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Urinary > Session 11 > Flashcards

Session 11 Flashcards

1
Q

Define Chronic kidney disease

A

The irreversible and sometimes progressive loss of renal function over a period of months to years

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2
Q

How does the kidney often respond to damage?

A

With fibrosis and scarring resulting to a decrease in functioning tissue

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3
Q

What is Chronic kidney disease strongly associated with?

A

An increase in cardiovascular morbidity and mortality

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4
Q

What are some of the different causes of Chronic kidney disease?

A 
Immunologic eg glomerulonephritis
Infection eg pyelonephritis
Genetic eg polycystic kidney disease
Hypertension
Systemic disease eg Diabetes
Idiopathic causes
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5
Q

What is the usual pathology of the kidney in Chronic kidney disease?

A

The Kidneys become smaller and shrunken, usually with a loss of the renal cortex. Tubules and Glomeruli are replaced with scar tissue
Except for in Polycycstic Kidney disease!

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6
Q

How can Chronic kidney disease cause Hypotension?

A

If the kidneys are damaged they may make less Renin which would cause a decrease in the levels of Angiotensin I to be converted to Angiotensin II (By ACE) so less vasoconstriction

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7
Q

What is the GFR in stage 1 of Chronic kidney disease?

A

> 90%
Early
Asymptomatic

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8
Q

What is the GFR in stage 2 of Chronic kidney disease?

A

60-89%

Asymptomatic

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9
Q

What is the GFR in stage 3 of Chronic kidney disease?

A

30-59%

Usually still asymtpomatic

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10
Q

What is the GFR in stage 4 of Chronic kidney disease?

A

15-29%

Symptomatic

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11
Q

What is the GFR in stage 5 of Chronic kidney disease?

A

<15%
Very symptomatic
Established renal failure
Patients usually have to go on dialysis

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12
Q

How can Creatinine clearance be misleading when used as a marker of renal function?

A

Creatinine clearance can still be relatively normal even with a GFR that is severely reduced (To around 40%)

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13
Q

How is GFR measured?

A

An equation is used to calculate eGFR

More accurate for seeing which patients have renal failure

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14
Q

What is Creatinine clearance determined by?

A

Muscle mass
Age
Gender
Ethinicity

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15
Q

What is the normal range for GFR?

A

80-120ml/min

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16
Q

How is Inulin clearance performed?

A

The patient is infused with a known amount of Inulin (An inert substance that is neither reabsorbed or secreted by the kidneys) until the plasma reaches a steady state
Then the amount excreted in the urine is measured

17
Q

When is eGFR NOT useful?

A

In acute renal failure because the GFR is not staying constant
Only accurate in adults

18
Q

How can you assess the cause of Chronic kidney disease?

A

Auto antibody screen
C reactive protein (Increased in response to infection)
ANCA (Anti-neutrophil cytoplasmic antibody)
Ultrasound scan (Size, obstruction)

19
Q

How can Chronic kidney disease cause Anaemia?

A

The kidneys produce Erythropoietin (Stimulates bone marrow to make RBCs) so a decrease in kidney function means a decrease in Erythropoietin production so less is less effect on the bone marrow and less red blood cells are made

20
Q

How can Chronic kidney disease cause Osteitis Fibrosa Cystica?

A

A decreased GFR causes an increase in phosphate due to it not being filtered normally (Stimulates a decrease in calcium)
The kidneys cannot hydroxylate vitamin D into its active form (Less calcium absorbed in the GIT)
Both lead to an increase in Parathyroid hormone

21
Q

What is Osteitis Fibrosa Cystica?

A

Increased Osteoclast stimulation leading to bone breakdown causing them to fracture more easily

22
Q

How can Chronic kidney disease progression be delayed?

A

Treat hypertension (To protect the renal function)
Use ACEi if Proteinuria is present
Lower lipid levels if Hypercholesterolaemia

23
Q

What is Renal replacement therapy?

A

When the native renal function is no longer adequate to support health, the kidneys need to be replaced with either Dialysis or Transplantation
Usually when the GFR is <10 ml/min
~8% of renal function

24
Q

What are some of the indications Dialysis is needed?

A 
Uraemic symptoms (Malaise, tiredness, nausea)
Acidosis
Pericarditis
Fluid overload
Hyperkalaemia
25
Q

What are the 2 types of Dialysis?

A 
Haemodialysis (Can be done at hospital or home)
Peritoneal dialysis (Can only be done at home)
26
Q

What is needed in both types of Dialysis?

A

Highly purified water

27
Q

What is an Arteriovenous fistula?

A

A connection between a vein and artery in the forearm is made. This causes the vein to become more muscular as blood flows from the artery to the vein.
Allowed for better cannulation

28
Q

What artery and vein is usually used to make an Arteriovenous fistula?

A

The Cephallic vein and Radial artery of the forearm

29
Q

What are the advantages of Haemodialysis?

A

Very effective

Only have treatment 3 days a week

30
Q

What are the disadvantages of Haemodialysis?

A

Diet restrictions (Cannot drink much)
Limits travel
CVS instability
High costs

31
Q

What does Peritoneal dialysis require?

A

The peritoneal membrane (Acts as a filter)
Peritoneal blood flow
Peritoneal dialysis fluid (Put into the Peritoneum and drained)

32
Q

How is Peritoneal dialysis done?

A

Peritoneal dialysis fluid emptied into the Peritoneum through a catheter
Waste products diffuse through the Peritoneal membrane into the Peritoneal dialysis fluid from the blood
Peritoneal dialysis fluid drained

33
Q

What are the advantages of Peritoneal dialysis?

A

Home technique
Easily learned
Allows more mobility
CVS stability

34
Q

What are the disadvantages of Peritoneal dialysis?

A

Peritonitis
Frequent exchanges
Has to be done every day?

35
Q

Is there an age cut off for renal transplant?

A

No, but co-morbidities do influence decisions

36
Q

Where is the transplanted kidney placed?

A

In the Iliac fossa and can be connected to the Iliac vessels for blood supply.
The native kidney is left in!

37
Q

What are the advantages of Kidney transplantation?

A

Restores function
Allows mobility
Improved survival
Cheaper than dialysis

38
Q

What are the disadvantages of Kidney transplantation?

A 
Not everyone is suitable
Lack of donors
Operation morbidity/mortality
Life long immunosuppression
Still have the original pathogenesis that is causing Chronic kidney disease

Urinary (14 decks)

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