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Week 6

Dolu Falowo Foundations 3 English 50 cards

Cards in this deck (50)

  1. 1Describe the 3 categories, functions of the kidney fall under-Homeostasis
    -Metabolic/endocrine
    -Excretion of drugs and drug metabolites
  2. 2Describe serum creatinine as a measure of kidney function-Traditional measure
    -Influenced by age, gender, ethnicity, body mass, diet, exercise
    -Not sensitive to small changes in function (beyond 50% renal function)
    -Not a reliable marker
  3. 3What is a better measure of kidney function?Estimated Glomerular Filtration Rate (eGFR)
    -Calculated from creatinine, age, gender, ethnicity
    -Best measure for use in stable renal function
    -eGFR equates well with measured GFR
  4. 4What is Chronic Kidney Disease (CDK)?-eGFR>60ml/min
    -Kidney damage via pathological abnormalities or blood/urine/imaging markers of damage
    -Must be present >3 months
    -Irreversible and tends to progress
  5. 5Describe the staging of CDK1: kidney damage, GFR is normal
    2: kidney damage, mild decrease in GFR
    3: moderate decrease in GFR
    4: severe decrease in GFR
    5: kidney failure
  6. 6Describe stage 5 CKD: end stage renal failure-Insufficient renal function to sustain life/health
    -Needs haemo/peritoneal dialysis OR kidney transplantation
    -Death if untreated
  7. 7What are the risk factors for CKD?-Increased age
    -Hypertension
    -Diabetes
    -Smoking
    -Poor education
  8. 8What are some of the causes of CKD?-Systemic diseases
    -Immune mediated diseases
    -Infectious diseases
    -Genetic diseases
    -Arterial disease
    -Obstruction
  9. 9Describe diabetic nephropathy-Associated with poor diabetes control and hypertension
    -Thickening of basement membrane
    -Mesangial expansion
    -Glomerulosclerosis (intraglomerular hypertension/ischaemic damage)
  10. 10What are the different ways obstruction can occur?-Stones
    -Benign prostate
    -Tumours (intrinsic/extrinsic)
    -Fibrosis
  11. 11What are some of the complications of CKD?-Anaemia
    -Hypertension
    -Disturbed calcium/phosphate homeostasis
    -CVD
    -Bone disease
    -Abnormal handling of drugs
    -Immune suppression
    -Bleeding tendency
  12. 12What does failure of fluid homeostasis result in?-Inability to concentrate urine
    -Inability to excrete water load
  13. 13What is the treatment for fluid overload?-Limit fluid intake
    -Salt restriction
    -Diuretics
    (Dialysis/transplantation)
  14. 14What happens to electrolytes such as Na in CKD?-Reduced ability for excretion (loss of nephrons)
    -Causes hypertension/fluid overload
    -High/low Na leads to confusion, seizures, coma
  15. 15What happens to electrolytes such as K in CKD?-Large functional reserve for excretion
    -Severe hyperkalaemia when GFR>10ml/min
    -Results in excessive load and interference with potassium excretion
  16. 16What does hyperkalaemia result in?Alterations in membrane excitability
    Cardiac arrhythmias
    ECG changes:
    -tall T waves
    -long QRS interval
    -long PR interval
    (cardiac arrest)
  17. 17What is the treatment to prevent hyperkalaemia and hypernatraemia?-Salt restriction
    -Potassium restriction
    (dialysis and transplantation)
  18. 18What happens with the carbonic acid buffer system in CKD?-H+ rises as you fail to excrete it
    -CO2is removed by the lungs to maintain pH
  19. 19Describe metabolic acidosis-Increased respiratory drive (feel breathless)
    -Chest pain
    -Confusion
    -Bone pain
    -Demineralisation of bone (buffering)
  20. 20What is the treatment for metabolic acidosis?Sodium bicarbonate
    (dialysis/transplantation)
  21. 21Describe how Vit.D, calcium and PTH is affected in renal failure-Vit.D is not activated in the kidney (25-Vit.D is not converted to 1,25-Vit.D)
    -Increased bone resorption leads to demineralisation over time
  22. 22What is ectopic calcification?-Pathological deposition of Ca salts in tissues
    -Symptom of hyperphosphataemia/hyperparathyroidism
  23. 23What treatments prevent bone disease and ectopic calcification?-Reduce dietary phosphate
    -Phosphate binders
    -Calcimimetics
    -1 alpha-hydroxylated Vit.D replacement
    (parathyroidectomy)
  24. 24What is the impact of anaemia?-Impaired QoL and cognition
    -Iron overload in transfusions (since it's not excreted)
    -Increased risk of left ventricular hypertrophy
    -Increased risk of CVD (than those with CKD but not anaemia)
  25. 25Treatment for renal anaemia?Recombinant EPO
  26. 26What are the treatments for hypertension?-Salt restriction
    -Diuretics
    -RAAS blockade
    -Anti-hypertensives
  27. 27What is uraemia? Treatment?Accumulation of toxic waste products: creatinine, nitrogenous waste, urate, phosphate
    Dialysis/transplantation
  28. 28What is the impact on drug excretion in CKD? Treatment?-Drug metabolism is impaired
    -Increased risk of toxicity
    -Modify the prescription or don't give it!
  29. 29What is Acute Kidney Injury (AKI)?-A rapid (hours to days) decline in kidney function
    -Measured in terms of serum creatinine or urine output
  30. 30What are the consequences of AKI?Increases:
    -mortality
    -ITU stay
    -Hospital stay
    -Dependency at discharge
    -Likelihood of developing CKD
  31. 31Who is at risk of AKI?-Older age
    -Diabetes mellitus
    -Hypertension
    -Heart disease
    -Liver disease
    -CKD
    -Medication: diuretics. ACEi, NSAIDs, antibiotics, chemo
  32. 32What are the categories of causes of AKI?Pre-renal: perfusion failure
    Renal: intrinsic disease
    Post-renal: obstruction of urinary system
  33. 33What are some of the causes of perfusion failure?-Hypotension
    -Hypovolaemia
    -Renal artery occlusion
    This all leads to less glomerular filtration and urine output
  34. 34What is perfusion failure made worse by?-RAAS blockade
    -NSAIDs
    -Antihypertensives
    -Diuretics
  35. 35What is the treatment for perfusion failure?-Inotopic drugs
    -Fluid volume replacement
    -Restore arterial patency
    -Stop RAA blockade
    -Stop NSAID use
  36. 36How can obstructions be treated?-Nephrostomy
    -Bladder catheter
    -Lithotripsy (break up stone with sound waves)
    -Tumour removal
    -Dilatation of stricture
  37. 37What are renal causes of AKI?-Diseases that damage the tubules, glomerulus or interstitium
    -Systemic diseases
    -Infection
    -Allergic
    -Drug toxicity
    -Glomerulonephritis
  38. 38What is ANCA (anti-neutrophil cytoplasm antibodies) asosciated vasculitis?-Mainly affects elderly
    -Airways/renal organs commonly affected
    -Causes life threatening acute/chronic organ damage
    -Neutrophils stick to endothelium and enter via gaps
    -Causes necrotic cells and compressed glomerular tufts
  39. 39How can inflammatory renal disease be treated?-Steroids
    (Chemo)
    -Plasma exchange (remove anti-bodies)
    -Immunosuppressants
  40. 40What are the causes of death in AKI?-Rarely uraemia
    -Most common is sepsis
    -Underlying disease
    -Hyperkalaemia
    -Acidosis
    -Pulmonary oedema
  41. 41What is dialysis?-External therapy where fluid and solutes are removed/added to the patient's blood
    -Separates the patient's blood and dialysis fluid with a semipermeable membrane
    -Not as good as own kidneys
  42. 42What is peritoneal dialysis?-Dialysis fluid enters the abdominal cavity
    -Blood and fluid is separated by the peritoneum which is a semi-permeable membrane
    -Fluid enters via a catheter which is under the umbilicus
    -Process needs to be repeated every 4-6 hours
    -Lasts for ~8-10 years
    -Risk of peritonitis
    -Offers more independence for the patient
  43. 43How does peritoneal dialysis work?-Overtime, water and metabolites build up in the blood
    -Less HCO3- is present
    -The dialysis fluid contains water, glucose, Na+, K+ and HCO3- which creates a concentration gradient
    -Water, Na+, K+, H+ and urea leave the blood and enter dialysis fluid
    -HCO3- enters the blood and buffers it
  44. 44Describe haemodialysis-Permanent access to the circulation via AV fistula or central venous catheter
    -4 hours 3 times per week
    -Can last indefinitely
    -Uses a counter-current system in the dialyzing filter
  45. 45How would you choose a type of dialysis?-No medical difference
    -Made on lifestyle factors
    -Peritoneal dialysis is contraindicated if previous abdominal surgery
    -PD is better in severe heart disease, young patients with remaining function or older frail patients with carers
  46. 46When would you start dialysis in CKD?-eGFR<10ml/min
    -Before patient becomes ill
    -Need dialysis access beforehand
  47. 47When would you start dialysis in AKI?-Creatinine>500mcmol/L
    -Uraemia
    -Hyperkalaemia, pulmonary oedema or metabolic acidosis that cannot be controlled medically
    -Emergency dialysis line
  48. 48What are some of the problems with dialysis?-Infection
    -Cardiac disease eg. LVH and calcification of ateries
    -Anaemia
    -Bone disease
    -Malnutrition
  49. 49Describe kidney transplants-In iliac fossa outside peritoneum
    -Native kidneys left in situ
    -Transplanted kidney attached to iliac vessels directly
    -Results in better life expectancy, QoL
    -Replaces all renal functions
    -First choice treatment for CKD 5
  50. 50What must be checked in transplantation recipients and donors?-ABO blood group matching (Group O is a universal donor, group AB is a universal recipient)
    -HLA-A, B, DR matching
    -Screening for anti-donor antibodies in the recipient

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Description
Chronic kidney disease Acute kidney injury Dialysis and transplantation
Created by
Dolu Falowo · Nov 2018
Updated
Nov 18, 2018
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