Week 8 - Kidney and Urinary System: Renal disease and failure

Question 1

What is acute renal failure?

Answer 1

AKA as acute kidney injury (AKI). It is the sudden loss of the kidney’s ability to function.

Question 2

What does AKI result in?

Answer 2

Impairment of fluid management
Acid base changes
Electrolyte imbalance
Waste accumulation

Question 3

True or false, AKI results in longer hospital stays?

Answer 3

True - double the length

Question 4

What are the risk factors of AKI turning chronic?

Answer 4

Age
Genetic factors
Diabetes
Sepsis
Cardiac surgery
Kidney toxic drugs
Contrast agents

Question 5

What are disease modifiers of AKI?

Answer 5

Severity of AKI
Stage of chronic kidney disease
Number of episodes
Duration of AKI
Proteinuria

Question 6

What are the outcomes of AKI?

Answer 6

Can become chronic kidney disease
Can also lead to:
Cardiovascular events
Kidney events
ESKD
Death

Question 7

What are the 3 causes of AKI?

Answer 7

1. Pre renal (before the kidney)
2. Intrarenal (in the kidney)
3. Post renal (after the kidney, bladder)

Question 8

What is an example of pre-renal causes of AKI?

Answer 8

Reduction in blood flow (impaired perfusion) due to:
Cardiac failure
Sepsis
Blood loss
Dehydration
Vascular occlusion

Question 9

What is an example of intrarenal causes of AKI?

Answer 9

Direct injury to the kidney
Medications
Contrast, overdose, poisons
Acute tubular necrosis

Question 10

What is an example of Post-renal causes of AKI?

Answer 10

Bladder or uretic obstruction

Question 11

What are signs and symptoms of AKI?

Answer 11

Decreased urine output
Peripheral oedema
Changes in mental state
High blood pressure
Hand tremors
Anorexia
Uremic frost or fetor

Question 12

How is AKI diagnosed?

Answer 12

Blood tests

Ultrasound

Question 13

How is AKI treated?

Answer 13

Fluid monitoring
Treat cause
Remove nephrotoxic
Modify diet
Dialysis

Question 14

What us chronic kidney disease?

Answer 14

A spectrum of renal impairment that occurs over years. There is a cumulative reduction in functioning units within the kidney and it is commonly asymptomatic until late late stages or non-specific symptoms

Question 15

What is the definition of CKD?

Answer 15

Kidney damage for 3 months or more as defined by structural or functional abnormalities of the kidney, with or without decreased GFR, manifest either by:

• pathological abnormalities
• Markers of kidney damage, including abnormalities in the composition of the blood or urine, or abnormalities in imaging tests

Question 16

What are the non-modifiable risk factors of CKD?

Answer 16

Genetics
Ethnicity
Increasing age
Previous kidney injury or disease
Low birth weight
Male
Socioeconomic status

Question 17

What are modifiable risk factors of CKD?

Answer 17

Smoking
Physical inactivity
Poor nutrition
Overweight and obesity

Question 18

What are comorbidities of CKD?

Answer 18

Diabetes
Hypertension
Cardiovascular disease
OSA - obstructive sleep apnoea

Question 19

What are the initial symptoms of CKD?

Answer 19

Unintentional weight loss
Nausea. vomiting
General ill feeling
Fatigue
Headache
Generalised itching
Restless legs
SOB

Question 20

When are symptoms of CKD usually present?

Answer 20

When function is below 25%

Question 21

What are the later stage symptoms of CKD?

Answer 21

Decreased urine output
Decreased alertness, drowsiness, lethargy, confusion, coma
Muscle twitching or cramps
Seizures
Uremic frost

Question 22

What are the complications of CKD?

Answer 22

Gout
Metabolic acidosis
Secondary hyperparathyroidism
Osteoporosis and high phosphorus
Heart disease/Atherosclerosis
High potassium
Fluid build up

Question 23

How is CKD diagnosed?

Answer 23

Proteinuria or albuminuria
Electrolytes, creatine and urea
Glomerular filtration rate

Question 24

How many stages of CKD are there?

Answer 24

5

Question 25

What are the stages of CKD?

Answer 25

1. Normal or higher kidney function GFR>90
2. Mildly decreased kidney function GFR 89-60
3. Moderately decreased kidney function GFR 59-30
4. Severely decreased kidney function GFR 29-15
5. Kidney failure, ESRD. GFR < 15

Question 26

How is end stage renal failure treated?

Answer 26

Optimise health to prevent further deterioration such as:

• diet and exercise
• strict blood sugar control
• good blood pressure management
• quit smoking
• monitor cholesterol
• avoid nephrotoxins

Question 27

How are the complications of CKD managed?

Answer 27

Fluid restriction
Renal diet
Medications to target raised electrolytes and prevent secondary effects
Iron supplementation and EPO

Question 28

What are medications used to treat CKD?

Answer 28

Antihypertensives
Diuretics
Statins

Question 29

What is end stage renal failure?

Answer 29

In severe cases, person’s kidney function deteriorates so much that it is no longer sufficient to sustain life. This requires kidney replacement therapy - dialysis or transplant to survive.

Question 30

What is peritoneal dialysis?

Answer 30

Dialysis fluid is run into the peritoneal cavity via a tenckhoff catheter.
The peritoneum allows waste products to move through it into the dialysis fluid and then out the catheter.

Question 31

When does peritoneal dialysis occur?

Answer 31

At night

Question 32

How long does peritoneal dialysis take?

Answer 32

8-10 hours

Question 33

What is haemodialysis?

Answer 33

• Uses a machine to act as the membrane to filter the blood
• It removes wastes and electrolytes from the blood through diffusion
• H2O passes into dialysis fluid through ultra filtration

Question 34

How long does haemodialysis take?

Answer 34

4-5 hours

Question 35

How often is haemodialysis required?

Answer 35

3 times per week

Question 36

How is haemodialysis accessed?

Answer 36

Through an AV fistula or vascath