Urinary 13 - CKI Flashcards
Describe CKI:
Irreversible loss of renal function over months/years, where damaged renal tissue is replaced by extracellular matrix
List the main causes of CKI:
- Immunologic (glomerulonephritis)
- Infection
- Genetic (polycystic kidney disease, Alport etc.)
- Obstruction (stones, enlarged prostate)
- Hypertension
- Vascular
- Systemic disease (DM, Myeloma)
- Unknown
List the risk factors for CKI:
- Increasing age
- Ethnic minorities
- Multi-morbid
- Socially disadvantaged
- Female > Male
- Nephrotoxins
- Decreased kidney perfusion
- Hyperlipidaemia
- Hyperphosphataemia
Give 5 nephrotoxins:
1) Myoglobin
2) Urate
3) Drugs
4) Poisons
5) Bilirubin
How is CKI classified?
According to GFR and ACR (Albumen:Creatinine ratio)
List the symptoms of CKI:
- Pruritus
- Fatigue
- Breathlessness
- Restless legs
- Sleep reversal
- Aches + Pains
- Nausea + Vomiting
- Chest pain
- Seizures
What are the 3 main complications of CKI?
1) Acidosis
2) Anaemia
3) Mineral/Bone disorders
How does CKI lead to anaemia?
CKI is the loss of renal function = decreased GFR
When GFR < 30 = decreased erythropoetin production
= Decreased RBC production = blood loss`
What is renal osteodystrophy?
Pathological bone changes due to abnormal levels of calcium and phosphate in blood, due to increased PTH in CKI
How does CKI affect serum phosphate, calcium, calcitriol and PTH?
- Increases serum phosphate
= Decreases serum calcium - Decreases calcitriol
= Increases PTH
Changes due to decreased GFR
What is a pathological bone change associated with CKI, seen in the spine?
‘Rugger jersey spine’
Sclerosis of end plates, giving sclerotic-lucent-sclerotic pattern
Due to hyperparathyroidism
What is Calciphylaxis?
Vascular calcification and skin necrosis associated with CKD
Why are CKI patients susceptible to Osteomalacia?
CKI = decreased GFR = decreased Calcitriol
= decreased calcification level per bone unit
= softening of bone
What are the symptoms of Osteomalacia?
- Bone pain
- Back ache
- Muscle weakness
- Fractures (commonly femoral neck, spine, ribs, pubic ramus)
What USS finding is common in CKI?
Small shrunken kidneys
What are the 2 types of dialysis available?
1) Haemodialysis
2) Peritoneal dialysis
What are the advantages of haemodialysis?
- Little responsibility for patient
- Days off
- Proven effectiveness
What are the disadvantages of haemodialysis?
- Hospital-based = ^^ cost
- Time consuming (travel/waiting time)
- Fluid + Diet restrictions
- CVS access problems = Fistula creation - ugly
- 19 pills/day
What type of fistula is usually created to aid access for haemodialysis?
Radiocephalic
What are the main complications of haemodialysis?
- Infection
- Thrombosis
- Venous stenosis
- CVS instability
Define dialysis:
Diffusion of solutes across a semi-permeable membrane.
- Allows removal of waste products and water from the blood
Name the 2 types of peritoneal dialysis:
1) Continuous Ambulatory PD
2) Automated PD
What is the main difference between Continuous Ambulatory PD, and Automated PD:
CAPD = dialysis throughout the day (4/5 bags per day) APD = dialysis throughout night
What are the advantages of Peritoneal dialysis?
- Self-sufficient
- Independent
- Home technique
- Easy-to-learn
- Allows mobility
- CVS stability
- Less fluid/food restriction (compared to haemodialysis)
What are the disadvantages of peritoneal dialysis?
- Frequent daily exchanges
- Responsibility of patient
- Peritonitis likely
- ^^ cost
- Body image problem
- 10 pills + injection per day
What is the most common complication of peritoneal dialysis (occurs ~ 1/20 months)?
Peritonitis
If patient with ESRD has had a hernia in the past, which type of dialysis should they have, and why?
Haemodialysis
Hernia weakens abdo wall, so peritoneal dialysis fluid would leak out of peritoneal cavity.
What is the gold standard treatment of ESRD?
Kidney transplant
What are the 3 types of kidney donation, in order of expected lifespan from longest to shortest:
1) Live donor (longest lifespan)
2) Deceased after brain death
3) Deceased after circulatory death
Kidney donations are matched to a patient according to what 4 factors?
- ABO blood type
- HLA (or MHC)
- Age
- Time on waiting list
What is the average waiting time for a kidney transplant?
~ 3 yrs
What are the disadvantages of a kidney transplant?
- Operative, Infection & Malignancy risk
- Requires immunosuppressive drugs
Side effects = tremor, hypertension, diabetes, headaches, nausea, diarrhoea, weight gain
