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module 104 - theme 3 > renal failure and its management > Flashcards

renal failure and its management Flashcards

1
Q

what are the possible dietary interventions for renal failure?

A
  • energy/kcal
  • protein
  • potassium
  • phosphate
  • fluid/salt
  • fibre
  • vitamins and minerals
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2
Q

what needs to be assessed for each individual patient?

A
  • trend blood results
  • type (AKI or CKD) and stage of kidney disease
  • type of treatment
  • fluid balance
  • malnutrition risk
  • other health conditions
  • medications
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3
Q

what is the role of nutrition in preserving kidney function?

A
  • avoiding excess protein/improving diet quality
  • optimising blood glucose
  • optimising blood pressure
  • weight management
  • keeping active
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4
Q

why do patients need to avoid excess protein/improve their diet quality?

A
  • inefficient filtering increases net endogenous acid (NEAP) and accelerates nephron damage
  • decreasing animal proteins/increasing fruit, veg and fibre reduces NEAP
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5
Q

what are some modifiable risk factors and nutrition management that can be done to help with renal failure?

A
  • optimise blood glucose levels in patients with diabetes
  • meticulous control of hypertension
  • reduce dietary sodium
  • smoking cessation
  • regular exercise
  • reduce alcohol consumption
  • careful monitoring of anti-hypertensive agents alongside dietary interventions
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6
Q

why do you need to balance fluids?

A

hypervolaemia:

  • oedema
  • pleural effusions
  • hypertension
  • congestive heart failure
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7
Q

what are the important differentials of fluids?

A
  • poor diabetes control
  • urine output has decreased
  • patient is unaware of fluid restriction
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8
Q

what is the treatment for hyperkalaemia/hypokalaemia?

A

low/increased potassium diet

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9
Q

what food are high in potassium?

A
  • bananas
  • mushrooms
  • parsnips
  • chips
  • jacket potato
  • coffe
  • mik
  • chocolate
  • marmite
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10
Q

what are the important differentials of potassium?

A
  • acidosis
  • inadequate dialysis dose
  • medications
  • poor diabetic control
  • constipation
  • blood transfusions
  • haemolysed samples
  • catabolism/sepsis
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11
Q

what foods are high in phosphate?

A
  • dairy produces
  • oily fish
  • shellfish
  • offal
  • nuts/chocolate
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12
Q

what are phosphate binders?

A
  • often required in addition to low phosphate diet
  • prescribed to take with means
  • difficult to remember for some patients
  • lots of different types/preparations
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13
Q

what are the important differentials for phosphate?

A
  • binders taken at wrong time
  • unable to swallow binders
  • forgetting to take binders
  • binder dose needs titrating up
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14
Q

what is eGFR?

A

estimated glomerular filtrate rate

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15
Q

how is eGFR calculated?

A

mathematically derived from the serum creatine level, age, sex and race

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16
Q

what is a ‘normal’ GFR?

A

> 90 mL/min

17
Q

what are the treatment choices for renal failure?

A
  • kidney transplant
  • peritoneal dialysis
  • home haemodialysis
  • physidia: new technology
  • unit haemodialyis + satellite haemodialysis
  • maximum conservative care
18
Q

what needs to be reviewed in the blood?

A
  • eGFR
  • urea
  • creatinine
  • Hb
  • transferrin saturation
  • potassium
  • phosphate
  • vaccinations
  • hepatitis B surface antibody
19
Q

what does chronic kidney disease consist of?

A
  • reduced kidney function
    AND/OR
  • kidney damage
20
Q

what are the 4 common multiple injurious stimuli of chronic kidney disease?

A
  • diabetes
  • hypertension
  • vascular disease
  • hyperfiltration
21
Q

what is the GFR of chronic kidney disease stage 1?

A

> 90

22
Q

what is the GFR of chronic kidney disease stage 2?

A

60-89

23
Q

what is the GFR of chronic kidney disease stage 3a?

A

45-59

24
Q

what is the GFR of chronic kidney disease stage 3b?

A

30-44

25
Q

what is the GFR of chronic kidney disease stage 4?

A

15-29

26
Q

what is the GFR of chronic kidney disease stage 5?

A

<15

27
Q

what are the 3 common types of cardiovascular disease found in chronic kidney disease?

A
  • atherosclerosis
  • arteriosclerosis
  • uremic cardiomyopathy
28
Q

what are the benefits of good management of chronic kidney disease?

A
  • prevent or slow progression to renal failure
  • reduce morbidities
  • improve quality of life
  • reduce costs
29
Q

what is GFR equal to?

A

the sum of all the filtration rates in all of the functioning nephrons

30
Q

what goes wrong as your kidneys fail?

A
  • accumulation of waste (uraemia)
  • fluid balance
  • electrolyte balace: hyperkalaemia
  • endocrine: anaemia and bone chemistry
  • acid base balance: acidosis
31
Q

what is the significance of proteinuria?

A
  • indicative of glomerular disease (leaky glomerular basement membrane)
  • proteinuria itself is nephrotoxic (causes downstream renal tubular cell damage)
  • marker for increased risk of progression of renal disease
  • major benefit from lower BP target, and ACE inhibitors
32
Q

how do you measure proteinuria?

A
  • dipstick is inaccurate can miss proteinuria
  • different ranges of normal for people with or without diabetes
  • no need for 24h urine collection
  • spot urine same for protein
  • all patients with CKD stage 3 or worse should have proteinuria measured at least once
33
Q

what is acute kidney injury?

A

a rapid decline in excretory kidney function

34
Q

what are the are and pre-morbid comorbidities of acute kidney injury?

A
  • pre existing chronic kidney disease
  • age >60
  • diabetes
  • cardiac failure
  • liver disease
35
Q

what are the laterogenic/pathological derangements for acute kidney injury?

A
  • sepsis
  • hypovolaemia
  • hypotension
  • contrast
  • post-op
  • drugs
36
Q

what are the potentially reversible/actively treatable causes of acute kidney injury?

A
  • obstruction
  • rapid progressive glomerulonephritis
  • multiple myeloma
37
Q

what are the indications for urgent renal replacement therapy?

A
  • uncontrollable fluid overload
  • uncontrollable severe metabolic acidosis
  • uncontrollable hyperkalaemia
  • uraemic pericarditis/encephalopathy

module 104 - theme 3 (13 decks)

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