renal failure and its management Flashcards
what are the possible dietary interventions for renal failure?
- energy/kcal
- protein
- potassium
- phosphate
- fluid/salt
- fibre
- vitamins and minerals
what needs to be assessed for each individual patient?
- trend blood results
- type (AKI or CKD) and stage of kidney disease
- type of treatment
- fluid balance
- malnutrition risk
- other health conditions
- medications
what is the role of nutrition in preserving kidney function?
- avoiding excess protein/improving diet quality
- optimising blood glucose
- optimising blood pressure
- weight management
- keeping active
why do patients need to avoid excess protein/improve their diet quality?
- inefficient filtering increases net endogenous acid (NEAP) and accelerates nephron damage
- decreasing animal proteins/increasing fruit, veg and fibre reduces NEAP
what are some modifiable risk factors and nutrition management that can be done to help with renal failure?
- 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
why do you need to balance fluids?
hypervolaemia:
- oedema
- pleural effusions
- hypertension
- congestive heart failure
what are the important differentials of fluids?
- poor diabetes control
- urine output has decreased
- patient is unaware of fluid restriction
what is the treatment for hyperkalaemia/hypokalaemia?
low/increased potassium diet
what food are high in potassium?
- bananas
- mushrooms
- parsnips
- chips
- jacket potato
- coffe
- mik
- chocolate
- marmite
what are the important differentials of potassium?
- acidosis
- inadequate dialysis dose
- medications
- poor diabetic control
- constipation
- blood transfusions
- haemolysed samples
- catabolism/sepsis
what foods are high in phosphate?
- dairy produces
- oily fish
- shellfish
- offal
- nuts/chocolate
what are phosphate binders?
- often required in addition to low phosphate diet
- prescribed to take with means
- difficult to remember for some patients
- lots of different types/preparations
what are the important differentials for phosphate?
- binders taken at wrong time
- unable to swallow binders
- forgetting to take binders
- binder dose needs titrating up
what is eGFR?
estimated glomerular filtrate rate
how is eGFR calculated?
mathematically derived from the serum creatine level, age, sex and race
what is a ‘normal’ GFR?
> 90 mL/min
what are the treatment choices for renal failure?
- kidney transplant
- peritoneal dialysis
- home haemodialysis
- physidia: new technology
- unit haemodialyis + satellite haemodialysis
- maximum conservative care
what needs to be reviewed in the blood?
- eGFR
- urea
- creatinine
- Hb
- transferrin saturation
- potassium
- phosphate
- vaccinations
- hepatitis B surface antibody
what does chronic kidney disease consist of?
- reduced kidney function
AND/OR - kidney damage
what are the 4 common multiple injurious stimuli of chronic kidney disease?
- diabetes
- hypertension
- vascular disease
- hyperfiltration
what is the GFR of chronic kidney disease stage 1?
> 90
what is the GFR of chronic kidney disease stage 2?
60-89
what is the GFR of chronic kidney disease stage 3a?
45-59
what is the GFR of chronic kidney disease stage 3b?
30-44
what is the GFR of chronic kidney disease stage 4?
15-29
what is the GFR of chronic kidney disease stage 5?
<15
what are the 3 common types of cardiovascular disease found in chronic kidney disease?
- atherosclerosis
- arteriosclerosis
- uremic cardiomyopathy
what are the benefits of good management of chronic kidney disease?
- prevent or slow progression to renal failure
- reduce morbidities
- improve quality of life
- reduce costs
what is GFR equal to?
the sum of all the filtration rates in all of the functioning nephrons
what goes wrong as your kidneys fail?
- accumulation of waste (uraemia)
- fluid balance
- electrolyte balace: hyperkalaemia
- endocrine: anaemia and bone chemistry
- acid base balance: acidosis
what is the significance of proteinuria?
- 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
how do you measure proteinuria?
- 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
what is acute kidney injury?
a rapid decline in excretory kidney function
what are the are and pre-morbid comorbidities of acute kidney injury?
- pre existing chronic kidney disease
- age >60
- diabetes
- cardiac failure
- liver disease
what are the laterogenic/pathological derangements for acute kidney injury?
- sepsis
- hypovolaemia
- hypotension
- contrast
- post-op
- drugs
what are the potentially reversible/actively treatable causes of acute kidney injury?
- obstruction
- rapid progressive glomerulonephritis
- multiple myeloma
what are the indications for urgent renal replacement therapy?
- uncontrollable fluid overload
- uncontrollable severe metabolic acidosis
- uncontrollable hyperkalaemia
- uraemic pericarditis/encephalopathy
