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Semester 3 - Urinary > Session 11 - Chronic Kidney Disease > Flashcards

Session 11 - Chronic Kidney Disease Flashcards

1
Q

Define chronic kidney failure

A

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

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2
Q

What is the underlying pathology of chronic kidney failure?

A

• Function renal tissue is replaced by extra-cellular matrix, which gives rise to glomerulosclerosis and tubular intersitial fibrosis

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3
Q

What does a diseased kidney do?

A
  • Shrinks

* Fibrosis

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4
Q

What does chronic kidney failure result in?

A
  • Progressive loss of both the excretory and hormone functions of the kidney
    • Proteinuria and systemic hypertension develops
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5
Q

Give 8 causes of chronic kidney disease

A 
I gave GOD HIV
	• Immunologic
		○ Glomerulonephritis
	• Infection
		○ Pyelonephritis
	• Genetic
		○ Polycystic Kidney Disease (PCK)
		○ Alport’s Syndrome
	• Obstruction and reflux nephropathy
	• Hypertension
	• Vascular
	• Systemic Disease
		○ Diabetes
		○ Myeloma
	• Cause unknown
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6
Q

What are the three most common causes of chronic kidney disease

A
  • Diabetes mellitus
    • Hypertension
    • Glomerulonephritis
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7
Q

What do most patients with CKD have?

A
  • Diabetes
    • Hypertension
    • Ischaemic Heart Disease
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8
Q

What is polycystic kidney disease?

A

• Multiple cysts appear on the kidney

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9
Q

What is Alport syndrome?

A
  • Hereditary nephritis caused by an x-linked mutation

* Proliferating and sclerosing kidney disease

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10
Q

How is Chronic Kidney Disease classified?

A

• By amount of GFR fall and kidney disease

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11
Q

How many stages of chronic kidney disease are there?

A

5

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12
Q

What is stage 1 of chronic kidney disease? GFR, description, clinical diagnosis, %population

A
  • > 90 GFR
    • Kidney damage with normal or increased GFR
    • Need other evidence of kidney damage

3.3% population

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13
Q

What is stage 2 of chronic kidney disease? GFR, description, clinical diagnosis, %population

A
  • 60-89% GFR
    • Kidney damage with mild GFR fall
    • Need other evidence of kidney dmage
    • 3% population
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14
Q

What is stage 3 of chronic kidney disease? GFR, description, clinical diagnosis, %population

A
  • 30-59% fall in GFR
    • Moderate fall in GFR
    • Symptoms +/-

6% population

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15
Q

What is stage 4 kidney disease?

A
  • 15-29%
    • Severe fall in GFR
    • Symptoms ++
    • 0.2% population
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16
Q

What is stage 5 kidney disease

A
  • <10ml/min GFR

* 0.1% population

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17
Q

What is the incidence of CKD?

A
  • 85% have diabetes, hypertension or ischaemic heart disease

* More common in the elderly, ethnic minorities and the socially disadvantaged

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18
Q

Why don’t most patients with CKD end up needing dialysis?

A

High cardiovascular mortality at all stages of CKD

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19
Q

Give four systems affected by CKF

A
  • CVS
    • Haematological
    • Musculoskeltal
    • CNS
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20
Q

What does CKF cause in the CVS system?

A
  • Atherosclerosis
    • Cardiomyopathy
    • Pericarditis
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21
Q

What does CKF cause in haemotologically

A

○ Decreased erythropoietin
○ Resistance to erythropoietin
○ Decreased RBC survival

Blood loss

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22
Q

Where is erythropoietin produced?

A

The interstitial fibroblasts in the kidney, in close assocaiation with peritublar capillaries.

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23
Q

What does CKF cause in the bone?

A

• Renal bone disease

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24
Q

Give two forms of renal bone disease

A
  • Decreased GFR means less phosphate is excreted, increasing serum conc. Then forms complexes with free Ca2+, reducing effective serum conc. Stimulated PTH release, causing overactivity of osteoclasts - Osteitis Fibrosa Cystica
    • Less Vitamin D hydroxylated to Calcitriol, causing hyperparathyroidism and osteomalacia
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25
Where does hydroxylation of vitamin D occur?
• First step in the liver - prohormone calcifedol Second step in the kidney
26
Give three CNS symptoms of CKD
* Neuropathy * Seizures * Coma
27
Give three general symptoms of CKD?
* Tiredness * Breathlessness Restless legs
28
How likely is a patient to require dialysis compared to their changes of having a CVS event?
• More likely to have CVS event than to require dialysis
29
What is a normal range of GFR?
• 80-120 ml/min
30
How can you compare current GFR of patient to normal GFR?
* % of normal GFR | * Use inulin clearance of 24hr creatinine clearance
31
What is inulin clearance?
* Extract inulin * Infuse inulin into patient until steady plasma state * Measure it's presence in the urine over a given rate
32
What is 51Cr EDTA?
* Measure radioactivity * Expensive * Radioactive
33
What is creatinine clearance?
* Patient collects urine over 24hrs | * Delivered to lab, blood sample taken
34
What is eGFR and what must be taken into account when finding it?
* Estimated GFR used to assess creatinine clearance | * Must take into account age, sex, gender and ethnicity
35
Why is creatinine clearance not a perfect marker of renal function?
* Someone with a GFR of 40% normal can still have a normal creatinine level * Only accurate in adults and not useful in acute renal failure
36
What is creatinine?
* Muscles produce creatine, which is converted to creatinine in blood * Levels determined by muscle mass and kidney function
37
Why is age taken into account when measuring creatinine?
• Lower muscle mass when old
38
Why is gender taken into account when measuring creatinine?
Females have lower muscle bulk
39
Why is ethnicity taken into account when measuring creatinine?
• Some ethnicitys have a higher muscle mass
40
Give three ways of imaging the kidney
* Ultrasound to look at size and hydronephrosis * CT * MRI
41
Give three ways of assessing cause of CFK
* Autoantibody screen * Complement * Immunoglobulin A * CRP
42
What does treatment of CFK aim to do?
• Delay progression
43
Give five modifiable risk factors of CKF
``` • Lifestyle ○ Smoking ○ Obesity ○ Exercise • Treat diabetes • Blood pressure • ACE inhibitor • Statins ```
44
When is Renal Replacement Therapy indicated? | What are the two types?
* When native renal function declines to a level where it can no longer support health * <10ml/min * RRT is either dialysis or renal transplantation
45
Give five indications for dialysis
* Uraemic symptoms * Acidosis * Pericarditis * Fluid overload * Hyperkalaemia
46
What are two types of dialysis
* Haemodialysis | * Peritoneal dialysis
47
What is haemodialysis
* Requires the creation of an arteriovenous fistula * Vascular access used to connect patient to dialysis machine, which contains highly purified water across a semi-permeable membrane, allowing for blood filtering
48
What is an arteriovenous fistulae?
- A connection between an artery and vein | • Difference in pressure means vein dilates and developes a muscular wall, which provides vascular access
49
Why is an AV fistula required?
* Increases strength of vein | * Increases blood flow through vein
50
What is used to keep blood flowing smoothly in dialysis
An anti-clotting agent
51
Give three advantages of haemodialysis
* Effective (survivors >25 years * 4/7 days free from treatment * Dialysis dose easily prescribed
52
Give five disadvantages of haemodialysis
* Fluid/diet restriction * Limits holidays * Access problems * CVS instability * High capital cost
53
What is peritoneal dialysis?
* Requires peritoneal membrane, blood flow and peritoneal dialysis fluid * Peritoneal dialysis fluid placed in peritoneal cavity and dialysis occurs across the peritoneal membrane * Fluid then drained away and disposed of
54
Give 5 advantages of peritoneal dialysis
* Low technology * Home technique * Easily learned * Allows mobility * CVS stability
55
Give 6 disadvantages of peritoneal dialysis
* Frequent exchanges * No long term survivors yet * Peritonitis * Frequent treatment failure * Limited dialysis dose range * High revenue cost
56
Who is considered for a kidney transplant?
• All patients with progressive CKD or end-stage renal failure
57
Give four sources of kidney transplants
* Cadaver donors * Non-heart beating donors * Living related donors * Altruistic donors * Kids from the backstreet of Nepal you tempted into a backstreet with the promise of free money. Sarah.
58
Where is a kidney put when it is transplanted?
* Iliac fossa | * Allows it to be easily connected to iliac vessels and the bladder
59
Give five advantages of kidney transplantation
* Restores near normal renal function * Allows mobility and rehabilitation * Improved survival * Good long term results Cheaper than dialysi
60
Give five disadvantages of kidney transplantation
* Not all are suitable * Limited donor supply * Operative morbiditiy and mortality * Life long immunosupression * Still left with progressive CKD

Semester 3 - Urinary (33 decks)

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