22. CKD lectures and videos Flashcards Preview

Medicine Y3 TCD 13-24 > 22. CKD lectures and videos > Flashcards

Flashcards in 22. CKD lectures and videos Deck (33)
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1
Q

what is CKD

A

• Kidney damage or GFR less than 60 for longer than 3 months due to any cause

2
Q

what does ESRD mean

A

the patient is no longer able to live with their kidney function and need to be commenced on RRT

3
Q

in someone with CKD what could urinalysis show

A

proteinuria, haematuria and glucosuria

4
Q

what do the following abbreviations mean;

  • AKI
  • ARF
  • ATN
  • AIN
  • RPRF
  • ESRD/ESRF
A
  • Acute kidney injury- AKI
  • Acute renal failure- ARF
  • Acute tubular necrosis- ATN
  • Acute interstitial nephritis- AIN
  • Rapidly progressive renal failure- RPRF
  • End stage renal disease- ESRD/ESRF
5
Q

what is azotaemia

A

elevation of nitrogenous metabolic waste in the blood due to failure of clearance by the kidneys

6
Q

what is uraemia

A

clinical syndrome resulting from failing kidneys and progressive azotaemia

7
Q

what systemic disease can cause Glomerulonephritis

A

vasculitis

8
Q

what is normal gas. exchange dependant on

A

o Adequate alveolar ventilation
o Adequate pulmonary perfusion
o Minimal barrier to gaseous diffusion

9
Q

which two organs work to maintain Ph

A

kidneys and lungs

10
Q

if there issues excessive CO2 then there is renal compensation and what occurs

A

bicarbonate is retained by the kidneys

11
Q

in chronic CO2 retention what is the most important thing to look at

A

the bicarbonate as it will be raised

12
Q

in a DKA patient what kind of breathing might they have and how does this link to the compensation

A

kussmaul breathing, and they will have low bicarbonate so there is a compensation by blowing off CO2 in the lungs

13
Q

what are the indications to start renal replacement therapy

A
•	Fluid overload 
•	Refractory hyperkalaemia 
•	Uraemic symptoms
o	Nausea, vomiting, weight loss
o	Neurological symptoms 
o	Uraemic pericarditis ( rarely seen in modern day practice)
14
Q

what are the main types of diuretics

A

osmotic
loop
thiazide
potassium sparing

15
Q

give an example of osmotic diuretics

A

mannitol, urea, glycerine ad isosorbide

16
Q

give an example of loop diuretics

A

furosemide and bemetanide

17
Q

give an example of a thiazide diuretic

A

hydrochlorothiazide, chlorothiazide

18
Q

give an example of a potassium sparing diuretic

A

spironolactone (aldosterone inhibitor)

19
Q

how do diuretics work in general

A

substances that help the body to get rid of sodium and water
they decrease BP due to decrease in plasma volume

20
Q

where do osmotic diuretics exert their effect

A

• Limit the reabsorption of water in the tubule and increase osmolality in renal tubule

21
Q

what is the issue with loop diuretics

A

can induce renin release due to plasma volume depletion

22
Q

which type of diuretic can increase the the reabsorption of urea in proximal tubule which increases plasma uric acid which can lead to gout

A

thiazide

23
Q

how do potassium sparing diuretics works

A

aldosterone secreted by adrenal glands (it’s a steroid so binds to receptor inside the cell)
o This causes more Na/K+ pumps to be made, therefore preventing excretions of potassium and also the reabsorption of sodium

24
Q

what are the absolute and relative contraindications to haemo-dialysis

A

inability to achieve suitable vascular access

severe dementia 
severe heart failure 
bleeding disorder 
low BP
severe active psychotic disorder
25
Q

what are the absolute and relative contraindications to peritoneal dialysis

A
active IBD
ischaemic bowel 
acute diverticulitis 
abdominal abscess 
pregnancy 3rd trimester 
abdominal hernia 
stomas
previous abdo surgery 
poor manual dexterity 
obesity 
severe. nephrotic range proteinuria 
severe obstructive airway disease
26
Q

tell me about haemodialysis

A

can be done through an IV line in your neck or by making a fistula
usually done for 4 hours 3X a week

27
Q

tell me about peritoneal dialysis

A
  • pour dialysate solution into your peritoneum which diffuses waste products out of your body, and then drain this fluid out
  • The exchange takes about 20-30 minutes
28
Q

what are the two options for peritoneal dialysis

A

o Two ways to do it, continuous ambulatory peritoneal dialysis (CAPD) which is where you do it 4 times a days, or automated peritoneal dialysis (APD) which is where you plug yourself into the machine overnight and this runs for 7-10 hours. With APD you may get some fluid in the stomach during the day

29
Q

what are the indications for having a renal transplant

A

o All patients with end stage renal failure (GRF less than 15) or those with CKD stage 4 (GFR 15-29) with progressive disease should als be assessed for renal transplantation

30
Q

what are the absolute contraindications for renal transplant

A

untreated malignancy
active infection
untreated HIV infection or AIDS
ant condition with a life expectancy less than 2 years
malignant melanoma within the previous 5 years

31
Q

what are the relative contraindications for renal transplant

A
co-morbidities eg diabetes 
age greater than 65 
obesity 
HBC or HCV infection 
previous malignancy (depending on type)
32
Q

what is the most common cause of mortality post-operatively within the first year of transplant

A

cardiovascular disease

33
Q

most other long term complications that aren’t cardiovascular disease are often related to what

A

related to the use of immunosuppressive agents such as recurrent infections, diabetes or malignancy