Uro - CKD and Renal Failure

Question 1

What are the 4 main functions of the kidneys

Answer 1

Homeostasis
Glucose metabolism
Endocrine
Excretion

Question 2

What are the homeostatic functions of the kidneys

Answer 2

Electrolyte balance
Acid base balance
Volume homeostasis

Question 3

What is the endocrine role of the kidneys

Answer 3

EPO

1-alpha hydroxyls (vitamin D)

Question 4

What is the excretory role of the kidneys

Answer 4

Nitrogenous waste
Hormones 
Peptides 
Middle sized molecules 
Salt and water

Question 5

What is the glucose metabolism role of the kidneys

Answer 5

Gluconeogenesis

Insulin clearance

Question 6

What happens in kidney failure

Answer 6

We have a loss of our normal kidney functions

Question 7

What happens in kidney failure with regards to homeostasis

Answer 7

Increase in potassium 
Loss of bicarbonate 
pH goes down 
Increase in phosphate 
Salt and water imbalance

Question 8

What happens in kidney failure with regards to endocrine function

Answer 8

Loss of calcium
Increase in PTH
Anemia

Question 9

What happens in kidney failure with regards to excretory function

Answer 9

Increase in urea
Increase in creatinine
Decrease in insulin requirement

Question 10

What happens in kidney failure with regards to glucose metabolism

Answer 10

Loss of gluconeogenesis and insulin clearance

Question 11

Why do some diabetes patients with renal failure think they have been cured of their diabetes

Answer 11

As they have not cleared insulin therefore endogenous insulin is not low

Question 12

What is the main risk of renal failure

Answer 12

Cardiovascular risk

Question 13

How does rate of deterioration affect clinical presentation in kidney failure

Answer 13

If the rate of deterioration is slow, then people will build up levels reflective of lots of damage (e.g. high urea) that they can cope with - as their bodies have adapted.

Question 14

In what context may kidney failure present

Answer 14

People may present due to the effects of renal failure or due to the cause of renal failure e.g. good pasture’s disease where we have antibodies against the GBM and in the lungs therefore we may get haemoptysis

May also be incidental e.g. for a skin rash

Question 15

What is the first thing you look in the context of nephrology

Answer 15

Volume status

Question 16

What is Kussmaul respiration

Answer 16

In kidney failure we often see metabolic acidosis therefore respiratory alkalosis would compensate - this is achieved through hyperventilation (Kussmaul breathing) to lower PCo2

Question 17

Why do we need to address hyperkalemia quickly

Answer 17

It is a medical emergency - can cause heart arrhythmia

Question 18

What is the dfference in presentation between CKD and AKI

Answer 18

Normally the presentation is much quicker and more sudden as patient’s bodies have not adapted - therefore we often don’t see anemia

Question 19

When may a person with ARF present with anemia

Answer 19

If they have haemolytic uremic syndrome then this can bee a cause of renal failure acutely