Renal Pathology Flashcards
Describe Chronic Kidney Disease (CKD).
CKD is the progressive loss of renal function, resulting in the failure of the body to maintain electrolyte balance.
Slow, irreversible impairment of renal excretory/regulatory function.
Describe the aetiology (causes) of CKD.
- Chronic glomerulonephritis (inflammation of the glomeruli)
- Long term infection e.g., Tuberculosis
- Autoimmune disorders
- Nephrotoxic agents
- Kidney infection/kidney stones
Describe some clinical complications of CKD (at least 5 of the below).
- Protein energy malnutrition (wasting)
- Fluid and sodium retention
- Hyperkalaemia
- Dyslipidaemia (high cholesterol)
- Uraemia (high serum urea)
- Metabolic acidosis (elevated pH due to lack of acid filtration by kidneys)
- Hypertension
- Gout (due to build up of uric acid)
- Anaemia (due to inability of kidney to produce EPO = low RBC production)
Describe some the risk factors for CKD.
Diabetes
- the leading cause of CKD and ESRD
- high blood sugar causes damage to the kidneys
Obesity
Age
- 60+ years at highest risk
High blood pressure
Smoking
Describe some methods of preventing CKD.
- be a healthy weight
- control blood pressure
- control blood sugar
- stop smoking
- reduce salt intake
- consume a healthy diet
Describe some clinical manifestations of CKD within the various body systems (neurological, gastrointestinal, blood, respiratory, cardiovascular & skin).
Neurological
- confusion
- lack of concentration
- personality change
- seizures (rare)
Gastrointestinal
- nausea and vomiting
- constipation or diarrhoea
- mouth ulceration
Blood
- anaemia (due to lack of EPO production and consequent low RBC production)
Respiratory
- thick sputum
- build up of fluid on lungs
- shortness of breath (linked to anaemia)
- inflammation of lung tissue
Cardiovascular
- hyperkalaemia
- dyslipidaemia (high cholesterol, low HDL, high LDL & VLDL)
- hypertension
- oedema
- pericarditis
Skin
- thin hair
- weak and brittle nails
Describe the approach to managing/treating CKD.
Who is involved?
Management of CKD involves treating the underlying cause of CKD e.g., controlling blood glucose.
Once the cause of kidney damage is found, the aim is to repair the kidneys, restore kidney function, and prevent the build up of waste whilst kidneys heal.
Requires involvement from a multidisciplinary team:
- Renal nurse
- Renal dietitian
- Nephrologist
- Pharmacist
Describe the three treatment approaches/methods for CKD.
Pharmacological
- antihypertensives (reduce blood pressure)
- diuretics (reduce blood pressure)
- low dose dopamine (causes renal artery dilation)
- antibiotics (treat associated infection)
Nutritional
- low protein, high energy diet
- low potassium: 40-60mEq/day
- low sodium: < 2g/day
CKD stages 1-3 includes the reduction of all modifiable CVD risks
CKD stages 4-5 includes more specialist dietary intervention
Fluid and electrolyte balance
- intravenous solution administered to rebalance fluid/electrolyte concentration (tailored to the patient based on their electrolyte status)
kidney function returns when fluid balance is restored.
Describe End Stage Renal Disease (ESRD) and the treatment methods.
ESRD is the final stage of CKD, where the kidneys no longer function to meet the needs of the body.
ESRD is permanent kidney damage.
The only treatment methods for ESRD are:
- Dialysis
- Kidney transplant (Renal Replacement Therapy)
Explain the two types of dialysis to treat ESRD.
Haemodialysis
- most common form of dialysis used
- artificial kidney machine
- waste products diffuse across a semi-permeable membrane into a dialysate
Peritoneal dialysis
- less common
- patients own peritoneum is used as the dialysing membrane
Explain RRT (kidney transplant) to treat ESRD.
Healthy kidney from a donor is transplanted into patient suffering from ESRD and performs the normal kidney function that the recipient’s failed kidney cannot perform.
Transplanted kidney is placed in the iliac area outside of the peritoneal cavity.
Kidney donor is usually a close relative.
Success of kidney transplant depends on similar HLA antibodies between donor and recipient.
Everyone has different HLA antigens (except for identical twins). Therefore, the recipient immune system will attempt to destroy/reject the donated kidney. Donor and recipient must have similar HLA antigens for transplant to be successful.
Immunosuppressants are given to the recipient after the transplant to reduce risk of immune system rejecting the transplanted kidney.
