S12 CKD Flashcards
What is adult polycystic kidney disease?
Autosomal dominant, mutation in either: PKD 1 gene (85%) or PKD 2 gene.
Cysts can occur in kidneys or liver and grow with age, diagnosed with US.
Define CKD?
The irreversible and sometimes progressive loss of renal function over months to years.
Renal injury causes renal tissue to be replaced by
extracellular matrix in response to tissue damage
What changes occur to the kidney in CKD?
The kidney becomes shrunken with an irregular outline, histology shows scar tissue, loss of tubules and replacement with fibrous tissue.
What are the causes of CKD?
Diabetes, hypertension, genetic (APCKD, Alport’s), infection (pyelonephritis), systemic disease (DM, myeloma).
What sign predicts the development of end stage renal disease?
Proteinuria
How is renal function measured in CKD?
Measure GFR using inulin or creatinine
Measure serum creatinine and then calculate eGFR
What investigations help diagnose CKD?
Blood tests: U+E, LFT, FBC
Imaging: USS (size), CT, MRI (stones)
Biopsy: considered if kidneys normal size and cause of CKD unknown
Acidosis is a complication of CKD, describe it
May affect muscle, bone and renal function progression. Treat with oral NaHCO3.
Anaemia is a complication of CKD, why does it occur?
Decreased erythropoietin production or resistance to erythropoietin, decreased RBC survival, blood loss. Treat with iron, then EPO injections.
Mineral and bone disorders are a complication of CKD, describe what occurs
Abnormal Ca2+/phosphorus metabolism.
Can cause renal osteodystrophy leading to rugger jersey spine
NB kidney usually excretes phosphate but in CKD it accumulates, suppressing Ca
What is the effect of CKD on bone?
Decreased GFR causes increased phosphate, which decreases calcium, which increases PTH, which causes osteitis fibrosa cystica.
Decreased GFR decreases amount of active vitamin D, which decreases calcium and increases PTH and also leads to osteomalacia
What is the management for the effects of CKD on bone?
Reduce phosphate intake
What are the affects of CKD on the kidneys water/salt handling functions?
Reduced GFR so less able to dilute urine
Decreased response to ADH so get osmotic diuresis and nocturia
What are the affects of CKD on the kidneys ability to control acid-base disturbances?
Generally asymptomatic but can get oedema, hyperkalaemia, acidosis
What are the affects of CKD on the kidneys ability to remove waste products?
Waste products accumulate causing increased urea, nausea, vomiting
What are the affects of CKD on the kidneys endocrine functions?
Altered endocrine functions such as RAAS and erythropoietin (causing anaemia)
What is end stage renal disease and what are its symptoms?
The final stage of CKD
Tiredness, insomnia, SOB, eGFR <15
Why do patients often feel tired in CKD?
Due to less O2 to muscles from anaemia, caused by reduced erythropoietin and increased blood loss
What is the management for CKD?
Lifestyle: smoking, obesity, lack of exercise
Treat DM, hypertension
ACEi in proteinuria
Stop PPI
What are the three form of renal replacement therapy?
Haemodialysis
Peritoneal dialysis
Kidney transplant
What is haemodialysis?
Artery fistula with a vein to make the vein under more pressure, then takes blood to dialyzer.
4 hours, 3 times a week, in hospital
What are the pros and cons of hameodialysis?
Pros: less responsibility
Cons: travel time
What are the pros and cons of home haemodialysis?
Pros: don’t need to travel away from home
Cons: need someone with you
What is peritoneal dialysis?
Waste products cross semi-permeable membrane into peritoneal space, toxins and water absorbed then drained out from peritoneal space into external drainage bag.
What are the pros and cons of peritoneal dialysis?
Pros: self-sufficiency
Cons: bag needs frequent/overnight exchanges
What are the pros and cons of kidney transplant in CKD?
Pros: decreased mortality and morbidity, better quality of life
Cons: peri-operative risk, infection risk
