What is the focus of Dr. Liu Peiyun's consultation?
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Acute Kidney Injury, Chronic Kidney Disease, and End Stage Renal Failure.
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What is the focus of Dr. Liu Peiyun's consultation?
Acute Kidney Injury, Chronic Kidney Disease, and End Stage Renal Failure.
What is a common treatment for pruritus in renal patients?
UV light therapy.
What is the relationship between Acute Kidney Injury and Chronic Kidney Disease?
They are part of a continuum where acute injury can lead to chronic disease.
What causes fluid retention in the body?
Failure of sodium and free water excretion.
What does end-stage renal failure indicate?
It indicates a severe decline in kidney function requiring dialysis or transplantation.
What syndrome is associated with both heart and kidney dysfunction?
Cardio-renal syndrome.
What are the two types of vascular catheters used for haemodialysis access?
Temporary non-tunneled vascular catheter and tunneled vascular catheter.
Which class of drugs requires careful dosing in patients with renal impairment?
Diuretics.
What symptom might indicate a mechanical complication in PD?
Abdominal pain.
What is one mechanism of injury in radiation nephropathy?
Damage to renal blood vessels resulting in ischaemic insult to the kidneys.
In which year was Mehran’s CIN Risk Score published?
What is a pleuro-peritoneal leak?
A leak between the pleural cavity and the peritoneal cavity.
What effect does ionizing radiation have on chemical bonds?
It disrupts chemical bonds and knocks electrons out of atoms.
What is Contrast Induced Nephropathy (CIN)?
A generally reversible form of acute kidney injury that occurs soon after administration of radiocontrast media.
What does the Singapore Renal Registry 2018 Report focus on?
Dialysis modality in Singapore.
What is the result of fluid retention?
Extracellular volume expansion and total-body volume overload.
What role does Vitamin D play in bone health?
It helps in bone reabsorption.
What syndrome involves liver and kidney dysfunction?
Hepato-renal syndrome.
How long must abnormalities be present to diagnose Chronic Kidney Disease?
More than 3 months.
What is post-renal acute kidney injury (AKI)?
AKI caused by urinary tract obstruction.
What type of thrombus can occur in the right atrium due to vascular catheters?
Mural thrombus/right atrium thrombus.
What is filtered at the glomeruli and reabsorbed by tubular epithelium?
Radioisotope protein conjugate.
Is a living donor available for renal transplant with no contraindications?
Yes.
What should be evaluated to understand CKD?
The cause of CKD.
What is a common characteristic of renal failure in its early stages?
Most patients are asymptomatic.
What can occur in end-stage renal failure?
Breathlessness due to accumulation of fluid in the body.
What offers the best survival rate for patients with End-Stage Renal Disease (ESRD)?
Transplantation.
What is the definition of Chronic Kidney Disease (CKD)?
Abnormalities of kidney structure or renal function present for more than 3 months, with implications for health.
What is a recommended dietary approach for managing blood pressure?
Low salt diet.
What complications can metabolic acidosis aggravate in patients with CKD?
Bone disease, protein/muscle wasting, CKD progression, and mortality.
How does a decrease in GFR affect phosphate levels?
It leads to decreased phosphate excretion, resulting in hyperphosphatemia.
What is a classical cause of kidney damage in patients at risk?
Post external beam radiation for treatment of solid cancers.
How can cardiac issues contribute to Acute Kidney Injury?
Cardiac-related causes can lead to decreased blood flow to the kidneys, resulting in injury.
What is pre-renal acute kidney injury (AKI)?
A type of kidney injury caused by inadequate blood flow to the kidneys.
Which journal published the study on Mehran’s CIN Risk Score?
JACC (Journal of the American College of Cardiology).
What role do kidney stones play in Acute Kidney Injury?
Kidney stones can obstruct urine flow, leading to increased pressure and potential kidney damage.
What are common causes of pre-renal AKI?
Dehydration, heart failure, and blood loss.
What is the volume and issue number of the JACC publication for Mehran’s CIN Risk Score?
Volume 44, Issue 7.
What type of infection can occur at the exit site of a vascular catheter?
Exit site/tunnel track infection.
What is the term for kidney damage caused by high blood pressure?
Hypertensive Nephrosclerosis.
What is Mehran’s CIN Risk Score used for?
To assess the risk of contrast-induced nephropathy (CIN) in patients undergoing procedures involving contrast media.
What are some traditional cardiovascular risk factors that should be controlled in CKD patients?
Obesity, smoking, diabetes mellitus (DM), hypertension, and lipids.
Which class of medications is preferred for controlling blood pressure?
ACE inhibitors (ACEi) or Angiotensin II Receptor Blockers (ARB).
What does the KDIGO 2012 Guideline recommend for people with CKD regarding physical activity?
They should be encouraged to undertake physical activity compatible with cardiovascular health and tolerance, aiming for at least 30 minutes 5 times per week.
What guidelines provide the clinical practice for the evaluation and management of Chronic Kidney Disease?
KDIGO 2012 Clinical Practice Guideline.
What is a common cause of post-renal AKI?
Urinary tract obstruction.
Which agents are important to consider for dosing adjustments in renal impairment?
Oral hypoglycemic agents.
What are the two types of arteriovenous grafts?
Loop graft and straight graft.
Where does Dr. Liu Peiyun work?
Singapore General Hospital.
What is a common treatment for fluid retention?
Diuretics.
How does chronic kidney disease (CKD) affect drug elimination?
It affects renal drug elimination, potentially leading to accumulation of both metabolite and parent compound.
What is a key reason to avoid unplanned initiation of Renal Replacement Therapy (RRT)?
To prevent infective complications associated with vascular catheters.
What dietary changes can help manage fluid retention?
Fluid restriction and a low salt diet.
Which report provides data on renal health in Singapore?
Singapore Renal Registry 2018 Report.
What is VO2peak and why is it significant in ESRD patients?
VO2peak is a measure of exercise capacity and an independent predictor of mortality in ESRD patients.
What are the criteria for deceased donor renal transplants?
Standard criteria, expanded criteria, and donation after cardiac death.
What are common strategies in conservative management of CKD?
Dietary modifications, blood pressure control, and management of comorbidities.
What can patients who develop acute radiation nephritis progress to?
Chronic kidney disease and subsequently end stage renal failure.
What are some causes of occlusion in vascular catheters?
Blood clot/fibrin, fibrin sheath, kink.
What is a common cause of glomerular disease leading to acute kidney injury?
Inflammation, specifically glomerulonephritis.
Why is early intervention important in CKD?
To prevent or delay the transition to ESRF.
What is one cause of Chronic Kidney Disease (CKD)?
Chronic Obstructive Uropathy.
Which condition involves inflammation of the kidney's filtering units and can lead to Chronic Kidney Disease?
Chronic Glomerulonephritis.
What can cause catheter obstruction in PD?
Fibrin, kink, omentum wrapping, and tip migration.
What does ESRD stand for?
End-Stage Renal Disease.
What is Mineral Bone Disease?
A condition characterized by abnormalities in bone metabolism and mineralization.
What are some options for symptomatic relief in renal failure?
Dialysis or symptomatic relief treatments.
Which report provides information on survival outcomes of dialysis modalities?
Singapore Renal Registry 2018 Report.
Name the three types of arteriovenous fistulas.
Radiocephalic, brachiocephalic, and brachiobasilic.
What should dialysis patients be regularly encouraged to do?
Increase their level of physical activity.
What benefit does timely initiation of RRT provide?
Allows timely dialysis access placement.
What is hyperkalaemia?
A condition characterized by reduced excretion of potassium from the kidneys.
How does CKD affect nonrenal clearance of medications?
It may lead to alterations due to changes in the activities of uptake and efflux transporters as well as cytochrome P450 in the liver and other organs.
Which antihistamine can be used for pruritus?
Gabapentin.
What is another class of medications that may require dosing adjustments in renal impairment?
Analgesics.
What dietary recommendation is often made for hyperkalaemia?
A low potassium diet.
What is the significance of the Singapore Renal Registry?
It provides data and insights on renal health and dialysis practices in Singapore.
In what context might someone say 'Thank You 86'?
It could imply gratitude for something that has been removed or resolved.
What is a common mechanical complication in Peritoneal Dialysis (PD) related to bowel issues?
Constipation.
What is a key characteristic of metabolic acidosis related to kidney function?
Kidneys are unable to produce enough ammonia in the proximal tubules to excrete endogenous acid as ammonium.
What is anuria?
Urine output less than 100 ml/day.
Which medication can be used to relieve nausea in renal patients?
Metoclopramide.
What is the function of a semi-permeable membrane in dialysis?
It allows certain substances to pass while blocking others.
What is the long-term plan for a patient transitioning from CKD to ESRF?
Conservative renal replacement therapy.
What factors can be altered in drug pharmacokinetics due to CKD?
Drug absorption, bioavailability, protein binding, distribution volume, and nonrenal clearance.
What is one consequence of unplanned initiation of RRT?
Increased morbidity.
What does the green stage indicate in Chronic Kidney Disease (CKD)?
Low risk (if no other markers of kidney disease, no CKD).
What is a tunneled catheter?
A vascular catheter that is inserted under the skin and tunneled to a central vein.
What type of membrane is used in haemodialysis?
Dialyzer membrane.
What does the yellow stage indicate in Chronic Kidney Disease (CKD)?
Moderately increased risk.
What is peritonitis?
An infection of the peritoneum, often indicated by cloudy dialysate in PD.
What process is used to pump blood through the dialyser?
Continuous pumping.
What is the first stage of Acute Kidney Injury according to KDIGO?
Stage 1: Increase in serum creatinine of 0.3 mg/dL or more within 48 hours.
What is a potential outcome for patients with Acute Kidney Injury?
Patients may not fully recover and can progress to end-stage renal failure.
What is non-oliguric AKI?
AKI with urine output greater than 400 ml/day.
What are the types of hernias associated with mechanical complications in PD?
Inguinal, femoral, ventral, umbilical, and paraumbilical hernias.
What is the leading cause of death in CKD patients?
Cardiovascular disease.
What complication can arise from central vein use of vascular catheters?
Central vein stenosis.
What is a peri-catheter leak?
A leak occurring around the catheter, often accompanied by subcutaneous edema.
What type of infection can occur at the exit site of a PD catheter?
Exit site infection.
What type of membrane is used in peritoneal dialysis?
Peritoneal membrane.
What are the two types of flow issues that can occur in PD?
Inflow and outflow problems.
What is a single kidney transplant?
A surgical procedure where a healthy kidney from a donor is transplanted into a recipient with kidney failure.
How does exercise affect dialysis patients?
Exercise improves oxygen peak consumption and strength in dialysis patients.
What is the accepted threshold dose of photon irradiation that can cause radiation nephropathy?
A total dose of 23Gy, fractionated in 20 doses over 4 weeks.
How does urinary tract obstruction lead to post-renal AKI?
It causes increased pressure in the urinary system, leading to kidney damage.
What type of exercise equipment is used for cycling during dialysis?
A modified exercise bike attached to the end of the patient’s couch.
What can inappropriate dosing in renal patients cause?
Toxicity or ineffective therapy.
What does CKD stand for?
Chronic Kidney Disease.
What therapy is associated with the use of radioisotope protein conjugates?
Radionuclide Therapy.
What causes hyperphosphataemia?
Reduced excretion of phosphate from the kidneys.
What factors can contribute to urinary tract obstruction?
Kidney stones, tumors, or enlarged prostate.
What is the significance of the number 86?
It is often used as a slang term meaning to remove or get rid of something.
What is a significant symptom of fluid accumulation in renal failure?
Breathlessness.
What does ESRF stand for?
End-Stage Renal Failure.
What type of agents should be monitored for dosing in renal impairment?
Antimicrobials.
Why is it important to control cardiovascular risk factors in CKD patients?
To reduce the risk of cardiovascular disease, which is a leading cause of death.
Name two other classes of medications used to control blood pressure.
Beta blockers and calcium channel blockers.
What is a potential treatment approach for metabolic acidosis in CKD?
Prescribing to decrease acidity in blood to reduce CKD progression.
What is an example of living unrelated renal donation?
Spousal donation.
Is preemptive renal transplant an option for patients transitioning to ESRF?
No.
What is a common barrier to exercise in dialysis patients related to exercise modality?
Uncertainty about optimal modality and dose of exercise.
How is Mineral Bone Disease diagnosed?
Through blood tests, imaging studies, and assessment of symptoms.
How does early RRT initiation affect transplantation?
It allows for transplantation referral for consideration of preemptive renal transplant.
What is the primary use of vascular catheters?
To provide access for dialysis or other medical treatments.
What is a common infective complication of Peritoneal Dialysis (PD)?
Peritonitis.
How should patients who are not currently active begin their exercise routine?
At very low levels and durations, gradually progressing to the recommended level.
What is a major risk factor for patients at risk of renal failure?
Chronic kidney disease.
What is the source of the kidney in a single kidney transplant?
The kidney can come from a living donor or a deceased donor.
What are phosphate binders used for?
To manage hyperphosphataemia.
What is a common cause of Chronic Kidney Disease related to diabetes?
Diabetic Nephropathy.
What defines oliguria in the context of AKI?
Urine output less than 400 ml/day.
What does an increase in creatinine levels indicate in the context of Acute Kidney Injury?
It indicates a decline in kidney function.
What is radiation nephropathy?
Renal injury and loss of function caused by ionizing radiation.
Which department is Dr. Liu Peiyun associated with?
Department of Renal Medicine.
What are some common infectious causes of Acute Kidney Injury?
Infections can lead to Acute Kidney Injury through sepsis or urinary tract infections.
How can treatment for metabolic acidosis affect CKD progression?
Treatment may reduce the CKD progression rate.
What does KDIGO stand for?
Kidney Disease: Improving Global Outcomes.
What is the primary function of the glomerulus?
To filter blood and form urine.
What does the radioisotope protein conjugate act as when lodged in the kidney?
A radioemitter.
What are the symptoms of a pleuro-peritoneal leak?
Vulva or scrotal swelling.
What is a dual kidney transplant?
A surgical procedure where two kidneys are transplanted into a single recipient.
What is a potential mechanism of progressive loss of nephrons in Chronic Kidney Disease (CKD)?
Glomerular hypertension leading to glomerulosclerosis.
What age qualifies a donor as an Expanded Criteria Donor (ECD)?
50 - 59 years of age with specific health criteria or ≥ 60 years of age.
What is one of the outcomes of ionizing radiation on cancer cells?
Death of cancer cells.
What topical treatment can help with pruritus?
Suu balm.
What are the health criteria that can classify a donor aged 50-59 as ECD?
Terminal Cr > 1.5 mg/dl, death due to CVA, hypertension, or diabetes mellitus of any age.
What compensatory mechanisms may occur in response to pre-renal AKI?
Activation of the renin-angiotensin-aldosterone system (RAAS) and increased sympathetic nervous system activity.
What type of acidosis is commonly associated with renal failure?
Metabolic acidosis.
What is a common complication associated with vascular catheters?
Catheter related blood stream infection.
What does CKD stand for?
Chronic Kidney Disease.
What is a key consideration when dosing drugs in renal impairment?
Adjustments may be needed for diuretics, antimicrobials, oral hypoglycemic agents, and analgesics.
What is a common sign of peritonitis in patients undergoing peritoneal dialysis (PD)?
Cloudy dialysate.
What is the primary function of a dialyser in haemodialysis?
To remove waste products and excess water from the blood.
What are the types of living donor renal transplants?
Living related, living unrelated (e.g., spousal donation), and ABO incompatible.
What is the focus of conservative management in CKD?
To slow the progression of the disease and manage symptoms.
What is the glomerulus?
A network of capillaries located at the beginning of a nephron, responsible for filtering blood.
What are common causes of Mineral Bone Disease?
Chronic kidney disease, vitamin D deficiency, and imbalances in calcium and phosphorus.
What condition is characterized by high phosphate levels due to decreased GFR?
Hyperphosphatemia.
What may cause an increase in the volume of distribution in CKD patients?
Decreased protein binding, increased tissue binding, or alteration in body composition (e.g., fluid overload).
What recent treatment has increased the risk of kidney damage?
Total body irradiation (TBI) used before hematopoietic stem cell transplant.
What are non-traditional cardiovascular risk factors in CKD patients?
Factors that are not typically associated with cardiovascular disease but may affect CKD patients.
What is another type of medication that can be used for blood pressure control?
Diuretics.
What is a dialysate solution?
A solution consisting of electrolytes dissolved in water.
What does ABO incompatible mean in the context of renal transplantation?
It refers to transplants where the donor and recipient have different blood types.
What are the potential benefits of a single kidney transplant?
Improved kidney function, better quality of life, and reduced need for dialysis.
What type of therapy is associated with kidney risk in neuroendocrine malignancies?
Targeted radionuclide therapy.
What happens to the lifespan of red blood cells (RBC) in patients with CKD?
The lifespan of RBC is shortened to 60-90 days.
What does CKD stand for?
Chronic Kidney Disease.
What is the significance of monitoring creatinine levels in patients with Acute Kidney Injury?
It helps assess the severity and progression of kidney damage.
What is an arteriovenous fistula?
A surgical connection between an artery and a vein, used for haemodialysis access.
How does blood become purified during haemodialysis?
Waste products diffuse from the blood across the membrane of the dialyser's tiny capillaries.
What is a tunnel track infection in the context of peritoneal dialysis?
An infection that occurs along the catheter tunnel from the exit site to the peritoneal cavity.
What can be used to manage loss of appetite in renal patients?
Nutritional supplements.
What are the symptoms of Mineral Bone Disease?
Bone pain, fractures, and deformities.
What is the purpose of the KDIGO 2012 Clinical Practice Guideline?
To provide a framework for the diagnosis and management of Acute Kidney Injury.
What is a non-tunneled catheter?
A vascular catheter that is inserted directly into a central vein without tunneling.
When does acute decline in renal function typically occur after contrast medium injection?
48 - 72 hours.
What benefits are associated with regular exercise in adults with CKD?
Improved physical fitness, cardiovascular dimensions, and health-related quality of life.
Are there contraindications to peritoneal dialysis?
No.
What factors influence normal creatinine levels?
Age, gender, and body size.
What is a common complication of renal failure related to blood health?
Anaemia.
What is meant by 'donation after cardiac death'?
It refers to organ donation that occurs after a donor's heart has stopped beating.
What is a key characteristic of CIN regarding its reversibility?
CIN is generally reversible.
What is the role of a dietician in managing CKD patients?
Dietician input is paramount, especially for non-compliant patients.
What is mentioned as toxic in relation to protein?
Protein in the wine protein area.
What role does the peritoneal membrane play in Peritoneal Dialysis?
It filters waste and fluids from blood into the PD solution.
What is a potential cause of acute interstitial nephritis?
Inflammation.
What metabolic complication can arise from Peritoneal Dialysis?
Hyperglycaemia.
What complication is common in CKD patients?
Malnutrition.
What are the options if a patient is not keen on renal transplant?
Continue with Peritoneal Dialysis (PD) or Hemodialysis (HD).
What is the volume and article number of the Yamaguchi et al. publication?
Volume 4, Article 1212.
What is the function of the renal corpuscle?
To filter blood and form urine.
What happens to the blood after it is purified in the dialyser?
It is returned to the patient’s body through larger tubes.
What is a Standard Criteria Donor (SCD)?
A deceased donor who does not meet the criteria for Expanded Criteria Donor (ECD).
What is creatinine?
A waste product derived from muscle metabolism, present in the bloodstream and excreted in urine.
How can cytotoxic chemotherapy affect kidney risk?
It can potentiate the effects of ionizing radiation.
How can an enlarged prostate affect kidney function?
An enlarged prostate can obstruct the urinary tract, causing urine retention and kidney injury.
When does serum creatinine peak after the administration of contrast medium?
3 - 5 days.
Why do electrolyte levels in dialysate resemble those in human blood?
To reduce the loss of electrolytes from blood into the dialysate during dialysis.
What characterizes Stage 2 of Acute Kidney Injury in KDIGO staging?
Increase in serum creatinine of 2.0 to 2.9 times the baseline.
What psychological barrier do dialysis patients often face regarding exercise?
Lack of motivation by patients.
What are the two main modalities of haemodialysis treatment?
Home and in-centre.
What side is the right kidney typically transplanted on?
The right side of the body.
In which journal was the article by Yamaguchi et al. published?
F1000Research.
What GFR level indicates a transition from Stage 4 CKD to ESRF?
Less than 20 mL/min.
What syndrome can occur due to rapid changes during dialysis?
Dialysis disequilibrium syndrome.
What year was the article by Yamaguchi et al. published?
What additional dietary consideration may be required for diabetic patients?
DM/low fat diet.
Why is renal tissue affected later after radiation exposure?
Due to slower cell turnover rates in renal tissue.
What is a key goal in managing CKD?
Retardation of Progression.
What is a potential consequence of hypocalcaemia?
Muscle spasms (Kramp).
What reaction can occur due to the dialyser during treatment?
Dialyser reaction.
What is Continuous Ambulatory Peritoneal Dialysis (CAPD)?
A modality where dialysis exchanges are performed 3-4 times during the day, with PD solution remaining in the abdomen for 4-6 hours before draining.
What is pre-renal acute kidney injury (AKI)?
A type of kidney injury caused by inadequate blood flow to the kidneys.
What can cause fluid shifts to the brain during dialysis?
Rapid changes in blood volume.
How does decreased blood flow affect kidney function in pre-renal AKI?
It leads to reduced glomerular filtration rate (GFR).
What are common causes of renal failure?
Conditions such as diabetes, hypertension, and glomerulonephritis.
What are common signs and symptoms of renal failure?
Fatigue, swelling, changes in urination, and confusion.
What complication related to dialysis is avoided through renal transplantation?
Complications related to dialysis access and treatment.
According to a Cochrane review, how often should adults with CKD exercise to improve health outcomes?
Regularly for more than 30 minutes per session for 3 sessions per week.
What is a consequence of hyperphosphatemia in renal disease?
It can lead to mineral bone disease.
What do oxygen radicals generated by ionizing radiation cause?
Prompt DNA injury within milliseconds of irradiation.
What is the recommended goal for cardiovascular exercise in dialysis patients?
Moderate intensity for 30 minutes most days of the week.
How does decreased blood flow affect kidney function in pre-renal AKI?
It leads to reduced glomerular filtration rate (GFR) and impaired kidney function.
What are the page numbers for the Mehran et al. study in JACC?
1393 - 1399.
What can cause acute tubular necrosis aside from toxins?
Ischaemia.
What is a key difference between tunneled and non-tunneled catheters?
Tunneled catheters are placed under the skin, while non-tunneled catheters are not.
What type of infection can occur at the exit site during PD?
Exit Site Infection.
What happens if only one kidney is irradiated with a threshold or higher dose?
Renal failure from radiation nephropathy will not occur, but radiation injury will occur in that kidney.
What is a common complication associated with arteriovenous fistulas and grafts?
Infection.
What is a common concern after a single kidney transplant?
The risk of organ rejection and the need for immunosuppressive medications.
What adjustments are required for maintenance doses in renal patients?
Dose reduction and lengthening dosing intervals.
What is the difference between cardiopulmonary criteria and neurologic criteria for declaring death?
Cardiopulmonary criteria involve irreversible cessation of circulatory and respiratory function, while neurologic criteria involve irreversible loss of all brain functions.
How does hyperglycemia affect nephron loss in CKD?
It can lead to diabetic nephropathy and increased nephron damage.
What is an important aspect of treating CKD?
Treatment of the underlying cause.
What effect does elevated serum phosphate levels have on calcium?
It causes increased calcium-phosphate binding.
What serious complication can arise from air entering the bloodstream during dialysis?
Air embolism.
What is a characteristic of renal injury expression post-radiation?
Delayed expression of renal injury.
What is a consequence of non-compliance with dietary restrictions in CKD?
Recurrent fluid overload and hyperkalaemia.
What role do family members play in peritoneal dialysis?
They can assist if patients are unable to perform therapy themselves.
What is the purpose of the second needle during haemodialysis?
To return cleansed blood to the body.
What muscle issue can patients experience during dialysis?
Muscle cramps.
What complication involves narrowing of the central veins?
Central vein stenosis.
What types of history are important in evaluating renal failure?
Family history, drug history, and past medical history.
How is renal failure defined?
A condition where the kidneys lose their ability to filter waste from the blood.
What are some complications associated with renal failure?
Anemia, bone disease, and cardiovascular issues.
Why might a patient need a single kidney transplant?
Due to end-stage renal disease or severe kidney dysfunction.
Where is the glomerulus located?
At the beginning of a nephron.
Under what condition will CKD not occur from irradiation?
If the total irradiated renal volume is less than 30% of both kidneys.
What is a common issue related to diet in patients?
Malnutrition.
What are potential consequences of untreated urinary tract obstruction?
Progression to chronic kidney disease or kidney failure.
What does CKD stand for?
Chronic Kidney Disease.
What is the first step in Peritoneal Dialysis?
A PD catheter is inserted permanently into the abdomen.
What dietary restriction is often recommended for patients with renal issues?
Low salt diet.
What does GFR stand for?
Glomerular filtration rate.
What role does inflammation play in the progression of CKD?
Inflammation can exacerbate nephron injury and fibrosis.
What defines Stage 3 of Acute Kidney Injury according to KDIGO?
Increase in serum creatinine of 3.0 times the baseline or initiation of renal replacement therapy.
What is the primary focus of the article by Lin et al. in the Journal of the Formosan Medical Association?
Pathophysiology of Diabetic Nephropathy.
Which organization is associated with the Onco-Nephrology Curriculum?
American Society of Nephrology.
How often is haemodialysis performed?
3 times a week.
How do the kidneys contribute to electrolyte balance?
By regulating the levels of sodium, potassium, and calcium in the blood.
What bone-related complication can arise from renal failure?
Mineral bone disorder.
What are the main components of a nephron?
The renal corpuscle and the renal tubule.
How many needles are used during haemodialysis?
2 needles.
What is the function of the kidneys in waste elimination?
They filter out waste products from the blood and excrete them in urine.
What is the inflow and outflow time during an exchange?
Inflow takes 10 minutes and outflow takes 20 minutes.
How do the kidneys affect red blood cell production?
By producing erythropoietin, which stimulates red blood cell production in the bone marrow.
What preventive measures should be taken for patients with an eGFR of < 45 ml/min?
IV hydration.
What is one way haemodialysis can improve patient quality of life?
By improving nutrition.
What role does diffusion play in peritoneal dialysis?
It helps in the movement of uremic toxins across the peritoneal membrane.
What does the Canadian Association of Radiologists recommend for patients at moderate risk of CIN?
IV hydration.
What are the uncertain benefit measures for preventing CIN according to the guidelines?
N-acetylcysteine and intravenous sodium bicarbonate.
What is the collecting duct's function?
To collect urine from multiple nephrons and transport it to the renal pelvis.
What is the significance of urine output in pre-renal AKI?
Urine output may decrease as the kidneys conserve water due to low blood flow.
What is intraabdominal pressure's relevance in peritoneal dialysis?
It can affect the efficiency of dialysis and patient comfort.
How long can the process of radiation nephropathy occur?
Slowly over years.
What type of injury does the radioisotope protein conjugate cause?
Injury to renal tissue.
What does the orange stage indicate in Chronic Kidney Disease (CKD)?
High risk.
When does acute radiation nephropathy typically occur after radiation exposure?
6 to 12 months.
How does tubulointerstitial fibrosis contribute to CKD?
It leads to nephron damage and loss of function.
What potential effect does physical activity have on renal function in CKD patients?
It may be associated with a slower decline in renal function.
What is the primary focus of the article by Yamaguchi et al.?
The pathophysiology of Chronic Kidney Disease (CKD).
Which diet is recommended to limit potassium intake?
Low potassium diet.
How long after radiation exposure can malignant hypertension develop?
12 to 18 months.
How often is intermittent haemodialysis typically performed in-centre?
3 times a week.
Why might exercise immediately after dialysis be poorly tolerated?
Due to postural hypotension, dizziness, and washout sensations.
What health concerns limit exercise in dialysis patients?
Safety and health concerns, including fatigue and shortness of breath.
What is the process of replacing used PD solution with fresh solution called?
An exchange.
What is the relationship between CKD patients and physical functioning?
CKD patients have poor physical functioning and reduced exercise capacity, which is associated with increased all-cause mortality.
What role do the kidneys play in acid-base balance?
They help maintain the pH level of the blood by excreting hydrogen ions and reabsorbing bicarbonate.
What type of complications can renal failure lead to in the cardiovascular system?
Cardiovascular complications.
What should be evaluated and managed in CKD patients?
Complications associated with CKD.
What complication can result from the failure of the peritoneal membrane?
Membrane Failure.
What type of administration of radiocontrast poses a higher risk?
Intra-arterial administration.
What family history should be considered in the evaluation of renal failure?
Family history of renal disease.
What is a significant difference between peritoneal dialysis and hemodialysis?
Peritoneal dialysis is painless and does not involve needling.
What is Continuous Cycling Peritoneal Dialysis (CCPD)?
A type of automated peritoneal dialysis that includes a day dwell.
What is the structure of the dialyser?
Made of tiny capillaries.
What investigations are conducted in the evaluation of renal failure?
Blood tests, urine tests, imaging, and renal biopsy.
What might lower limb swelling indicate in a patient with renal failure?
Fluid retention due to impaired kidney function.
What is a surgical risk associated with renal transplantation?
Surgical risks.
What condition is characterized by damage to the renal tubules due to toxins?
Acute Tubular Necrosis.
What is a timing-related barrier for exercise interventions in dialysis patients?
Uncertainty about the best time for intervention (intra vs extra dialytic therapy).
What type of blood vessels make up the glomerulus?
A network of capillaries.
How should dosages of drugs cleared renally be adjusted?
According to the glomerular filtration rate of the patient.
Is haemodialysis an option for patients transitioning to ESRF?
Yes.
What is the latent period for chronic radiation nephropathy?
18 months or more.
What are common intradialytic complications related to blood pressure?
Hypertension and hypotension.
What considerations should dialysis patients take into account when exercising?
They may need to modify routines to match their dialysis schedule due to potential postural hypotension, dizziness, and washout sensations.
What is a barrier related to the treatment team in promoting exercise for dialysis patients?
Lack of enthusiasm from treatment team and providers.
What is a nephron?
The basic structural and functional unit of the kidney.
What dietary restrictions are important for CKD patients?
Fluid restriction, salt intake, low potassium diet, and low phosphate diet.
What is a key characteristic of peritoneal dialysis?
It is a home-based therapy.
What is the typical duration of intermittent haemodialysis?
Approximately 4 hours.
How long does each haemodialysis session last?
About 4 hours, depending on body size and medical condition.
What complication involves narrowing of the blood vessel in arteriovenous access?
Stenosis.
What is one treatment option for anemia in CKD patients?
Subcutaneous erythropoietin injections.
List one benefit of haemodialysis.
Improves volume and blood pressure control.
What condition can result from high blood flow in arteriovenous access?
High Outflow Cardiac Failure.
How can renal failure affect a patient's diet?
It can lead to malnutrition.
What is the role of the kidneys in vitamin D metabolism?
They convert vitamin D into its active form, calcitriol, which is important for calcium absorption.
What does 'cap up' mean in the context of peritoneal dialysis?
It refers to keeping the abdomen dry overnight.
What is Bowman's capsule?
A cup-like structure that encases the glomerulus and collects filtrate.
What is the function of the kidneys in detoxification?
They filter and remove toxins and drugs from the bloodstream.
What compensatory mechanisms may occur in response to pre-renal AKI?
Activation of the renin-angiotensin-aldosterone system (RAAS).
What happens to the blood during haemodialysis?
It is pumped from the body to the dialyser for cleansing.
What effect can glucose in the dialysate have on patients?
It may lead to constipation and absorption of extra fluid.
What role does physiotherapy play in renal disease?
It helps improve physical function and quality of life for patients.
What is a potential outcome of renal transplantation regarding the transplanted organ?
Transplant failure.
What does 'ameside' refer to in the context of kidney transplants?
It is unclear; further context is needed to define 'ameside' in this context.
What treatments are available for Mineral Bone Disease?
Calcium and vitamin D supplements, phosphate binders, and medications to manage parathyroid hormone levels.
What is the first step in the management of Chronic Kidney Disease (CKD)?
Prevention of CKD Development.
What is ESRF?
End-Stage Renal Failure.
Do loading doses need to be adjusted in renal impairment?
Usually, loading doses do not need to be adjusted.
What defines a Donor after Cardiac Death (DCD)?
Death declared based on cardiopulmonary criteria rather than neurologic criteria.
What is the average waiting time for a renal transplant?
Approximately 9 years.
What cardiovascular issue is often seen in patients with renal failure?
Hypertension.
What can lead to intravascular volume depletion?
Reduced cardiac output.
What is the function of glomeruli in the kidneys?
They filter waste from the blood.
Where can peritoneal dialysis be performed aside from home?
At work or on trips, with careful supervision.
How long does each exchange take in Peritoneal Dialysis?
About 30 minutes.
What enzyme is mentioned in relation to diabetic nephropathy?
Angiotensin converting enzyme.
What is haematuria?
The presence of blood in urine, which is a marker of kidney damage.
What is the purpose of one needle during haemodialysis?
To remove blood from the body.
What is the role of the renal tubule?
To reabsorb water and essential substances, and secrete waste products.
What syndrome can occur due to excessive blood flow diversion from the hand?
Steal Syndrome.
What dietary change may be necessary despite high doses of phosphate binders?
A low phosphate diet.
How do the kidneys contribute to fluid balance?
By adjusting the volume of urine produced based on the body's hydration status.
What is the special filter used in haemodialysis called?
Dialyser.
What is the significance of the tonicity of the dialysate solution?
It affects fluid movement and the efficiency of toxin removal during dialysis.
What is dwell time in the context of peritoneal dialysis?
The period during which the dialysate remains in the abdominal cavity to facilitate toxin removal.
How does renal transplantation affect metabolic abnormalities?
It corrects metabolic abnormalities.
When is cycling considered safe during dialysis?
During the first hour or two of dialysis.
Can lower radiation doses cause kidney injury?
Yes, lower radiation doses may still cause kidney injury after many years of follow-up.
What does the red stage indicate in Chronic Kidney Disease (CKD)?
Very high risk.
What is the significance of the 'S' in the context of kidney transplants?
Further context is needed to clarify the meaning of 'S'.
What is the difference between intradialytic and extra dialytic therapy?
Intradialytic therapy tends to have higher adherence compared to extra dialytic therapy.
What type of disease involves inflammation of small blood vessels and can lead to acute kidney injury?
Small Vessel Disease, specifically vasculitis.
What is one primary function of the kidneys?
Regulation of blood pressure.
What cardiac issue can occur during dialysis?
Cardiac arrhythmia.
What effect do uraemic toxins have on platelets in CKD patients?
They induce platelet dysfunction and increase bleeding tendencies.
What is the time frame for benign hypertension to manifest after radiation exposure?
18 months or more.
What is ESRF?
End-Stage Renal Failure.
What is the duration of nocturnal haemodialysis?
6 to 8 hours.
What is the first step if a patient is keen on a renal transplant?
Register for the waitlist.
What should be supplemented alongside erythropoietin for treating anemia in CKD?
Iron.
What is Automated Peritoneal Dialysis (APD)?
A modality performed by a cycler while the patient sleeps at night, typically attached to the machine for 8-10 hours.
What electrolyte imbalance is commonly seen in renal failure?
Hyperkalaemia.
What are common causes of pre-renal AKI?
Dehydration, heart failure, and blood loss.
What is Nocturnal Intermittent Peritoneal Dialysis (NIPD)?
A modality where the abdomen is dry during the day and dialysis occurs overnight.
What is a key method for evaluating renal failure?
Measuring serum creatinine levels and glomerular filtration rate (GFR).
What are the main types of renal replacement therapies?
Transplant, peritoneal dialysis, and haemodialysis.
What type of disease risk is increased after renal transplantation?
Cancer.
What type of tissues can be injured by radiation therapy?
Irradiated normal tissues, such as the kidney.
What hormone's synthesis is reduced in CKD patients, affecting RBC production?
Erythropoietin.
What is the GFR level for Stage 4 CKD?
Less than 30 mL/min.
What is a potential complication related to the catheter in PD?
Catheter Obstruction.
What is primary failure in the context of arteriovenous access?
The inability of the fistula or graft to mature and function properly.
What is the hypothesis regarding uremia's effect on bone marrow?
Uremia contributes to bone marrow suppression.
What mechanical complication can occur during PD?
Hernias.
What percentage of exercise capacity do CKD patients have compared to healthy, sedentary individuals?
Approximately 50% of the exercise capacity of non-uraemic, healthy, sedentary people.
What general health issue can arise in patients with renal failure?
Constitutional symptoms.
What organization provides guidelines for kidney disease management?
National Kidney Foundation / Kidney Disease Outcome Quality Initiative (NKF/KDOQI).
What is important for planning renal replacement therapy?
Timing and planning for renal replacement therapy.
What condition related to PD can lead to insulin resistance?
Dyslipidaemia.
How is the patient connected to the dialysis machine?
Via tubing through a vein in the arm.
What are some symptoms of complications of renal failure?
Vomiting, loss of appetite, breathlessness, lower limb swelling, and itching.
How can pre-renal AKI be differentiated from intrinsic AKI?
By assessing urine output and specific gravity, along with BUN and creatinine levels.
How does renal transplantation impact quality of life?
It improves quality of life.
What can renal transplantation aggravate in patients?
Pre-existing comorbidities.
How much PD solution is typically used in each session?
Approximately 2 liters.
What is required for peritoneal dialysis catheter insertion?
Standby AVF creation.
What is the significance of recognizing pre-renal AKI early?
Early recognition can prevent progression to intrinsic renal injury and improve outcomes.
What dietary restriction is advised to manage phosphate levels?
Low phosphate diet.
What eGFR level indicates very low risk for Contrast-Induced Nephropathy (CIN)?
≥ 60 ml/min.
What are nephrotoxins?
Substances that can cause damage to the kidneys.
What does proteinuria indicate?
The presence of greater than normal amounts of protein in the urine.
What should be avoided for patients with an eGFR of ≥ 60 ml/min to prevent CIN?
Dehydration.
What is a long-term plan for patients transitioning from CKD to ESRF?
Counseling and preemptive renal transplant.
How can phosphate absorption from food be reduced?
By using phosphate binders.
Why might CKD patients require a low potassium diet?
To manage recurrent hyperkalaemia, which limits the use of ARB/ACE inhibitors.
How does daily therapy in peritoneal dialysis affect treatment?
It makes it a gentler treatment with lesser food restrictions.
Which type of radiocontrast is associated with higher renal risk?
Hyperosmolar radiocontrast.
What fluid-related complication can occur in renal failure?
Fluid overload.
What is the significance of the loop of Henle?
It plays a crucial role in concentrating urine and conserving water.
What are the membrane characteristics relevant to peritoneal dialysis?
Membranes can be categorized as low transporter, low average, high average, or high transporter.
What is a renal bruit?
A sound heard over the kidneys indicating possible vascular issues.
Why is drug dosing important in renal impairment?
Because impaired kidneys can affect drug clearance, leading to toxicity.
What is a potential consequence of renal transplantation related to the immune system?
Rejection.
What type of drug-related issue can occur after renal transplantation?
Toxicities of drugs due to immunosuppression.
Which condition is associated with an increased risk of renal failure?
Diabetes mellitus.
What is the normal range for GFR?
≥ 60 ml/min.
What is the impact of systemic hypertension on CKD progression?
It can worsen kidney function and accelerate nephron loss.
What can happen to the unirradiated kidney after severe unilateral renal scarring?
It is likely to become damaged from renin-mediated hypertension.
What should be done if a living donor is available for renal transplant?
Continue with the transplant process.
How can frequent hospitalization affect exercise training in dialysis patients?
Frequent hospitalization and clinical status changes can interrupt training.
What procedural factor increases the risk of renal failure?
Increased dose of radiocontrast.
What advantage does peritoneal dialysis provide in terms of patient experience?
It allows more flexibility and patient ownership.
What is the risk level for patients with an eGFR of 45 - 59 ml/min?
Low risk.
What are the contraindications to renal transplant?
Specific medical conditions that prevent a successful transplant.
How does physical inactivity affect cardiovascular risk in CKD patients?
Cardiovascular risk is increased with physical inactivity.
What is the glomerulus?
A network of capillaries involved in the filtration of blood.
What are non-dialytic therapies?
Treatment options that do not involve dialysis.
What is the basic functional unit of the kidney?
The Nephron.
What is one major benefit of renal transplantation?
Improved patient survival.
What is a financial benefit of renal transplantation?
Reduced healthcare costs.
What must be absent for a diagnosis of CIN?
An alternative explanation for the acute decline in renal function.
How is the severity of CKD assessed?
By estimating and monitoring GFR (Glomerular Filtration Rate).
What is hypocalcaemia?
A condition caused by decreased intestinal calcium absorption due to low plasma calcitriol levels.
How many nephrons are typically found in a human kidney?
Approximately 1 million nephrons.
What must be considered for patients on dialysis regarding drug dosing?
The clearance of the drug by dialysis therapy.
What can lead to intratubular obstruction in the kidneys?
Crystal formation or myoma.
How does a dietician assist with CKD progression?
Through ongoing counseling and nutritional advice tailored to the type of renal replacement therapy (RRT).
What is thrombosis in relation to arteriovenous fistulas and grafts?
The formation of a blood clot that obstructs blood flow.
What is a serious complication that can lead to abdominal pain in PD patients?
Encapsulating Peritoneal Sclerosis.
What are some causes of poor physical functioning in CKD patients?
Anaemia, chronic inflammation, muscle wasting, reduced muscle function, malnutrition, and comorbidities like diabetes and cardiac disease.
What is a potential consequence of haemolysis during dialysis?
Destruction of red blood cells.
What is the primary purpose of peritoneal dialysis?
To remove uremic toxins from the blood.
What is the risk level for patients with an eGFR of < 30 ml/min?
High risk.
What are the three types of treatment durations mentioned for haemodialysis?
Short daily, long daily, and long frequent.
How does diabetes mellitus (DM) relate to peritoneal dialysis?
DM control is important for patients undergoing peritoneal dialysis to manage blood sugar levels.
What physical examination findings are important in renal failure evaluation?
Fluid status, signs of uraemia, and palpation for distended bladder.
What laboratory findings are typically seen in pre-renal AKI?
Increased BUN-to-creatinine ratio and concentrated urine.
How does peritoneal dialysis work?
It uses the lining of the abdomen to filter waste from the blood.
What cardiovascular issue can arise post-transplant?
Cardiovascular disease.
How does the timing of procedures affect renal risk?
Multiple procedures within 72 hours increase risk.
How does haemodialysis affect medication requirements?
It leads to fewer medications.
What is a preemptive renal transplant?
A transplant performed before the need for dialysis.
How can CKD be managed in relation to diabetes and hypertension?
By controlling risk factors.
What is a common non-infective complication of PD?
Weight gain.
What are non-infection complications related to arteriovenous access?
Includes stenosis, thrombosis, and steal syndrome.
What signs might indicate uraemia during a physical examination?
Signs such as nausea, vomiting, and altered mental status.
What infection-related risk is associated with renal transplantation?
Infections.
