Urinary 13 - CKI

Question 1

Describe CKI:

Answer 1

Irreversible loss of renal function over months/years, where damaged renal tissue is replaced by extracellular matrix

Question 2

List the main causes of CKI:

Answer 2

• Immunologic (glomerulonephritis)
• Infection
• Genetic (polycystic kidney disease, Alport etc.)
• Obstruction (stones, enlarged prostate)
• Hypertension
• Vascular
• Systemic disease (DM, Myeloma)
• Unknown

Question 3

List the risk factors for CKI:

Answer 3

• Increasing age
• Ethnic minorities
• Multi-morbid
• Socially disadvantaged
• Female > Male
• Nephrotoxins
• Decreased kidney perfusion
• Hyperlipidaemia
• Hyperphosphataemia

Question 4

Give 5 nephrotoxins:

Answer 4

1) Myoglobin
2) Urate
3) Drugs
4) Poisons
5) Bilirubin

Question 5

How is CKI classified?

Answer 5

According to GFR and ACR (Albumen:Creatinine ratio)

Question 6

List the symptoms of CKI:

Answer 6

• Pruritus
• Fatigue
• Breathlessness
• Restless legs
• Sleep reversal
• Aches + Pains
• Nausea + Vomiting
• Chest pain
• Seizures

Question 7

What are the 3 main complications of CKI?

Answer 7

1) Acidosis
2) Anaemia
3) Mineral/Bone disorders

Question 8

How does CKI lead to anaemia?

Answer 8

CKI is the loss of renal function = decreased GFR
When GFR < 30 = decreased erythropoetin production
= Decreased RBC production = blood loss`

Question 9

What is renal osteodystrophy?

Answer 9

Pathological bone changes due to abnormal levels of calcium and phosphate in blood, due to increased PTH in CKI

Question 10

How does CKI affect serum phosphate, calcium, calcitriol and PTH?

Answer 10

• Increases serum phosphate
  = Decreases serum calcium
• Decreases calcitriol
  = Increases PTH

Changes due to decreased GFR

Question 11

What is a pathological bone change associated with CKI, seen in the spine?

Answer 11

‘Rugger jersey spine’
Sclerosis of end plates, giving sclerotic-lucent-sclerotic pattern
Due to hyperparathyroidism

Question 12

What is Calciphylaxis?

Answer 12

Vascular calcification and skin necrosis associated with CKD

Question 13

Why are CKI patients susceptible to Osteomalacia?

Answer 13

CKI = decreased GFR = decreased Calcitriol
= decreased calcification level per bone unit
= softening of bone

Question 14

What are the symptoms of Osteomalacia?

Answer 14

• Bone pain
• Back ache
• Muscle weakness
• Fractures (commonly femoral neck, spine, ribs, pubic ramus)

Question 15

What USS finding is common in CKI?

Answer 15

Small shrunken kidneys

Question 16

What are the 2 types of dialysis available?

Answer 16

1) Haemodialysis

2) Peritoneal dialysis

Question 17

What are the advantages of haemodialysis?

Answer 17

• Little responsibility for patient
• Days off
• Proven effectiveness

Question 18

What are the disadvantages of haemodialysis?

Answer 18

• Hospital-based = ^^ cost
• Time consuming (travel/waiting time)
• Fluid + Diet restrictions
• CVS access problems = Fistula creation - ugly
• 19 pills/day

Question 19

What type of fistula is usually created to aid access for haemodialysis?

Answer 19

Radiocephalic

Question 20

What are the main complications of haemodialysis?

Answer 20

• Infection
• Thrombosis
• Venous stenosis
• CVS instability

Question 21

Define dialysis:

Answer 21

Diffusion of solutes across a semi-permeable membrane.

- Allows removal of waste products and water from the blood

Question 22

Name the 2 types of peritoneal dialysis:

Answer 22

1) Continuous Ambulatory PD

2) Automated PD

Question 23

What is the main difference between Continuous Ambulatory PD, and Automated PD:

Answer 23

CAPD = dialysis throughout the day (4/5 bags per day)
APD = dialysis throughout night

Question 24

What are the advantages of Peritoneal dialysis?

Answer 24

• Self-sufficient
• Independent
• Home technique
• Easy-to-learn
• Allows mobility
• CVS stability
• Less fluid/food restriction (compared to haemodialysis)

Question 25

What are the disadvantages of peritoneal dialysis?

Answer 25

• Frequent daily exchanges
• Responsibility of patient
• Peritonitis likely
• ^^ cost
• Body image problem
• 10 pills + injection per day

Question 26

What is the most common complication of peritoneal dialysis (occurs ~ 1/20 months)?

Answer 26

Peritonitis

Question 27

If patient with ESRD has had a hernia in the past, which type of dialysis should they have, and why?

Answer 27

Haemodialysis

Hernia weakens abdo wall, so peritoneal dialysis fluid would leak out of peritoneal cavity.

Question 28

What is the gold standard treatment of ESRD?

Answer 28

Kidney transplant

Question 29

What are the 3 types of kidney donation, in order of expected lifespan from longest to shortest:

Answer 29

1) Live donor (longest lifespan)
2) Deceased after brain death
3) Deceased after circulatory death

Question 30

Kidney donations are matched to a patient according to what 4 factors?

Answer 30

• ABO blood type
• HLA (or MHC)
• Age
• Time on waiting list

Question 31

What is the average waiting time for a kidney transplant?

Answer 31

~ 3 yrs

Question 32

What are the disadvantages of a kidney transplant?

Answer 32

• Operative, Infection & Malignancy risk
• Requires immunosuppressive drugs
  Side effects = tremor, hypertension, diabetes, headaches, nausea, diarrhoea, weight gain