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Urinary > Week 11 > Flashcards

Week 11 Flashcards

1
Q

What is CKD

A

Irreversible, and sometimes progressive, loss of renal function over a period of months to years

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2
Q

Macroscopic appearance of kidneys in CKD

A

Shrunken
Irregular outline
Thin cortex

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3
Q

Histological appearance of kidneys in CKD

A

Tubule loss
Interstitial fibrosis
Glomerulosclerosis

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4
Q

Causes of CKD

A 
Majority of patients have a combination of:
Infection - pyelonephritis 
Genetics - Alports 
Immunological - glomerulonephritis
Obstruction 
Hypertension
Vascular disease
Systemic disease - diabetes, myeloma
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5
Q

Demographics of CKD

A

Elderly
Comorbidities
Ethnic minorities
Socially disadvantaged groups

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6
Q

How can CKD be classified

A

By:
GFR
Albumin creatinine ratio

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7
Q

Stages of CKD classified by GFR

A 
G1 - >90ml/min/1.73m2
G2 - 60-89
G3 - 30-59
G4 - 15-29
G5 - <15 or renal replacement therapy
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8
Q

Which G stages are symptomatic

A

G4-5

G3 can be symptomatic or asymptomatic

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9
Q

Which G stage require hospital admission

A

G3-5

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10
Q

Which G stages require other evidence of kidney damage and why

A

G1-2

GFR above 60 is inaccurate

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11
Q

Stages of CKD classified by ACR

A

A1 - <3
A2 - 3-30
A3 - >30

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12
Q

Investigations for CKD

A

Urine dipstick - proteinuria increases incidence of end stage renal disease
Measure serum creatinine to calculate eGFR

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13
Q

Why is serum creatinine a bad measure of GFR

A

Normal serum creatinine when GFR is 40

Dependent on renal function and muscle mass which is affected my sex, ethnicity and age

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14
Q

Limitations of eGFR

A

Only accurate in adults

Isn’t useful in AKI

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15
Q

Why don’t we measure GFR in clinical practice

A

Measuring clearance rates is expensive and takes a long time (need to measure 24 hour urine output)

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16
Q

Finding cause of CKD

A 
History
Examination - palpable kidneys
Autoantibody screen
Complement
Immunoglobulin
Anti neutrophil cytoplasmic antibodies
CRP 
Imaging - USS (hydronephrosis), CT (stones), MRI (renal artery stenosis)
If cause not obvious consider biopsy
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17
Q

How to prevent or delay progression of CKD

A 
Exercise
Stop smoking
Treat diabetes
Treat hypertension with ACEi/AT2 antagonists 
Lower lipids with statins/diet
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18
Q

Complications of CKD and how they are combated in treatment

A

Increased risk of cardiovascular death - lifestyle factors, ACEi, statins
Acidosis - give oral NHCO3 tablets
Anaemia - erythropoietin injections
Metabolic bone disease

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19
Q

Why do patients with CKD get anaemia

A

Decreased erythropoietin production and decreased platelet function
Leads to decreased RBC survival and bleeding

20
Q

Why do patients with CKD develop metabolic bone disease

A

Low GFR leads to increased phosphate and decreased calcitriol synthesis so hyperparathyroidism occurs

21
Q

What bone disorder is hyperparathyroidism associated with

A

Osteitis fibrosa cystica (painful soft bones leading to deformity)

22
Q

What bone disorder is associated with low calcitriol

A

Osteomalacia

23
Q

What occurs to bone at different levels of vitamin D

A

Deficiency - rickets or osteomalacia
Normal - mineralisation
High - osteoclast activity

24
Q

What other metabolic bone disorders occur in CKD patients

A

Rugger jersey spine - sclerosis of end plates so middle of vertebral bodies look greyer
Erosion of terminal phalanges
Calciphylaxis - vascular calcification, thrombosis and skin necrosis

25
Q

What is end stage renal disease

A

GFR <15ml/min

Death is likely with out renal replacement therapy

26
Q

Symptoms of ESRD

A 
Tiredness
Difficulty sleeping and concentrating 
Symptoms of volume overload - oedema, gallop rhythm, raised JVP and high BP
Nausea and pruritis due to accumulation of waste products 
Leg cramps
Pruritis
Low fertility
Increased infections
27
Q

Why do ESRD patients need dose alterations

A

Decreased drug elimination

Increased drug sensitivity - more side effects

28
Q

When do patients need RRT

A

Renal function declines to a level that’s no longer adequate to support health

29
Q

Types of RRT

A

Haemodialysis
Peritoneal dialysis
Renal transplantation

30
Q

What symptoms suggest dialysis is needed

A 
Volume overload
Acidosis
Uraemic symptoms
Pericarditis
Hyperkalaemia
31
Q

What needs to be done before haemodialysis begins

A

Create an arteriovenous fistula (connection between an artery and vein) so that venous pressure increases and the vein dilates and develops a muscular wall

32
Q

Alternative to arteriovenous fistula

A

Tunnel line

Has a lower infection risk but increased risk of stenosis

33
Q

What happens in haemodialysis

A

Venous blood passes through a pump to increase its pressure and an anticoagulant is added
Dialyser contains highly purified H2O across a semipermeable membrane so waste products are removed from the blood
Clean blood is returned to the venous system

34
Q

Advantages of haemodialysis

A

Effective
Don’t need to use everyday
Don’t need to manage treatment themselves
Erythropoietin given in haemodialysis fluid

35
Q

Disadvantages of haemodialysis

A

Fluid and diet restrictions
Tied to dialysis times
Need 4 hours 3 times a week
Need 19 tablets a day

36
Q

Contraindications of haemodialysis

A

Failed vascular access
Heart failure - can’t tolerate removal of blood
Coagulopathy - high chance of bleeding when the needle is used

37
Q

Complications of haemodialysis

A

Infection
Steal syndrome - arterial blood enters venous system so get ischaemia in fingers
CVS instability
Feel chronically unwell

38
Q

What is peritoneal dialysis

A

Highly purified peritoneal dialysis fluid is put into the peritoneal cavity and the dialysis occurs at the peritoneal membrane
Fluid containing waste products from the blood is drained away and disposed of

39
Q

Advantages of peritoneal dialysis

A 
Less food and diet restriction
Self sufficient
Easier to travel
CVS stability 
Less (10) tablets per day
40
Q

Disadvantages of peritoneal dialysis

A

Need 4/5 bag a day
High risk of peritonitis
Need to inject erythropoietin

41
Q

Contraindications of peritoneal dialysis

A

Failure of peritoneal membrane e.g surgery, adhesions
Unable to (dis)connect bags
Obese or large muscle mass - can’t get enough dialysis fluid

42
Q

Complications of peritoneal dialysis

A

Peritonitis (about every 20 months)
Leaks e.g into scrotum or diaphragm
Herniae

43
Q

Where do kidneys for transplants come from

A

Live donor
Deceased after brain death
Deceased after circulatory death

44
Q

Where are kidneys transplanted to

A

Iliac fossa

Connected to iliac vessels and bladder

45
Q

What are kidneys matched according to

A

Tissue match - blood type, HLA

Number of points - time on waiting list, age

46
Q

Advantages of renal transplants

A

Less morbidity and mortality
Cheaper
Better QoL

47
Q

Disadvantages of renal transplant

A

Life long immunosuppression (side effects, increased infection and malignancy)
Perioperative risk

Urinary (6 decks)

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