Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

104: Theme 3 - 304 - Renal > Renal failure & its management symposium > Flashcards

Renal failure & its management symposium Flashcards

1
Q

What stimuli contribute to causing the following?

  • Glomerulosclerosis
  • Interstitial Scarring
  • Tubular atrophy
A
  • Diabetes
  • Hyperfiltration
  • Vascular disease
  • Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the classification of Chronic Kidney Disease

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How should proteinuria be measured?

A
  • Spot urine sample for protein: creatinine or albumin: creatinine ratio
  • all patient with CKD stage 3+ should have proteinuria measured at least once
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is normal and abnormal Proteinuria in non-diabetics?

A

Normal

  • ACR <_ 30 mg/mmol
  • PCR <_ 50mg/mmol

Abnormal

  • ACR > 30 mg/mmol
  • PCR > 50mg/mmol
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is normal and abnormal Albuuminuria in diabetics (men and women)?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the target BP and treatment in CKD in patients with PCR <50 mg/mmol?

A
  • BP target:140/90
  • NICE 120-139/<90
  • ACE inhibitors optional
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the target BP and treatment in CKD in patients with PCR between 50-99 mg/mmol?

A
  • BP target 140/90
  • NICE 120-139/<90
  • Use ACE inhibitors as the first line
  • Refer only if haematuria also present, or progressive GFR decline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the target BP and treatment in CKD in patients with PCR >_ 100 mg/mmol?

A
  • BP target <130/80
  • NICE 120-129/<80
  • Use ACE inhibitors as first line
  • Refer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is staging/ classification of Acute Kidney Injury?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is ESRF?

A

End-stage Renal Failure

  • mortality increase with age and in incidents of diabetes in younger patients (around 45)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What assessment can be made for AKI?

  • using an acronym
A
  • Sepsis: identity/screen and teat
  • Toxins: drugs/ iv contrast
  • Optomis BP/volume statute: withhold diuretics/ antihypertensive?
  • Prevent harm: identify other causes i.e obstruction, review medication and fluid does and prescription
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 main categories/ types of AKI?

A
  • Pre-renal AKI
  • Intrinsic AKI
  • Post-renal AKI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the cause of Pre-renal AKI?

A
  • Sepsis
  • TOxins: IV contrast
  • Hypotension: V&D, Diuretics, Haemorrhage, burns, medication ACEi, cardiac failure
  • Hepatorenal syndrome: linked with portal hypertension and liver cirrhosis
  • Renal artery stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the cause of Post-renal AKI?

A
  • Kidney stones
  • Prostatic hypertrophy (enlarged prostate causes occlusion of the urethra)
  • Tumours
  • Retroperitoneal fibrosis (Ormand’s disease): excess fibrous tissue develops in the space behind your stomach and intestine- the retroperitoneal area
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the cause of Intrinsic AKI?

A
  • Acute tubular injury: prolonge pre-renal, nephrotoxins
  • Tubulointerstitial injury
  • Glomerulonephritis
  • Myeloma
  • Lupus Nephritis (an autoimmune disease)
  • Vasculitis: ANCA ( antineutrophil cytoplasmic antibody-associated) autoimmune disease
  • Haemolytic uraemic syndrome (HUS): the destruction of platelets, also affects blood vessels and RBC
  • TTP: Thrombotic Thrombocytopenic Purpura- blood clots found in small blood vessels, a severe decrease in platelets, and destruction of RBC
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What symptoms would indicate urgent renal replacement?

A
  • Uncontrollable fluid overload
  • Uncontrollable, severe metabolic acidosis
  • Uncontrollable hyperkalaemia
  • Uraemic pericarditis/encephalopathy

(poisoning ethylene glycol, lithium NSAIDs)

17
Q

What drug would cause issues at stage 3A CKD?

  • eGFR 45-59
A
  • Metformin: used in diabetes
  • increased lactate production
  • results in lactic acidosis
  • most other drugs would be fine to metabolism at this level
18
Q

What needs to be considered in drug distribution when administering drugs?

A
  • whether the drug needs to be protein-bound e.g warfarin and phenytoin
  • both bound to albumin
  • if albumin level is low as they may be in renal failure, the free phenytoin or warfarin is increased which isn’t effective
19
Q

How is Vitamin D absorbed?

A
20
Q

What needs to be assessed for kidney patients?

A
  • the trend of the BLood results
  • type of kidney disease and the stage
  • type of treatment the patients is on: dialysis transplant, conservative management
  • Fluid balance: weight, urine output, observation
  • Malnutrition risk (MUST
  • other heat conditions: diabetes, CVD
  • the medications the patients are on
21
Q

How should fluid be balanced in renal patients?

A
  • No kidney function 500-750mls per day
  • Impaired kidney function- generally encourage to drink
  • Transplant- Generally drink lots post-transplant, to make sure transplant is well perfused (can be difficult for previous dialysis patients)
  • Haemodialysis- 500mls plus the amount of urine passed over 24-hour
  • Peritoneal dialysis- 750mls plus 24-hour urine
22
Q

What differentials may impact a patients fluid balance?

A
  • poor diabetic control can make a patient more thirsty
  • decreased urine output (rapid weight gain due to water retention)
  • the patient is unaware of fluid restriction
23
Q

What is the target potassium levels for dialysis and low clearance levels?

and what is the importance of K

A
  • Dialysis: 4-6mmol/L
  • Low clearnace: 3.2-5.5mmol/L
  • muscle and cardiac function
24
Q

What are some other differential causes for high potassium levels?

A
  • Acidosis
  • Inadequate dialysis dose
  • Medications (especially ACE inhibitors), some diuretics as well
  • Poor diabetic control
  • Constipation
  • Blood transfusions
  • Haemolysed samples
  • Catabolism/sepsis/ infection
25
Q

What are the targets for phosphate for dialysis and low clearance patients?

what is the treatment for high and low levels?

A
  • 1.1 – 1.7 mmol/L dialysis.
  • 0.9 – 1.5 mmol/L low clearance

high phosphate- Low phosphate diet plus phosphate binders (these can be difficult to adhere to check up on patient)/ alfacalcidol (PTH)

low phosphate - Low PO4: Assess malnutrition risk, especially in renal patients

26
Q

What are the target protein levels?

A
  • Targets: 0.8g/ kg ideal body weight low clearance and transplant patients
  • 1-1.2g/ kg ideal body weight dialysis patients
27
Q

What nutrient advice is useful for end-stage kidney disease?

A
  • avoid fat-soluble vitamins, e.g A, D E and K
  • routine supplementation of water-soluble vitamins for all dialysis patients
28
Q

How can kidney function be preserved?

A
  • Avoiding excess protein and salt
  • Optimising blood glucose
  • Optimising blood pressure
  • Weight management
  • Optimising nutrition
  • Keeping active
29
Q

What needs to be considered for managing nutrition for multiple health conditions?

  • what conditions need nutrition to be managed?
A

• Special diet burnout

  • Diabetes
  • Malnutrition
  • Obesity
  • Gastro complications

• Depression

30
Q

What are the 3 categories of renal patients?

A
  • Stable poor renal patients
  • Renal function deteriorating
  • Renal patient deteriorating, chosen conservative management

104: Theme 3 - 304 - Renal (5 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions