Week 8 - Kidney and Urinary System: Renal disease and failure Flashcards
What is acute renal failure?
AKA as acute kidney injury (AKI). It is the sudden loss of the kidney’s ability to function.
What does AKI result in?
Impairment of fluid management
Acid base changes
Electrolyte imbalance
Waste accumulation
True or false, AKI results in longer hospital stays?
True - double the length
What are the risk factors of AKI turning chronic?
Age Genetic factors Diabetes Sepsis Cardiac surgery Kidney toxic drugs Contrast agents
What are disease modifiers of AKI?
Severity of AKI Stage of chronic kidney disease Number of episodes Duration of AKI Proteinuria
What are the outcomes of AKI?
Can become chronic kidney disease Can also lead to: Cardiovascular events Kidney events ESKD Death
What are the 3 causes of AKI?
- Pre renal (before the kidney)
- Intrarenal (in the kidney)
- Post renal (after the kidney, bladder)
What is an example of pre-renal causes of AKI?
Reduction in blood flow (impaired perfusion) due to: Cardiac failure Sepsis Blood loss Dehydration Vascular occlusion
What is an example of intrarenal causes of AKI?
Direct injury to the kidney
Medications
Contrast, overdose, poisons
Acute tubular necrosis
What is an example of Post-renal causes of AKI?
Bladder or uretic obstruction
What are signs and symptoms of AKI?
Decreased urine output Peripheral oedema Changes in mental state High blood pressure Hand tremors Anorexia Uremic frost or fetor
How is AKI diagnosed?
Blood tests
Ultrasound
How is AKI treated?
Fluid monitoring Treat cause Remove nephrotoxic Modify diet Dialysis
What us chronic kidney disease?
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
What is the definition of CKD?
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
What are the non-modifiable risk factors of CKD?
Genetics Ethnicity Increasing age Previous kidney injury or disease Low birth weight Male Socioeconomic status
What are modifiable risk factors of CKD?
Smoking
Physical inactivity
Poor nutrition
Overweight and obesity
What are comorbidities of CKD?
Diabetes
Hypertension
Cardiovascular disease
OSA - obstructive sleep apnoea
What are the initial symptoms of CKD?
Unintentional weight loss Nausea. vomiting General ill feeling Fatigue Headache Generalised itching Restless legs SOB
When are symptoms of CKD usually present?
When function is below 25%
What are the later stage symptoms of CKD?
Decreased urine output Decreased alertness, drowsiness, lethargy, confusion, coma Muscle twitching or cramps Seizures Uremic frost
What are the complications of CKD?
Gout Metabolic acidosis Secondary hyperparathyroidism Osteoporosis and high phosphorus Heart disease/Atherosclerosis High potassium Fluid build up
How is CKD diagnosed?
Proteinuria or albuminuria
Electrolytes, creatine and urea
Glomerular filtration rate
How many stages of CKD are there?
5
What are the stages of CKD?
- Normal or higher kidney function GFR>90
- Mildly decreased kidney function GFR 89-60
- Moderately decreased kidney function GFR 59-30
- Severely decreased kidney function GFR 29-15
- Kidney failure, ESRD. GFR < 15
How is end stage renal failure treated?
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
How are the complications of CKD managed?
Fluid restriction
Renal diet
Medications to target raised electrolytes and prevent secondary effects
Iron supplementation and EPO
What are medications used to treat CKD?
Antihypertensives
Diuretics
Statins
What is end stage renal failure?
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.
What is peritoneal dialysis?
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.
When does peritoneal dialysis occur?
At night
How long does peritoneal dialysis take?
8-10 hours
What is haemodialysis?
- 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
How long does haemodialysis take?
4-5 hours
How often is haemodialysis required?
3 times per week
How is haemodialysis accessed?
Through an AV fistula or vascath
