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!!!!! BRS YR2 !!!!! > Uro - CKD + Renal Failure > Flashcards

Uro - CKD + Renal Failure Flashcards

1
Q

What are the homeostatic functions of the kidney?

A

→ electrolyte balance
→ acid-base balance
→ volume homeostasis

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2
Q

What are the excretory functions of the kidneys?

A 
→ nitrogenous waste
→ hormones
→ peptides
→ middle sized molecules
→ salt + water
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3
Q

What are the endocrine functions of the kidney?

A

→ erythropoietin

→ 1 alpha-hydroxylate vitamin D

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4
Q

What are the glucose metabolic functions of the kidneys?

A

→ gluconeogenesis

→ insulin clearance

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5
Q

How does kidney failure affect homeostatic function?

A 
→ increase in K+
→ decrease in bicarbonate
→ decrease in pH
→ increase in phosphate
→ salt + water imbalance
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6
Q

How does kidney failure affect excretory function?

A

build-up of waste products
→ increased urea
→ increased creatinine
→ decreased insulin requirement as insulin is no longer being cleared so it circulates in blood

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7
Q

How does kidney failure affect endocrine function?

A

→ hypocalcemia due to lack of 1 alpha-hydroxylase
→ lack of erythropoietin = anaemia
→ hyperparathyroidism due to compensation for calcium

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8
Q

What is a general important risk from kidney failure?

A

cardiovascular risk

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9
Q

What factors can influence clinical presentation?

A

cause of renal failure
rate of deterioration
→ chronic slow deterioration can present much slower and less obviously as body adapts to kidney’s changes
→ acute kidney failure or change presents quicker

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10
Q

*What is abnormal about this urogram?

A

contrast only showing up on right side, only showing shadow of her right kidney

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11
Q

What is the blood volume + blood pressure of someone with renal failure like?

A

hypovolemia + low BP

may also present with decreased capillary refill time + not visible JVP

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12
Q

Why might someone with renal failure be tachypneic?

A

→ due to metabolic acidosis as a result of renal failure
→ compensatory mechanism of respiratory alkalosis
→ causes them to breathe faster

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13
Q

Does renal failure cause urea and creatinine to increase or decrease?

A

increase

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14
Q

Does renal failure cause sodium to increase or decrease?

A

difficult to say, depends on hydration

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15
Q

Does renal failure cause potassium to increase or decrease?

A

increase

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16
Q

Does renal failure cause haemoglobin to increase or decrease?

A

decrease

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17
Q

What happens in blood pH in renal failure?

A

Goes down due to acidic.

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18
Q

What would happen to pCO2 if the patient is tachypneoic?

A

Goes down due tonthe resp compensation

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19
Q

What would happen to pO2 is patient is tachypneoic?

A

Goes up

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20
Q

What are the main differences in presentation between chronic and acute renal failure?

A

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21
Q

What are the main differences between investigaton results between chronic and acute renal failure?

A

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22
Q

What is the effect of kindey failure usually on salt + water balance?

A

Reduces secretion of salt and water, leading to :
Hypertension
Oedema
Pulmonary oedema

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23
Q

When does kidney failure not cause its usual effects on salt + water imbalance ? What are the effects instead?

A

Salt + water loss can be seen in tubulointerstitial disorders (damage to the concentrating mechanism)
And hypovolemia could then be the cause of AKI

24
Q

Why does hyponatremia actually represent?

A

Does not represent reduced total body sodium

Represent fluid balance in the body

25
Q

What are the effects of metabolic acidosis in renal failure?

A

Reduced excretion of H+ ions, retention of acid bases
Increased excretion of intracellular K+

This can all lead to anorexia + muscle catabolism

26
Q

What are the causes of hyperkalaemia in kidney failure?

A

Reduced potassium secretion in the distal tubule

But increased intracellular potassium excretion from cells due to acidosis

27
Q

What are the symptoms of hyperkalaemia in kidney failure?

A

Cardiac arrhythmias
Neural + muscular activity
Vomiting (body’s way of trying to get rid of potassium)

28
Q

What are the ECG changes visible in renal failure?

A 
Due to hyperkalaemia:
Peaked T waves
Broadened P waves (reduced amplitude, some disappear)
QRS widening 
Heart block
Asystole
VT/VF
29
Q

Why can kidney failure cause anaemia?

A

Due to recuced erythropoietin

30
Q

What are the effects of reduced 1-25 Vitamin D levels in kidney failure?

A

Reduced calcium intestinal absorption
Hypocalcaemia
Hyperparathyroidism ( as compensation for hypocalcaemia)

31
Q

How does chronic renal failure result in hyperparathyroidism?

32
Q

What other general risks metabolic effects of renal failure have?

A

Increased cardiovascular risk

33
Q

What is the major predictor of end stage renal failure?

34
Q

What is the major outcome for a patient with CKD?

A

Cardiovascular disease

35
Q

What is a CKD patient more likely to die from, CVD or end stage renal failure?

36
Q

What are the additional CVD risk factors that need to be monitored in renal failure?

A 
Hypertension
Diabetes
Lipid abnormalities
Inflammation 
Oxidative stress
Mineral / bone metabolism disorder
37
Q

What are the 2 bases that need to be covered when managing kidney failure?

A

Fluid balance

Hyperkalaemia

38
Q

What is the inital management is patient is hypovolaemic?

A

Give fluids

39
Q

What is the initial management if the patient is hypervolaemic?

A

Trial of diuretics or dialysis (dialysis if patient cannot pee)

40
Q

What is the initial management of hyperkalaemia?

A

Drive potassium into cells : use sodium bicarbonate or insulin dextrose (with caution, be careful of hypoglycaemia)
Drive potassium out of body : diuretics or dialysis
Stop K+ gut absorption : potassium binders

41
Q

What is conservative treatment for long-term management of kidney failure?

A
  • erythropoietin injections to correct anaemia
  • diuretics to correct salt water overload
  • phosphate binders
  • 1.25 vit d supplements
  • symptom management
42
Q

What are thebhome therapies available for long-term management of CKD?

A
  • haemodialysis

- peritoneal dialysis/assisted programmes

43
Q

What are the in-centre therapies available for long-term management of CKD?

A

haemodialysis, 4 hours 3 times a week

44
Q

What is the final step in managing CKD

A

Transplantation

45
Q

What are some key points about haemodialysis?

A

Veins are very important

Fistulas may be necessary later

46
Q

What needs to be avoided in patients getting a kidney transplant?

47
Q

What are the main ways of assessing GFR?

A
  • Urea
  • Creatinine clearance
  • creatinine
  • radionuclide studies
  • insulin clearance
48
Q

How is urea as a method of assessing GFR?

A

Poor indicator

• Confounded by diet, catabolic state, GI bleeding (bacterial breakdown of blood in gut), drugs, liver function etc.

49
Q

How is creatinine as a method of assessing GFR?

A

Affected by muscle mass, age, race, sex etc.

• Need to look at the patient when interpreting the result. TREND helpful.

50
Q

How is creatinine clearance as a method of assessing GFR?

A

Difficult for elderly patients to collect an accurate sample

• Overestimates GFR at low GFR (as a small amount of creatinine is also secreted into urine)

51
Q

How is insulin clearance as a method of assessing GFR?

A

Laborious - used for research purposes only

52
Q

How useful are radionuclide studies in assessing GFR?

A

EDTA clearance etc

• Reliable but expensive

53
Q

What is eGFR?

A

estimated GFR

what’s used clinically

54
Q

What are the different equations for eGFR?

55
Q

What happens to the accuracy of eGFR as it increases?

56
Q

How is the eGFR classified by NICE guidelines?

!!!!! BRS YR2 !!!!! (72 decks)

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