potassium can return to cell

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19
Q

What causes hyperkalaemia?

A

↓ Distal tubule potassium secretion

Acidosis

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20
Q

What are the symptoms of hyperkalaemia?

A

Cardiac arrhythmias
Neural and muscular activity
Vomiting

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21
Q

What do the symptoms of hyperkalemia depend on?

A

Chronicity

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22
Q

What are the ECG findings for arrhythmias caused by hyperkalaemia?

A 
tented T waves
P wave - broadens - - reduced amplitude -	- disappears
QRS widening
Heart block
Asystole
VT/VF
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23
Q

What does reduced erythropoietin cause?

A

Anaemia

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24
Q

What does reduced Vit D result in?

A

Reduced intestinal calcium absorption

Hypocalcaemia

Hyperparathyroidism

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25
Q

What do the effects on metabolism result in?

A

Increased risk of CVD

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26
Q

What is a major predictor of end stage renal failure?

A

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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27
Q

What are standard cardiovascular risks?

A

Hypertension
Diabetes
Lipid abnormalities

28
Q

What are the additional cardiovascular risks in renal faliure?

A

Inflammation
Oxidative stress
Mineral/bone metabolism disorder

29
Q

How do you treat hypovolaemia?

A

Fluids

30
Q

How do you treat hypervolaemia?

A

Diuretics if there is sustained urine ouput

Dialysis

31
Q

How do you treat hyperkalaemia?

A

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

32
Q

What is the long term conservative management for kidney failure?

A
  • erythropoietin injections to correct anaemia
  • diuretics to correct salt water overload
  • phosphate binders
  • 1.25 vit d supplements
  • symptom management
33
Q

What is the ultimate aim in renal failure?

A

Transplantation if fit enough

34
Q

Why would you opt for conservative mangement for renal failure?

A

Sometime dialysis would not be hugely beneficial

Dialysis is not very pleasant

35
Q

What home therapy is available?

A

Heamodialysis

Peritoneal dialysis/Assisted programmes

36
Q

What in centre therapy is available?

A

Haemodialysis

4 hours, 3 times a week

37
Q

How is a fistula created?

A

Connect artery to vein

Vein swells up - easy to get needles in to

38
Q

What should be avoided in kidney patients?

A

Taking blood or IV lines into the veins in the ante-cubital fossa

Avoiding transfusions in transplantable patients

39
Q

Why do you avoid transfusions?

A

Sensitisation can risk transplant success

40
Q

What are the features of using Urea to assess GFR?

A

Poor indicator

Confounded by diet, catabolic state, GI bleeding (bacterial breakdown of blood in gut), drugs, liver function etc.

41
Q

What are the features of using Creatinine to assess GFR?

A

Affected by muscle mass, age, race, sex etc.

Need to look at the patient when interpreting the result. TREND helpful.

42
Q

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

A

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)

43
Q

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

A

Laborious - used for research purposes only

best way to calculate GFR

44
Q

What are the features of using radionuclide to assess GFR?

A

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

45
Q

What is the GFR equation? MDRD

A

GFR (mL/min/1.73m2) = 175 x (SCr)-1.154 x (Age)-0.203 x (0.742 if female) x (1.212 if Afr American)

46
Q

What is the GFR equation? (CKD-EPI)

A

GFR = 141 x min (SCr/K,1)-α x max (SCr/K,1)-1.209 x 0.993Age x 1.018 [if female] x 1.159 [if black]

47
Q

What are the different methods of dialysis?

A

Haemodialysis

48
Q

How does haemodilaysis work?

A

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

49
Q

How does peritoneal dialysis work?

A

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

50
Q

What are the pros and cons of haemodialysis?

A

Dialysis centre visits (can be performed at home)

3-4.5 hours of treatment 3x a a week

51
Q

What are the pros and cons of peritoneal dialysis?

A

-

52
Q

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

A 
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
53
Q

What advice should be given to those post transplant?

A 
Low salt
Hygiene
No grapefruit
Manage BP
Use sunscreen
Be mindful of psychiatric disorders
Regular fluid intake
54
Q

Why is the old kidney left in situ?

A

Operative risk of removing is significant

55
Q

When would you remove the old kidney?

A

Concern in the native kidney e.g. cancer/TB

Polycystic kidneys - too bug

56
Q

What should be avoided after having a transplant?

A

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

57
Q

What should be avoided after having a transplant?

A

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

58
Q

AKI vs CKD history

A

acute vs chronic

history of acute illness e.g gastroenteritis vs history of impaired renal function

59
Q

AKI vs CKD on examination

A

AKI - acutely ill, SOB, arrythmia, fatigue, nausea, may be hypotensive/acidotic/fluid overload
CKD - signs of anaemia, cachexia, grey skin, weak

60
Q

AKI vs CKD bloods

A

AKI - rapidly increasing creatinine, normal calcium, normal-low Hb
CKD - slowly trending increase creatinine, low calcium (untreated), normocytic anaemia

61
Q

ultrasound AKI vs CKD

A

AKI - normal

CKD -scarring, smaller kidneys

62
Q

GFR using renal plasma flow

A

renal plasma flow x filtration fraction

63
Q

GFR using filtration coefficient

A

net ultrafiltration pressure x filtration coefficient

64
Q

renal clearance calculation

A

rate of urine production x concentration of urine / concentration of substance in plasma
in mL/min

65
Q

what are all the functions of the kidneys A WET BED

A 
Acid base balance
Water balance
Electrolyte balance
Toxin removal
Blood pressure control
Erythropoietin
vitamin D metabolism

Year 2 Uro (5 decks)

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