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Regulation of Body Function > Renal Failure - de Zoysa > Flashcards

Renal Failure - de Zoysa Flashcards

1
Q

What are the key roles of the kidneys?

A 
Elimination of waste products 
Control of fluid balance 
Regulate acid base balance 
Produce hormones 
Regulate electrolytes
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2
Q

GFR?

A

The rate at which blood is cleared of waste products

Normals >/= 120ml/min

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3
Q

AKI vs CKD

A

AKI = hours to days, potentially reversible
CKD =weeks/months/ years
progressive irreversible

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4
Q

ARF vs AKI

A

KDIGO guidelines for AKI
To move away form inconsistent use of diagnosis of acute tubular necrosis and acute renal failure
To highlight that this might be a mini or significant change

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5
Q

staging for AKI

A

there are 3 stages with increasing severity, usually measured by amount of urine output over time.

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6
Q

Types of AKI

A

Pre renal
renal
post renal

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7
Q

Baseline risk - AKI

A 
CKD 
Age > 75 years 
DM 
CHF 
Liver failure 
Nephrotoxic medications 
Past history of AKI
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8
Q

Acute illness patient may get…?

A

Hypotension
Sepsis
Hypovolemia
High EWS

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9
Q

at risk patients?

A 
emergency surgery 
- sepsis or hypovolemia 
intraabdominal surgery 
CKD 
Diabetes 
CHF 
Age > 75 years 
Nephrotoxic medication
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10
Q

General approach

A 
Identify patient at high risk 
Assess and optimise volume status 
stop all nephrotoxic agents 
Review medications - dose adjust or stop 
monitor creatinine and urine output 
Non-invasive diagnostic workup 
invasive diagnostic work up 
Daily weights 
Diet 
targeted therapy
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11
Q

CKD definition

A

Abnormalities of kidney structue or function, presenter >3 months with implications for health.

CKD is classified on cause GFR and albuminuria

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12
Q

Calculating GFR

A

there are several ways to measure GFR

  • clearance of artificially injected substances
  • creatinine clearance

can do inulin and isotope clearance

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13
Q

insulin clearance

A

inulin is a sugar which is filtered by the glomerulus and neither reabsorbed nor secreted into the tubule
The gold standard is to inject inulin into the blood and measure the clearance of inulin in the urine

GFR = (vol urine per time x conc inulin in urine)/conc inulin in blood

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14
Q

creatinine clearance

A

creatinine is produced by creatinine metabolism
is freely filtered by the glomerulus thus can be used to estimate the GFR
Is also secreted in small amounts by the tubules
thus the creatinine clearance tends to overestimate the GFR
Serum creatinine also reflects body size and muscle mass

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15
Q

What does moderate to severe CKD do to CrCl (creatinine clearance)

A

the presence of moderate to severe CKD also confounds the interpretation of CrCl
As glomerular filtration declines, extra renal excretion of creatinine increases and there is decreased muscle mass
This results in an overestimation of GFR in patients nearing end stage renal disease

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16
Q

Cockcroft anf Gault formula

A

eCrCl = [(140-age) xWt x (1.23M or 1.04F)] / SCr

then another complicated formula to estimate eGFR from Scr with age, ethnicity and gender

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17
Q

Albuminuria

A

Is also a marker for renal disease and prognosis

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18
Q

Sociodemographic risk factors for CKD

A 
Age
sex 
ethnicity 
low income 
obesity 
smoking
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19
Q

causes of CKD

A

Diabetic neuropathy
Glomerulonephritis
Hypertensive nephrosclereosis
Polycystic kidney disease

20
Q

progression of CKD

A

Lack of control of the primary disease will lead to progression of CKD to end stage kindly disease
Irrespective of the primary factors secondary factors will develop which are likely to contribute to progression.

21
Q

Secondary factors

A 
Systemic hypertension 
Intra-glomerular hypertension 
glomerular hypertrophy 
calcium and phosphate 
Dyslipidemia 
Protinuera 
tubulo- intervista fibrosis 
Toxicity of iron / ammonia / middle molecules.
22
Q

Slowing progression

A

Intervention to the primary renal disease

Intervention into secondary factors

23
Q

Hypertension and CRF

A 
progression of CRF has been linked to hypertension 
Lowering BP alters speed of progression 
target 140/80mmHg or better 
Weight loss 
salt restriction 
exercise 
moderation of alcohol 
stop smoking
24
Q

HT treatment

A

lifestyle
naturesis (diuretics)
Renin: angiotensin
Sympathetic nervous system

25
Q

Proteinuria

A

important prognostic factor
In a wide range of GN outcome is determined by the degree of proteinuria
reduction of proteinuria improves outcome

26
Q

Modifying proteinuria

A

important prognostic factor
In a wide range of GN outcome determined by degree of proteinuria
Reduction of prtoinuria improves outcome

27
Q

Modifying proteinuria

A 
weight loss 
ACE-I + AIIRB 
Aldosterone antagonists 
Statins 
Moderate protein restriction 
BP < 125/70mmHg
28
Q

Smoking associated with the progression of?

A

non-diabetic and diabetic kidney disease

29
Q

Dyslipidemia

A

common

No proof of benefit in terms of preservation of renal function

30
Q

Calcium and phosphate

A

Ca and Ph content of the kidney increased in experimental CRF and ESRF
Increased Ca/P product is associated with progressive renal impairment and decline in renal function
Improvement of the Ca/P product is associated with reduction in the rate of decline

31
Q

Calcium / phosphate management

A

Limiting phosphate in the diet
Phosphate blinders e.g. calcium carbonate
Typically aim for CaxP less than 4.5

32
Q

Water balance

A

the kidneys regulate the volume state

With CKD patients are more prone to both dehydration and volume overload

33
Q

Electrolyte regulation

A

Sodium, potassium, calcium, phosphate

34
Q

Acid base regulation

A

the kidneys are the long term regulatory mechanism of maintenance of pH
Typically with CKD a metabolic acidosis develops due to a lack of excretion of non-organic acids
Addition of oral sodium bicarbonate may be required

35
Q

Uraemia

A

Uraemia - the manifestation of organ dysfunction typically seen in CKD 4and 5
Uraemia syndrome resembles a systemic intoxication
unfortunately no single compound has been found to produce the clinical picture of uraemia

36
Q

Uraemic manifestations of neuro

A 
fatigue and lethargy 
sleep disturbances 
Headache 
Seizures 
Encepalpoathy 
peripheral neuropahty 
paralysis
37
Q

uraemia - haematological

A

anaemia
bleeding tendency
platelet dysfunction
infection

38
Q

Uraemia - cardiovascular

A 
pericardidits 
hypertension 
Heart failure 
IHD 
Cardiomyopathy 
CVA 
PVD
39
Q

Uraemia pulmonary

A

pleuritis

Uraemic lung

40
Q

uraemia - GI tract

A

Anorexia
Nausea
Vomiting
GI bleeding

41
Q

uraemic - metabolic

A 
Glucose intolerance 
hyperlipidima 
malnutrition 
Sexual dysfunciton 
osteodysplasia
42
Q

uraemia - skin

A

Pigmentation
easy bruising
Uraemic frost
Pruritus

43
Q

Uraemia - psychological

A

Depression
Anxiety
Denial
Psychosis

44
Q

Uraemia management

A 
Treat the primary disease 
Treat secondary factors 
Avoid nephrotoxins 
correct abnormalities - haemoglobin 
- calcium phosphate PTH 
- other electrolytes 
- Acid base balance 
- Volume 
Renal replacement therapy
45
Q

ESKD treatment options

A 
Conservative 
Dialysis - peritoneal 
- haemodyalysis 
Renal transplant 
- cadaveric 
- living

Regulation of Body Function (31 decks)

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