renal failure and its management Flashcards
1
Q
what is chronic kidney disease? 2
A
- Kidney function- GFR <60mL/min/1.73 m2 for > 3 months with or without kidney damage
- AND/ OR
kidney damage- >3 months, with or without decreased GFR, manifested by either pathological abnormalities (markers of kidney damage) or urine albumin to creatinine ratio
2
Q
what happens in the kidney in chronic kidney disease? 7
A
- Diabetes
- Hypertension
- Vascular disease
- Hyperfiltration
- Glomerulosclerosis
- Interstitial scarring
- Tubular atrophy
3
Q
whaat is the pathogenesis of the manifestations of CKD? 6
A
- We have a large physiologic reserve of renal functional mass
- Each kidney has at least 1 million nephrons
- Slow, progressive loss of functioning nephrons may not be noticeable
- This triggers maladaptive compensatory mechanisms
- Either the loss of renal function or the adaptations to reduced renal function led to the manifestations of kidney failure
- The person with CKD may not feel different (silent disease)
4
Q
describe cardiovascular disease in CKD? 3
A
- Atherosclerosis
- Arteriosclerosis
- Uremic cardiomyopathy
5
Q
what are the benefits of good CKD management? 4
A
- Prevent or slow progression to renal failure
- Reduce morbidities
- Improve quality of life
- Reduce costs
6
Q
describe the relationship between Cr and actual clearance?
A
not linear
7
Q
describe GFR vs estimated GFR? 4
A
- GFR is equal to the sum of the filtration rates in all of the functioning nephrons
- Actual GFR (inulin clearance) is not routinely measured in clinical settings
- Estimated GFR gives a rough measure of the number of functioning nephrons
- The normal range for population is not the normal range for an individual with plasma creatinine
8
Q
what is the significance of proteinuria? 4
A
- Indicative of glomerular disease (leaky glomerular basement membrane)
- Proteinuria 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
9
Q
how do we measure proteinuria? 4
A
- Dipstick is inaccurate and can miss significant proteinuria
- Different ranges of normal for people with or without diabetes
- No need for 24-hour urine collection
- Spot urine sample for protein: creatinine or albumin: creatinine ratio is usually sufficient
10
Q
what are the lifestyle measures for CKD?3
A
- Careful diuretic history
- Salt restriction
- Stop smoking
11
Q
what is acute kidney injury? 2
how do we diagnose it?
distant organ effects? 2
A
- A rapid decline in excretory kidney function
- Has a significant mortality risk from infection and CVD
- Could be made within 6hours of oliguria or within 48hours of 50% rise in Cr
- AKI morbidity and mortality remains high
- Inflammatory condition which leads to distant organ dysfunction
12
Q
what patients are at increased risk of AKI? 8
A
- Pre-existing CKD >60 - Diabetes, cardiac failure, liver disease - Sepsis - Hypovolaemia - Hypotension - Contrast - Post-op - Drugs
13
Q
what are the reversible and treatable causes of AKI? 3
A
- Obstruction
- Rapidly progressive glomerulonephritis
- Multiple myeloma
14
Q
what are the 3 different types of AKI and 3 things that cause each one?
A
- pre-renal AKI= sepsis, toxins, hypotension
- post-rena AKI= kidney stones, prostatic hypertrophy, tumours
- intrinsic AKI= acute tubular injury, glomerulonephritis, myeloma
15
Q
what is the AKI assessment?
A
- S- sepsis- screen and test
- T- toxins- drugs/ iv contrast
- O- optimise BP/ volume status
- P-prevent harm (identify cause, treat complications)
