11. Chronic Kidney Disease Flashcards
What is chronic kidney failure?
Progressive and irreversible loss of renal function over a period or months to years.
What are the histological features of renal tissue in chronic kidney failure?
Functional tissue is replaced by extra-cellular matrix causing glomerulosclerosis and tubular interstitial fibrosis.
What are the causes of chronic kidney disease?
Immunological, infection, genetics, obstruction and reflux nephropathy, hypertension, vascular, systemic disease, unknown.
What immunological cause can lead to chronic kidney disease?
Glomerulonephritis.
What infection can lead to chronic kidney disease?
Pyelonephritis.
What genetic causes can lead to chronic kidney disease?
Polycystic kidney disease, Alport’s syndrome.
Which systemic disease can lead to chronic kidney disease?
Diabetes or myeloma.
How can the stages of chronic kidney disease be classified according to GFR?
- > 90
- 60-89
- 30-59
- 15-29
- <15 or RRT
Briefly describe the five stages of chronic kidney disease.
- Kidney damage with normal or increased GFR.
- Kidney damage with mild GFR fall.
- Moderate fall in GFR, may or may not have symptoms.
- Severe fall in GFR, have some symptoms.
- Established renal failure, lots of symptoms.
How are 85% of patients with chronic kidney disease identified?
By looking on registries for diabetes, hypertension, and ischaemic heart disease.
In what populations is chronic kidney disease more common?
In elderly, ethnic minorities, and socially disadvantaged.
How does chronic kidney failure affect cardiovascular health?
Leads to atherosclerosis, cardiomyopathy, pericarditis.
How does chronic kidney failure affect the haematopoietic system?
Causes anaemia from decreased synthesis or resistance to erythropoietin.
How does chronic kidney failure affect bone health?
Causes renal bone disease. The decreased GFR means that less phosphate is excreted so its serum concentration is raised, it forms complexes with free calcium reducing free concentration. This stimulates parathyroid hormone release so there is overactivity of osteoclasts - osteitis fibrosa cystica. Also damage to kidneys means less vitamin D is activated by hydroxylation so hyperparathyroidism and osteomalacia. Finally there is non-bone calcification.
How does chronic kidney failure affect the CNS?
Neuropathy, seizures, coma.
What are the general symptoms of chronic kidney failure?
Tiredness, breathlessness, restless leg, sleep reversal, seizure, aches and pains, nausea and vomiting, itching, chest pain.
Are patients more likely to need dialysis or die from a CVS event if they have chronic kidney disease.
Die from a cardiovascular event.
How can GFR be measured?
By inulin clearance or 24 hour creatinine clearance.
What is an estimated GFR?
GFR measured using creatinine that has been modified to take into account age, sex, gender, and ethnicity.
What are the limitations in using creatinine as a marker for renal function?
GFR can fall to 40% of normal before having abnormal creatinine. It is only accurate in adults. It only defines chronic kidney disease, not acute.
How can the cause of chronic kidney disease be assessed?
Auto-antibody screen, complement, immunoglobulin, ANCA, CRP, SPEP/UPEP, imaging of the kidneys.
How can the kidneys be imaged?
Ultrasounds for size and hydronephrosis, CT, or MRI.
What are the modifiable risks for preventing progression of CKD?
Lifestyle changing like stopping smoking, losing weight so not obese, exercise. Treat diabetes, blood pressure if needed. ACE inhibitors or angiotensin receptor blockers. Lipid lowering drugs.
When is renal replacement therapy given in CKD?
When the renal function declines to a level when it is no longer adequate to support health, GFR >10ml/min.
