Kidneys Stop Working

Question 1

4 effects of kidneys not working

Answer 1

1. Loss of excretory function
2. Loss of homeostatic function
3. Loss of endocrine function
4. Abnormality of glucose homeostasis (less gluconeogenesis)

Question 2

What are 2 outcomes of loss of endocrine function?

Answer 2

Loss of erythropoietin production

Failure to make 1 alfa hydroxyls Vitamin D

Question 3

What is the normal range of plasma creatinine?

Answer 3

50-110 micromol/L

Question 4

What are 2 signs of renal failure?

Answer 4

Elevated plasma urea and creatinine

Question 5

What 3 things can salt and water retention cause?

Answer 5

Hypertension, oedema, pulmonary oedema

Question 6

What are the implications of acidosis?

Answer 6

1. Decreased excretion of H+ ions.
2. Hyperkalaemia
3. Kussmahl respiration (air hunger)
4. Increases muscle catabolism and exacerbates anorexia

Question 7

What are the implications of hyperkalaemia?

Answer 7

1. Failure of DCT to secrete potassium.
2. Exacerbated by acidosis - causes K to shift from intercellular to extracellular space
3. Can cause cardiac arrhythmias
4. Neural/muscular activity

Question 8

What detrimental effects can kidney failure have on metabolism?

Answer 8

1. Anaemia due to lower erythropoietin
2. Poor intestinal calcium absorption, hypocalcaemia (short term) and hyperparathyroidism (long term) - due to low 1-25 Vit D levels
3. Increased CV risk

Question 9

What is a major outcome for a patient with CKD?

Answer 9

CV disease

can cause hypertension, cardiac effects, endothelial effects, lipid abnormalities

Question 10

What are some differences between acute and chronic loss of kidney function?

Answer 10

Acute: unchanged renal size, previously normal creatinine

Chronic: renal size small, chronic uraemia symptoms, previously normal creatinine

Question 11

How is kidney failure initially managed?

Answer 11

1. Intravenous saline to correct fluid depletion.
2. IV sodium bicarbonate to correct acidosis
3. IV insulin and dextrose - lower plasma K
4. Dialysis

Question 12

What were some traditional methods of assessing GFR?

Answer 12

1. Urea
2. Creatinine
3. Creatinine clearance
4. Inulin clearance
5. Radionuclide studies

Question 13

2 new ways of measuring GFR?

Answer 13

1. MDRD

2. CKD-EPI (better estimate of true GFR >45l/min)