Uro - CKD and Renal Failure Flashcards
What are the 4 main functions of the kidneys
Homeostasis
Glucose metabolism
Endocrine
Excretion
What are the homeostatic functions of the kidneys
Electrolyte balance
Acid base balance
Volume homeostasis
What is the endocrine role of the kidneys
EPO
1-alpha hydroxyls (vitamin D)
What is the excretory role of the kidneys
Nitrogenous waste Hormones Peptides Middle sized molecules Salt and water
What is the glucose metabolism role of the kidneys
Gluconeogenesis
Insulin clearance
What happens in kidney failure
We have a loss of our normal kidney functions
What happens in kidney failure with regards to homeostasis
Increase in potassium Loss of bicarbonate pH goes down Increase in phosphate Salt and water imbalance
What happens in kidney failure with regards to endocrine function
Loss of calcium
Increase in PTH
Anemia
What happens in kidney failure with regards to excretory function
Increase in urea
Increase in creatinine
Decrease in insulin requirement
What happens in kidney failure with regards to glucose metabolism
Loss of gluconeogenesis and insulin clearance
Why do some diabetes patients with renal failure think they have been cured of their diabetes
As they have not cleared insulin therefore endogenous insulin is not low
What is the main risk of renal failure
Cardiovascular risk
How does rate of deterioration affect clinical presentation in kidney failure
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.
In what context may kidney failure present
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
What is the first thing you look in the context of nephrology
Volume status
What is Kussmaul respiration
In kidney failure we often see metabolic acidosis therefore respiratory alkalosis would compensate - this is achieved through hyperventilation (Kussmaul breathing) to lower PCo2
Why do we need to address hyperkalemia quickly
It is a medical emergency - can cause heart arrhythmia
What is the dfference in presentation between CKD and AKI
Normally the presentation is much quicker and more sudden as patient’s bodies have not adapted - therefore we often don’t see anemia
When may a person with ARF present with anemia
If they have haemolytic uremic syndrome then this can bee a cause of renal failure acutely
