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Renal > 1: Chronic Kidney Disease > Flashcards

1: Chronic Kidney Disease Flashcards

1
Q

Define chronic kidney disease

A

Abnormalities kidney function or structure present for 3-months

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2
Q

What is the time-frame to diagnose CKD

A

3-months

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3
Q

How many categories of CKD are there

A

5

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4
Q

What is CKD categorised based on

A

eGFR

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5
Q

What is normal eGFR

A

More than 60

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6
Q

What is G1

A

eGFR >90 and evidence of renal dysfunction (haematuria, proteinuria, renal tubule disorder, disorder on imaging or biopsy)

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7
Q

What is G2

A

eGFR 60-90

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8
Q

What is G3a

A

eGFR 45-60

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9
Q

What is G3a referred to as

A

Mild-Moderate CKD

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10
Q

What is G3b

A

eGFR 30-45

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11
Q

What is G3b referred to as

A

Moderate-Severe CKD

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12
Q

What is G4

A

eFGR 15-30

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13
Q

What is G4 known as

A

Severe CKD

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14
Q

What is G5

A

eGFR <15

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15
Q

What is G5 known as

A

Renal Failure

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16
Q

Aside from GFR, how else can CKD be classified

A

Albuminuria

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17
Q

How is albuminuria measured

A

mg per 24h

Or, albumin: creatinine ratio

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18
Q

What is A1

A

a. <30mg/24h

b. A: Cr < 3

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19
Q

What is A2

A

a. 30-300 /24h

b. A: Cr = 3-30

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20
Q

What is A3

A

a. >300 / 24h

b. A: Cr = >30

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21
Q

What is the most common cause of CKD

A

Diabetes

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22
Q

What are 3 most common causes of CKD

A
  • Diabetic neprhopathy
  • HTN neprhopathy
  • Glomerulonephritis
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23
Q

What are 5 RF for CKD

A
  • Age
  • DM
  • HTN
  • FH
  • SAH
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24
Q

Why does SAH increase risk of CKD

A

Those with SAH have increased risk of CKD

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25
Q

How do patients present initially with CKD

A

Asymptomatic

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26
Q

What is required for CKD

A

Requires significant dysfunction of both kidneys to cause symptoms

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27
Q

What are 4 abnormalities that occur with CKD

A
  • High uric acid
  • High Potassium
  • Sodium and fluid retention
  • Loss ability to hydroxylate vitamin D
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28
Q

What 3 symptoms does increase retention of sodium and fluid lead to

A

Peripheral oedema
Pulmonary oedema
HTN

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29
Q

What 3 symptoms does K+ retention lead to

A
  • Arrhythmias
  • ECG changes
  • Diarrhoea
  • Muscle weakness
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30
Q

What are 3 ECG changes associated with high potassium

A

Tall tented T waves
Flat P wave
Broad QRS

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31
Q

What does loss of ability to hydroxylate vitamin D cause

A

Secondary hyperparathyroidism = renal osteodystrophy

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32
Q

What does a high concentration of uric acid cause

A
  • Pericarditis
  • Skin: pruritus, pigmentation
  • Fatigue
  • Weakness
  • Neurological - hiccups, cramps, encephalopathy (seizures)
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33
Q

What is pathophysiological mechanism of CKD

A

CKD is caused by irreversible loss of neurons.

Loss of neurons causes shunting of filtrate to functional neurons called glomerular hyper filtration. Initially these neurons can tolerate it. However, over time results in glomerular sclerosis - leading to irreversible loss of neurons. Eventually so many neurons die to causes drop in GFR and oliguria. Drop in GFR means less excretion of waste products including uric acid that causes clinical manifestation of CKD.

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34
Q

When enough nephrons are lost in CKD what happens

A

Unable to produce renin = hypotension

Unable to produce EPO = anaemia

Unable to produce vitamin D = renal osteodystrophy

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35
Q

What does oliguria result in

A

Decreased excretion of fluid - causing fluid accumulation leading to HTN, peripheral oedema and pulmonary oedema

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36
Q

Explain why hyperkalaemia occurs in CKD

A

Reduced GFR causes build-up of potassium

Kidney damage - reduces renin secretion causing decrease action Na+-K+ ATPase and potassium retention

37
Q

Why does metabolic acidosis occur in CKD

A

Impaired ability to secrete H+ and form HCO3-

38
Q

Explain vitamin D disturbance in CKD

A

Loss of ability of kidney to hydroxylate 1a-vitamin D to 1,25-a hydroxy vitamin D

39
Q

What does deficiency in active vitamin D mean

A

Reduced calcium absorption form the gut

40
Q

What does hypocalcaemia stimulate

A

PTH release causing secondary hyperparathyroidism

41
Q

What does drop in GFR mean for phosphate

A

Phosphate cannot be excreted - binds calcium and precipitate

42
Q

Why does CKD cause anaemia

A
  • Reduce EPO

- Uric acid has toxic effect on bone marrow

43
Q

What is first-line investigation for CKD

A

eGFR

44
Q

How is eGFR estimated

A

Cockcroft Gault Equation

45
Q

What does cockcroft-gault equation use

A

Serum creatinine
Age
Gender
Ethnicity

46
Q

What are 3 factors that can impact estimation of GFR

A
  • Red meat 12-hours before
  • Muscle mass
  • Pregnant women
47
Q

What is used to diagnose CKD

A

Albumin: Creatinine Ratio

A: Cr

48
Q

What is used for monitoring CKD

A

Protein: Creatinine Ratio

P: Cr

49
Q

What simple investigation is ordered in CKD

A

Urinanalysis

50
Q

What may be present on urinalysis in CKD

A

Proteinuria

Haematuria

51
Q

If positive proteinuria, what does this mean A:Cr must be

A

> 30mg/mmol

52
Q

What is seen on U+Es in CKD

A
  • High K+
53
Q

When is a bone profile ordered in CKD

A

GFR <30

54
Q

What will a bone profile show in CKD

A
  • Low Calcium
  • High Phosphate
  • High PTH
55
Q

When is a FBC ordered in CKD

A

Stage 3 CKD (GFR less than 45)

56
Q

What anaemia is present in CKD

A

Anaemia of chronic disease

57
Q

What are indications for Renal USS in CKD

A
  • Accelerate progression
  • Persistent haematuria
  • Urinary tract obstruction
  • PKD
  • GFR <30
58
Q

How often is A:CR and GFR monitored in renal disease patients

A

Every 3-months

59
Q

When is a CKD patient referred to nephrologist

A
  • Stage 4 or 5
  • A:Cr > 70
  • Proteinuria and haematuria
  • Treatment-resistant HTN
  • Suspect genetic cause
60
Q

What are 3 important categories for slowing progression of CKD

A

BP
Lifestyle
DM

61
Q

What is target BP in CKD

A

<140/90mmHg

62
Q

What is target BP in CKD if diabetic or A:Cr >70

A

<130/80mmHg

63
Q

What is given to control BP

A

ACEi (or ARB)

64
Q

When is ACEi indicated in CKD

A

DM with A:Cr > 3
HTN and A: Cr > 30
CKD with A: Cr > 70

65
Q

When should ACEI be stopped in CKD

A
  • AKI
  • Hyperkalaemia
  • GFR drops below 45
66
Q

If GFR drops below 45 in CKD, what is used as alternative to control BP

A

Furosemide

67
Q

What HbA1c is aimed for in CKD

A

53 (7%)

68
Q

What are 4 lifestyle measures for CKD

A
  • Exercise
  • Weight loss
  • Limit dietary salt to 2g/day
  • Smoking cessation
69
Q

When should FBC be checked

A

GFR <60

70
Q

How is anaemia in CKD managed

A

EPO

71
Q

How is oedema managed in CKD

A
  • Fluid restriction
  • Salt restriction
  • Loop diuretics: be careful as may worsen renal function
72
Q

How is renal osteodystrophy managed

A

Vitamin D:

  • 1,a- Calcidiol
  • Or calcitriol
73
Q

How are cramps or restless leg syndrome (due to high uric acid) managed in CKD

A

Sleep hygiene

Pregabalin/Gabapentin

74
Q

What does CKD increase risk of

A

CVD

75
Q

How is Cardiovascular risk reduced

A

All individuals with GFR less than 60 are given 20mg atorvastatin

76
Q

When is RRT planned for

A

When risk of renal failure is 10-20% in one-year

77
Q

What should all patients be listed for 6-months before anticipated start RRT

A

Deceased donor transplant

78
Q

When is long-term dialysis usually started

A

6-months prior

79
Q

What are the 3 types of RRT

A

Haemodialysis
Peritoneal dialysis
RRT

80
Q

Explain haemodialysis

A

Blood passed over semi-permeable membrane with dialysis fluid flowing in opposite direction. Waste moves down concentration gradient

81
Q

What is required for haemodialysis

A

AV Fistula

82
Q

how often do individuals with attend for haemodialysis

A

3-times per week

83
Q

what is peritoneal dialysis

A

Uses peritoneum as semi-permeable membrane

84
Q

what are two types of transplantation

A

living donor

deceased donor

85
Q

what has best outcomes

A

living donor

86
Q

if a patient needs dialysis, but has not had it before, what is started

A

venovenous haemofiltration

87
Q

when is venovenous haemofiltraiton seen

A

ITU

88
Q

if a patient has a renal transplant, what 3 drugs are they put on

A
  1. Calcineurin Inhibitor
  2. Myclophenolate
  3. Prednisolone

Renal (15 decks)

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