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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
Q

Where does hydroxylation of vitamin D occur?

A

• First step in the liver - prohormone calcifedol

Second step in the kidney

26
Q

Give three CNS symptoms of CKD

A
  • Neuropathy
    • Seizures
    • Coma
27
Q

Give three general symptoms of CKD?

A
  • Tiredness
    • Breathlessness

Restless legs

28
Q

How likely is a patient to require dialysis compared to their changes of having a CVS event?

A

• More likely to have CVS event than to require dialysis

29
Q

What is a normal range of GFR?

A

• 80-120 ml/min

30
Q

How can you compare current GFR of patient to normal GFR?

A
  • % of normal GFR

* Use inulin clearance of 24hr creatinine clearance

31
Q

What is inulin clearance?

A
  • Extract inulin
    • Infuse inulin into patient until steady plasma state
    • Measure it’s presence in the urine over a given rate
32
Q

What is 51Cr EDTA?

A
  • Measure radioactivity
    • Expensive
    • Radioactive
33
Q

What is creatinine clearance?

A
  • Patient collects urine over 24hrs

* Delivered to lab, blood sample taken

34
Q

What is eGFR and what must be taken into account when finding it?

A
  • Estimated GFR used to assess creatinine clearance

* Must take into account age, sex, gender and ethnicity

35
Q

Why is creatinine clearance not a perfect marker of renal function?

A
  • 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
Q

What is creatinine?

A
  • Muscles produce creatine, which is converted to creatinine in blood
    • Levels determined by muscle mass and kidney function
37
Q

Why is age taken into account when measuring creatinine?

A

• Lower muscle mass when old

38
Q

Why is gender taken into account when measuring creatinine?

A

Females have lower muscle bulk

39
Q

Why is ethnicity taken into account when measuring creatinine?

A

• Some ethnicitys have a higher muscle mass

40
Q

Give three ways of imaging the kidney

A
  • Ultrasound to look at size and hydronephrosis
    • CT
    • MRI
41
Q

Give three ways of assessing cause of CFK

A
  • Autoantibody screen
    • Complement
    • Immunoglobulin A
    • CRP
42
Q

What does treatment of CFK aim to do?

A

• Delay progression

43
Q

Give five modifiable risk factors of CKF

A 
• Lifestyle 
		○ Smoking
		○ Obesity
		○ Exercise
	• Treat diabetes 
	• Blood pressure
	• ACE inhibitor 
	• Statins
44
Q

When is Renal Replacement Therapy indicated?

What are the two types?

A
  • 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
Q

Give five indications for dialysis

A
  • Uraemic symptoms
    • Acidosis
    • Pericarditis
    • Fluid overload
    • Hyperkalaemia
46
Q

What are two types of dialysis

A
  • Haemodialysis

* Peritoneal dialysis

47
Q

What is haemodialysis

A
  • 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
Q

What is an arteriovenous fistulae?

A
  • A connection between an artery and vein

• Difference in pressure means vein dilates and developes a muscular wall, which provides vascular access

49
Q

Why is an AV fistula required?

A
  • Increases strength of vein

* Increases blood flow through vein

50
Q

What is used to keep blood flowing smoothly in dialysis

A

An anti-clotting agent

51
Q

Give three advantages of haemodialysis

A
  • Effective (survivors >25 years
    • 4/7 days free from treatment
    • Dialysis dose easily prescribed
52
Q

Give five disadvantages of haemodialysis

A
  • Fluid/diet restriction
    • Limits holidays
    • Access problems
    • CVS instability
    • High capital cost
53
Q

What is peritoneal dialysis?

A
  • 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
Q

Give 5 advantages of peritoneal dialysis

A
  • Low technology
    • Home technique
    • Easily learned
    • Allows mobility
    • CVS stability
55
Q

Give 6 disadvantages of peritoneal dialysis

A
  • Frequent exchanges
    • No long term survivors yet
    • Peritonitis
    • Frequent treatment failure
    • Limited dialysis dose range
    • High revenue cost
56
Q

Who is considered for a kidney transplant?

A

• All patients with progressive CKD or end-stage renal failure

57
Q

Give four sources of kidney transplants

A
  • 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
Q

Where is a kidney put when it is transplanted?

A
  • Iliac fossa

* Allows it to be easily connected to iliac vessels and the bladder

59
Q

Give five advantages of kidney transplantation

A
  • Restores near normal renal function
    • Allows mobility and rehabilitation
    • Improved survival
    • Good long term results

Cheaper than dialysi

60
Q

Give five disadvantages of kidney transplantation

A
  • 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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