10 CKD Flashcards by Anon Anon

Why is serum creatinine not used to measure kidney function?

because it does not respond to small changes in kidney function

doesn’t offer a good comparison between people

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Why is eGFR used to measure kidney function?

It is the best measure in stable kidney function

Can be used to compare between people

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What is CKD?

Chronic kidney disease

either
eGFR < 60ml/minute/1.73m2
or
kidney damage…

must be present for at least 3 months

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What is the eGFR range for stage 1?

kidney damage with normal GFR

at least 90

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What is the eGFR range for stage 2?

mild kidney damage

60-89

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What is the eGFR range for stage 3?

moderate kidney damage

30-59

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What is the eGFR range for stage 4?

severe damage

15-29

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What is the eGFR range for stage 5?

kidney failure

less than 15

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How might stage 5 CKD be treated?

haemodialysis
peritoneal dialysis
transplant

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What are the groups of causes of CKD?

Systemic diseases
immune mediated diseases
infectious diseases
genetic diseases
arterial diseases
obstruction

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What sorts of systemic diseases might cause CKD?

diabetes

hypertension

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What sorts of immune mediated diseases might cause CKD?

membranous nephropathy

IgA nephropathy

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What sorts of infectious diseases might cause CKD?

HIV
HBV
HCV
TB

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What sorts of genetic diseases might cause CKD?

Polycystic kidneys

cystinosis

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what sort of arterial diseases might cause CKD/?

atherosclerosis

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What sorts of obstructions might cause CKD?

tumours
stones
fibrosis

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What would you see down the microscope in chronic glomerulonephritis?

scleroses glomeruli

atrophied tubules

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What proportion of those with diabetes experience renal disease?

40%

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What is the pathology of nephropathy?

BM thickens
mesangial expansion
glomerulosclerosis

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What facilitates mesangial expansion?

hyperglycaemia stimulates increased matrix production by mesangial cells
stimulation of TGF-beta release

What facilitates glomerulosclerosis?

intraglomerular hypertension or ischaemic damage

What might cause vascular disease?

renal artery stenosis
stones
benign prostate
tumours
fibrosis

How can CKD lead to a failure of fluid homeostasis?

inability to concentrate urine (early)

and then, an inability to excrete water load (dilution hyponatraemia, oedema hypertension)

How might we treat fluid overload?

diuretic
decrease fluid intake
less salt

if all else fails dialysis or transplant

How does nephropathy cause hypertension?

inability to excrete salt and water

What can sodium inbalance lead to?

confusion, fits, coma

How can interference with Potassium excretion cause very low GFR?

acidosis with volume contraction | diabetic nephropathy

What effect does hyperkalaemia have on ECGs? What might this cause?

tall T waves Long QRS interval long PR interval Cardiac arrest

What treatment is there for hyperkalaemia and hypernatraemia?

eat fewer bananas and crisps

What is the basis of the carbonic acid buffer system?

a failure to secrete acid pushes the PoE to the right, meaning more CO2 has to be removed by the lungs to balance pH

What are the symptoms of metabolic acidosis?

breathlessness chest pain confusion bone pain (demineralisation)

How would you treat metabolic acidosis?

sodium bicarbonate otherwise dialysis/transplant

What effect does renal failure have on calcium homeostasis?

less GI calcium absorption hyperparathyroidism hyperphosphataemia ectopic clacification

How might you treat the effects of renal failure on calcium homeostasis?

active form of Vit D (we can't activate it) calcium supplements phosphate restriction phosphate binders if fails parathyroidectomy

How would you treat renal anaemia?

recombinant Epo

What are the mechanisms of renal hypertension?

``` sodium retention volume expansion RAS activation Sympathetic NS activity endothelial dysfunction ``` causes over-production of renin, not under-production

How would you treat renal hypertension?

less sodium and water take BP tablets diuretic RAS blockade

What happens in a failure of excretory function?

creatinine rise (only after significant damage) retention of nitrogenous waste retention of urate retention of phosphate

How would you treat Uraemia?

dialysis or transplant you could restrict protein intake although this cause malnourishment

What might happen if the kidney fails to excrete insulin?

hypoglycaemia

What might happen if the kidney fails to excrete opiates?

narcosis

What might happen if the kidney fails to excrete antibiotics?

encephalopathy

What might happen if the kidney fails to excrete sedatives?

respiratory arrest

What might happen if the kidney fails to excrete digoxin?

cardiac arrhythmia

How would you treat drug toxicity in renal disease?

lower the dose!

Why does CKD progress?

uncontrolled underlying disease hypertension proteinuria smoking

How do you limit the progression of CKD?

treat underlying disease stop smoking ACEi / ARB block renin angiotensin system to stop protein leaking

What are the characteristics of hyperparathyroidism?

browns tumour | rugger jersey vertebrae