Session 11 - CKD

Question 1

Define CKD. What is injured tissue replaced by?

Answer 1

• Irreversible and sometimes progressive loss of renal function over a period of months to years
• Injured renal tissue replaced by ECM

Question 2

Give 3 causes of CKD

Answer 2

• Immunologic – e.g. glomerulonephritis
• Infection
• Genetic – e.g. Alport’s
• Obstruction and reflux nephropathy
• Hypertension – damages the small blood vessels in the kidney
• Vascular
• System diseases – e.g. diabetes, myeloma
• Idiopathic

Question 3

What measurement is used to measure renal function? How must it be corrected for certain groups?

Answer 3

eGFR Corrected for black patients due to higher muscle mass

Question 4

How would you assess CKD?

Answer 4

• Image kidneys – can use ultrasound, CT or MRI. Look at size and hydronephrosis (distention of renal pelvis and calyces)

Question 5

Give the renal disease classification for kidney failure and define how many ml/min that is

Answer 5

G5 (kidney failure) - <15 ml/min

Question 6

Give the renal disease classification kidney failure in albumin:creatinine ratio

Answer 6

>30mg/mmol albumin:creatinine

Question 7

Why would kidney damage likely result in anaemia?

Answer 7

• Kidney makes erythropoietin. Resistance to erythropoietin occurs due to uraemia (build up of urea in blood)
• Erythropoietin necessary for RBC production. Therefore leads to decreased RBC survival and possible catastrophe during blood loss.

Question 8

Explain how osteomalacia comes as a result reduced renal blood flow

Answer 8

1) Decreased GFR from CKD
2) Results in decreased Active vitamin D due to renal impairment
3) Results in osteomalacia due to lack of calcium absorption because of lack of vitamin D
4) Lack of calcium in blood results in increased PTH which leaches calcium from bones, resulting in osteitis fibrosa cystica (weakened bones which are replaced with fibrous tissue and formation of cyst like brown tumours in and around bones)

Question 9

Explain how osteitis fibrosa cystica comes as a result of reduced renal blood flow

Answer 9

a) Decreased GFR from CKD
b) Phosphate is usually in excess in diet, therefore decrease GFR = increase in serum phosphate
c) Increase in phosphate results in decreased calcium due to homeostasis between them
d) Low calcium triggers increased PTH and leads to osteitis fibrosa cystica.

Question 10

How can CKD result in CVD? How would you manage CVD?

Answer 10

• CKD results in heart disease risk factors e.g. hyperlipidaemia.
• Treat with ACEi and statins
• Monitor and control blood pressure
• ARBs (angiotensin II receptor blockers) for proteinuria

Question 11

What are the advantages and diadvantages of haemodialysis?

Answer 11

Adv – less responsibility and days off

Disadv – have to travel to clinic, tied to dialysis times, and big restriction on fluid/food intake

Question 12

What contraindications would you have for haemodialysis?

Answer 12

o Failed vascular access

o Heart failure

o Coagulopathy

Question 13

What complications are associated with haemodialysis?

Answer 13

o Lines – infection, thrombosis

o CVS – instability

o Chronically unwell feeling o Arteriovenous fistula (AVF) – thrombosis, bleeding, steal syndrome (ischaemia caused by AVF)

Question 14

Expain how peritoneal dialysis works

Answer 14

• Fluid placed in peritoneum and left for an amount of time
• The peritoneum acts as a semipermeable membrane through which waste products cross into the peritoneal space
• Low efficiency but done all day every day

Question 15

Give the advantages and disadvantages of peritoneal dialysis

Answer 15

Adv:

o Independence

o Less fluid and food restrictions

o Easy to travel with

o Renal function better preserved initially

Disadv:

o Frequent daily exchanges

o Your own responsibility

Question 16

What contraindications are associated with peritoneal dialysis?

Answer 16

o Failure of peritoneal membrane

o Previous abdo surgery, hernias, stoma

o Obese or large muscle mass

Question 17

What complications are associated with peritoneal dialysis?

Answer 17

o Peritonitis

o Leaks

o Development of herniae