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EXMD4743 > WK1-kidney disease > Flashcards

WK1-kidney disease Flashcards

1
Q

What is the function of kidneys?

A
  • excretion of waste products
    –> filters blood which passes through nephrons
  • controls fluid balance
    –> BP control, increase body fluid volume when BP falls or decrease volume when pressure rises
  • produces/regulates hormones
    –> erthropoitin
    –> renin
    –> active Vit D
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2
Q

Define CKD.

A

Chronic Kidney Disease

  • estimated glomerular filtration rate <60mL/min/1.73m^2 that is present for >3M with/without evidence of kidney damage

OR

  • evidence of kidney damange with/out decreased GFR present for >3M as evidenced by… irrespective of the underlying cause
  • albuminuria
  • haematuria after exclusion of urological causes
  • structural abnormalities (imaging results)
  • pathological abnormalities (renal biopsy)
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3
Q

What does Kidney function stage 1 mean?

A

GFR >90

URine ACR mg/mmol
Male <2.5
female <3.5

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4
Q

What does Kidney function stage 2 mean?

A

GFR 60-89
URine ACR mg/mmol
Male <2.5
female <3.5

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5
Q

What does Kidney function stage 3a mean?

A

GFR 45-59

microalbuminuria
URine ACR mg/mmol
male 2.5-25
female 3.5-35

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6
Q

What does Kidney function stage 3b mean?

A

GFR 30-44

microalbuminuria
urine ACR mg/mmol
male 2.5-25
female 3.5-35

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7
Q

What does Kidney function stage 4 and 5 mean?

A

GFR 15-29
GFR <15 or on dialysis

macroalbuminuria
urine ACR mg/mmol
male >25
female >35

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8
Q

What are the 3 components of reporting CKD?

A

eGFR results
Urine ACR results
underlying pathology

= CKD disease

e.g. Stage 2 CKD with microalbuminuria secondary to diabetic nephropathy

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9
Q

What are the early onset Sx of kidney disease for stage 2?

A
  • small amount of kidney damange, although GFR may be normal
  • oftne no Sx, blood test can be normal
  • scarring/blockages that alter blood flow to kidney
  • increased risk of heart disease

[for Stage 2]

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10
Q

How to detect stage 3?

A
  • some feel unwell/notice increase urine frequency
  • BP can rise as kidneys slow down
  • high BP increases heart disease/attack and stroke
  • early Sx of bone disease
  • anaemia may appear - insufficient RBC in blood to carry O2 around body. Inc. weakness, fatigue and SOB

[Stage 3]

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11
Q

What are the Sx in stage 4?

A
  • HBP
  • change in amount of urine excreted
  • lack of energy, incrased tiredness/reduced appetite
  • require dietary changes - limit salt use, reduce K and P in diet

[stage 4]

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12
Q

How to classify end-stage kidney disease (stage 5)?

A
  • kidneys function at <15% of capacity
  • unable to properly fiter waste products, remove extra water, maintain chemical balance
  • doctor considers commencing renal replacement therapy (dialysis/kidney transplant)
  • dialysis
  • haemodialysis
  • peritoneal dialysis
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13
Q

What is haemodialysis?

A
  • blood passed from patient through dialyser
  • dialysate - imilar content of electrolytes as plasma (allows small molecules to diffuse across membrane)
  • remove toxins/excess fluid
  • 3sessions/wk, 3-5h per sesion
  • home dialysis
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14
Q

What is peritoneal dialysis?

A

Peritoneum used as semi-permeable membrane to dialyse blood

2 types
Automatic PD
* requires machine - deliveres fluid into abdomen
* occurs at night, machine connect to PD catheter
* while sleeping, machine drains use dialysis solution and supplies clean dialysis solution

Continuous PD
* uses gravity to fill and drain dialysis solution from abdomen
* CPD involves 4 2L fluid exchanges daily, each takes 30-40mins

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15
Q

What occurs in a kidney transplant?

A
  • replace one kidney
  • world-wide shortage of donors
  • live donor vs cadaver
  • complications associated with replacement improved by immunosuppression techniques // graft survival is >85% at 1yr
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16
Q

What is diabetic nephropathy?

A
  • most common cause of kidney disease in western society, 35% of new causes of CKD caused by this
  • results from long-term diabetes
  • causes permanent microvascular damage wtihin glomeruli, resulting in glomeruli sclerosis and proteinuria
  • early marker of DN is development of microalbuminuria
  • pathology of DN in Type I and II is similar
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17
Q

What is glomerulonephritis?

A

GN = 25% patietns ESRD in Aus
* inflammation of/immune deposits in glomeruli and sometimes small kidney blood vessels
* GN often presents with isolated haematuria/proteinuria or nephrotic syndrome, acute kidney injury or CKD

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18
Q

What is polycystic kidney disease?

A
  • inherited disorder - involves progressive formation of cysts in both kidneys
  • 7% new cases of CKD in AUS
  • may be asymptomatic/Sx may be result from rupturing cysts and decline renal function
  • cysts can be painful, may rupture/bleed
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19
Q

What are other causes of CKD?

A
  • renal vascular disease
  • reflux nephropathy
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20
Q

How to detect CKD?

A

generally asymptomatic - up to 90% kidney function may be lost before Sx are present

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21
Q

What are CKD Sx?

A
  • HBP
  • changes in amount/no. of times urine passed
  • urine appearance different
  • blood in urine
  • puffiness e.g. legs and ankles
  • pain in kidney area
    *tiredness
  • loss of appetite
  • difficulty sleeping
  • headaches
  • lack of concetration
  • itching
  • SOB
  • nausea/vomitting
  • bad breath/metallic taste in mouth
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22
Q

What is part of a kidney health check?

A
  1. blood test
  2. urine test
  3. BP test
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23
Q

How does a blood test indicate CKD?

A

Estimates GFR
* best measure of kidney function. efficiency at cleaning blood
* usually eGFR from creatinine blood test
* eGFR of 100mL/min/1.73m^2 is normal range which equals 100% kidney function
* 50mL/min/1.73m^2 50% kidney function

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24
Q

How does a urine test indicate CKD?

A

Determines Albumin Creatinine Ratio (ACR)
* excessive proteins in urine = kidney damage
* protein is mainly albumin (albuminuria)
* urine ACR predicts renal/CV risks in pop. studies
* elevated urine ACR more common CKD sign than decreased eGFR

25
What is the prevalence of CKD in AUS?
approx. 1.7mil (1 in 10) aged 18y+ have reduced kidney function/albumin in urine CKD twice as common as diabetes 1 in 3 Aus adults has CKD riss
26
What is overlooked in prevalence of CKD?
* <10% people with CKD are aware they have it * late referral is common - 18% people commence dialysis within 90days of being referred to renal service
27
What is the prevalence of CKD among Aboriginal and TOrres Strait Islander peoples?
2x likely to have, 4x more likely to have stage 4-5 than non-indigenous Aus 90% Aboriginal Torres Strait Islander people unaware having the condition
28
Provide summary of dialysis and kidney transplantation in Aus 2021.
* 3199 started dialysis * 857 received transplant * 82 received transplant before dialysis * 13,349 living with transplant * 15,193 receiving dialysis * majority receiving Tx 55y-74y * diabetes being main cause of transplant/dialysis * kidney donation from deceased 76%, living 24%
29
Who is at risk of CKD?
* diabetes * hypertension * CVD * family Hx * obesity * smoker * 60y+ * Aboriginal/Torres Strait Islander * Hx acute kidney damage
30
What are modifiable risk factors?
* healthy weight * smoking * (diabetics) maintain blood glucose control * take meds (e..g BP lowering)
31
What are general health factors to prevent CKD?
* regular PA * maintain healthy cholesterol levels * healthy diet * drink alcohol in moderation
32
What are other factors that can reduce CKD?
* awareness of family CKD Hx * avoid taking NSAIDs e.g. ibuprofen on regular basis People at "increased risk" of developing kidney disease should ask GP for kidney health check
33
Purpose of angiotensin-converting enzyme (ACE) inhibitor?
decrase BP by vasodilating blood vessels slow progression of CKD
34
Purpose of angiotensin II receptor blockers (ARB)?
block angiotensin II action, cause vasodilation slow progression of CKD
35
purpose of SGL2 inhibitor?
block glucose from being re-absorbed in kidney slow progression of CKD
36
purpose of diuretics?
* remove excess Na+ fluid
37
Purpose of beta blockers?
decrease BP, by decreasing HR and CO
38
Purpose of Ca2+ channel blockers?
dilate blood vessels, relax muscles reducing resistance
39
purpose of vasodilators?
relax smooth muscle of blood vessel
40
purpose of direct renin inhibitors?
block renin, reduced resistance
41
purpose of analgesics?
manage pain (PCKD)
42
What are the complications of CKD?
* rarely occurs in isolation, more a comorbidity * CKD + CVD = 3.5% * CKD+diabetes = 0.6%
43
How is CVD the most common comorbidity?
* atherosclerosis, heart failure, cardio-renal syndrome *MSK highly prevalent (muscle atrophy, myalgia, low BMD) * chronic pain
44
What are benefits of Ex on CKD?
* decrease CVD risk * healthy impact on other comorbidities * increase muscle mass/strength * decrease falls risk * increase energy/decrease fatigue * improve QoL, mental health, appetite * decrease inflammation/oxidative stress
45
Why recommend a baseline cardipulmonary Ex testing with 12-lead ECG?
* establish aerobic capacity * determine suitability for Ex training/whether medical stabilisation required * provide data for individual program Ex testing not widely available for CKD patients
46
Why is submaximal testing recommended for CKD patients?
* HR response may be impacted by meds impacting accuracy of aerobic capacity estimate * still provide valuable data (BP and RPE response to different Ex intensities
47
What are common testing measures for CKD patients?
* 6MWT * neuromuscular fitness (30s/5R STS, timed floor rise to stand, grip strength) * functional measures (balance, usual walking speed, leg strength endurance (pyhsical performance battery)
48
What is the Ex Px for ESKD inter-dialysis?
Aerobic: 30-45mins, non-dialysis days, 55-70% max HR, RPE 11-13, Preferably >60% Weekly duration: up to 180mins walking/cycling/other RT: 2 non-consecutive days, 8-12 Ex on major muscle groups, weight cuff, therabands, light dumbbells, machines. * 1S to fatigue, 12-15R or 60-70% RM * non-dialysis days * cachexia, poor BMD/BMI
49
What is the Ex Px for ESKD intra-dialysis?
Aerobic: 30-45mins, during first 2h dialysis 55-70% maxHR, RPE 11-13 Up to 180mins, cycling while seated using arm/leg ergometer RT: 2 non-consecutive days, up to 12 Ex, as many practical in dialysis session. 1S to fatigue, 12-15R Weighted Ex, therabands, cuff, dumbbells. * Cachexia, poor BMD, low BMI
50
What is the flexibility Px for inter/intra and non-dialysis patients?
5-7days ~10min sessions Where possible combine with aerobic or RT and balance for those at falls risk
51
What is the Ex Px for non-dialysis patients?
Aerobic: 30-45min, according to patient needs. 55-90% HRMax, RPE 11-16 mod-vig Up to 180mins: walking, jogging, cycling, other RT: 2 non-consecutive days, 8-12 Ex 1S to fatigue, 10-15R or 60-70% Rep max. Weight-bearing activities
52
What are some special considerations for Ex intolerances, such as cardiac?
*microvascular/systolic/diastolic dysfunction * increase left ventricular * pulsatile load * myocardial stunning
53
What are some special considerations for Ex intolerances, such as vascular?
* endothelial dysfunction * microvascular dysfunction * decrease capillary:fibre * impaired functional sympatholysis * thickened capillary membrane * arterial stiffness * abnormal arterial haemodynamics
54
What are some special considerations for Ex intolerances, such as renal?
* uremia * metabolic acidosis
55
What are some special considerations for Ex intolerances, such as skeletal muscle?
* sarcopenia * incrase intermuscular fat * Type I to Type II fibre switch * Acqiured myopathies * mitochondrial dysfunction
56
What are some special considerations for Ex intolerances, such as pulmonary?
* obstructive diosrders * restrictive disorders * fluid retention * respiratory muscle wasting
57
What are some special considerations for Ex intolerances, such as neural?
* increase SNS * increase central command * increase renal nerve afferent * mechanoreflexes
58
What are some special considerations for medications?
* beta blockers - decrease utility of using Ex HR response to Ex * glycaemic control meds - Ex-induced hypoglycaemic risk (during/following Ex) * BP meds - hypotension risk (esp. when changing body position - postural hypotension)
59
What are the risks of Ex?
* MSK injury --> hyerparathyroidism and bone disease - increased fracture risk *cardiac events --> no data for specific CKD but there would be increased risk --> in general pop. - 1 death during 20,000 maximal Ex tests --> BP controls are SO important!! More advanced CKD = more ECF patient is likely to carry which increases risk

EXMD4743 (9 decks)

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