Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What does Kidney function stage 1 mean?

A

GFR >90

URine ACR mg/mmol
Male <2.5
female <3.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What does Kidney function stage 2 mean?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are other causes of CKD?

A
  • renal vascular disease
  • reflux nephropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How to detect CKD?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is part of a kidney health check?

A
  1. blood test
  2. urine test
  3. BP test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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
Q

What is the prevalence of CKD in AUS?

A

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
Q

What is overlooked in prevalence of CKD?

A
  • <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
Q

What is the prevalence of CKD among Aboriginal and TOrres Strait Islander peoples?

A

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
Q

Provide summary of dialysis and kidney transplantation in Aus 2021.

A
  • 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
Q

Who is at risk of CKD?

A
  • diabetes
  • hypertension
  • CVD
  • family Hx
  • obesity
  • smoker
  • 60y+
  • Aboriginal/Torres Strait Islander
  • Hx acute kidney damage
30
Q

What are modifiable risk factors?

A
  • healthy weight
  • smoking
  • (diabetics) maintain blood glucose control
  • take meds (e..g BP lowering)
31
Q

What are general health factors to prevent CKD?

A
  • regular PA
  • maintain healthy cholesterol levels
  • healthy diet
  • drink alcohol in moderation
32
Q

What are other factors that can reduce CKD?

A
  • 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
Q

Purpose of angiotensin-converting enzyme (ACE) inhibitor?

A

decrase BP by vasodilating blood vessels

slow progression of CKD

34
Q

Purpose of angiotensin II receptor blockers (ARB)?

A

block angiotensin II action, cause vasodilation

slow progression of CKD

35
Q

purpose of SGL2 inhibitor?

A

block glucose from being re-absorbed in kidney

slow progression of CKD

36
Q

purpose of diuretics?

A
  • remove excess Na+ fluid
37
Q

Purpose of beta blockers?

A

decrease BP, by decreasing HR and CO

38
Q

Purpose of Ca2+ channel blockers?

A

dilate blood vessels, relax muscles reducing resistance

39
Q

purpose of vasodilators?

A

relax smooth muscle of blood vessel

40
Q

purpose of direct renin inhibitors?

A

block renin, reduced resistance

41
Q

purpose of analgesics?

A

manage pain (PCKD)

42
Q

What are the complications of CKD?

A
  • rarely occurs in isolation, more a comorbidity
  • CKD + CVD = 3.5%
  • CKD+diabetes = 0.6%
43
Q

How is CVD the most common comorbidity?

A
  • atherosclerosis, heart failure, cardio-renal syndrome
    *MSK highly prevalent (muscle atrophy, myalgia, low BMD)
  • chronic pain
44
Q

What are benefits of Ex on CKD?

A
  • 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
Q

Why recommend a baseline cardipulmonary Ex testing with 12-lead ECG?

A
  • 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
Q

Why is submaximal testing recommended for CKD patients?

A
  • 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
Q

What are common testing measures for CKD patients?

A
  • 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
Q

What is the Ex Px for ESKD inter-dialysis?

A

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
Q

What is the Ex Px for ESKD intra-dialysis?

A

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
Q

What is the flexibility Px for inter/intra and non-dialysis patients?

A

5-7days
~10min sessions

Where possible combine with aerobic or RT and balance for those at falls risk

51
Q

What is the Ex Px for non-dialysis patients?

A

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
Q

What are some special considerations for Ex intolerances, such as cardiac?

A

*microvascular/systolic/diastolic dysfunction
* increase left ventricular
* pulsatile load
* myocardial stunning

53
Q

What are some special considerations for Ex intolerances, such as vascular?

A
  • endothelial dysfunction
  • microvascular dysfunction
  • decrease capillary:fibre
  • impaired functional sympatholysis
  • thickened capillary membrane
  • arterial stiffness
  • abnormal arterial haemodynamics
54
Q

What are some special considerations for Ex intolerances, such as renal?

A
  • uremia
  • metabolic acidosis
55
Q

What are some special considerations for Ex intolerances, such as skeletal muscle?

A
  • sarcopenia
  • incrase intermuscular fat
  • Type I to Type II fibre switch
  • Acqiured myopathies
  • mitochondrial dysfunction
56
Q

What are some special considerations for Ex intolerances, such as pulmonary?

A
  • obstructive diosrders
  • restrictive disorders
  • fluid retention
  • respiratory muscle wasting
57
Q

What are some special considerations for Ex intolerances, such as neural?

A
  • increase SNS
  • increase central command
  • increase renal nerve afferent
  • mechanoreflexes
58
Q

What are some special considerations for medications?

A
  • 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
Q

What are the risks of Ex?

A
  • 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)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions