Session 11 Flashcards
Who is at increased risk of CKD?
Elderly, multi-morbid patients, ethnic minorities, socially disadvantaged.
What is chronic kidney disease?
Disease of kidney structure and/or function causing irreversible and sometimes progressive loss of renal function over a period of months to years. Renal tissue is replaced with an extracellular matrix in response to tissue damage.
What is the most common cause of CKD?
Unknown cause.
What visible changes occur in CKD?
Interstitium of the kidney is replaced by fibrous scar tissue; kidneys become smaller and have a more irregular outline; kidney cortex becomes thinner.
How is CKD classified?
GFR is below 60 (Stage G3a), ACR is also used to create a more accurate combined classification.
How does CKD progress?
Kidney function slowly declines, decrease in GFR also increases the risk of cardiovascular death and overall mortality.
What is polycystic kidney disease?
Autusomal dominant condition where multiple cysts form in the kidneys, causes reduced kidney function and patients usually need dialysis by age 50.
What complications may occur due to CKD?
Acidosis and anaemia if very low GFR; mineral and bone disorders.
How does CKD cause metabolic bone disease?
Decreased GFR decreases active vit D levels and increases phosphate levels. Decreased active vid D causes osteomalacia and increased PTH. Increased phosphate levels causes reduced calcium levels causing increased PTH levels. Increased PTH causes osteitis fibrosis cystica.
How does renal osteodystrophy present on x-ray?
Rugger jersey spine due yo end plate sclerosis, erosion of terminal phalanges, bone cysts.
How is CKD prevented in at risk groups?
Stop smoking, lose weight if obese, increase exercise, treat diabetes, treat BP, ACE-I/ARBs if proteinuria, reduce lipid levels.
When is renal replacement therapy offered to CKD patients?
If renal function declines to a point where it isnt adequate to support health.
Define end stage renal failure.
eGFR is below 15; death is likely without renal replacement therapy.
What are the common symotoms of ESRD?
Tiredness, difficulty sleeping, difficulty concentrating, volume overload, nausea, vomiting, reduced appetite, restless legs, cramps, pruritis, sexual dysfunction, increased infections, uraemia, altered drug metabolism, anaemia.
How is haemodialysis performed?
Fistula created between artery and vein, usually brachiocephalic fistula or a tunnel line is inserted, blood removed from body and filtered in dialyzer several times a week. Performed by clinicians in hospital.
What are the contraindications for renal haemodialysis?
Failed vascular access, heart failure, coagulopathy.
What complications can result from haemodialysis?
Infection, thrombosis, venous stenosis, bleeding, access failure, steal syndrome, CVS instability, feeling chronically unwell, acute morbidities.
How is peritoneal dialysis performed?
Catheter inserted into the peritoneal cavity and dialysate is injected; peritoneal membrane acts as dialysis membrane; dialysis fluid is drained periodically and replaced with fresh fluid.
What are the disadvantages of haemodialysis?
Food and fluid restrictions, very time consuming, many medications in addition to dialysis.
What are the disadvantages of peritoneal dialysis?
Patient must be responsible for their own treatment.
What are the contraindications of peritoneal dialysis?
Failures of peritoneal membrane, adhesions, previous abdo surgery, hernia, stoma, patient/career unable to connect and disconnect equipment, obesity, large muscle mass.
What complications can result from peritoneal dialysis?
Peritonitis, exit or tunnel site infections, ultrafiltration failure, scrotal or diaphragmatic leaks, hernias.
Where are kidneys usually transplanted to?
The iliac vessels but may be transplanted onto the IVC.
What type of kidney transplant plant has the best prognosis?
Live donor transplants.
What are the potential side effects of kidney transplants?
High BP, cholesterol or BM; hair loss; headache; GI ulceration; nausea; diarrhoea; low WCC and platelet count; weight gain; DM; gastritis; osteoporosis.
What are the common causes of death in ESRD?
Cardiac disease, cerebrovascular disease, infection, malignancy, treatment withdrawal, uncertain causes.
