19 - CKD Flashcards
What is adult polycystic kidney disease?
- Autosomal dominant with PKD 1 or 2 gene mutation (1 causing earlier disease)
- Cysts grow with age and diagnosed on ultrasound. Kidneys enlarge and decline in function
- Prognosis depends on rate of increase in kidney size
What are some secondary complications of APCKD?
- Pain, bleeding in cyst, infection, renal stones (stasis)
- Hypertension
- Intracranial aneurysms
- Heart valve abnormalities
How is APCKD managed?
- Treat hypertension by blocking RAAS
- Low salt diet
- Lots of fluids
- Tolvaptan
What is the definition of chronic kidney disease?
- Progressive and irreversible loss of renal function over a period of years to months. Functioning renal tissue is replaced by extracellular matrix giving rise to glomerulosclerosis and tubular interstitial fibrosis
- Loss of excretory and endocrine function of kidney
Why is CKD hard to define and what is the prevalence in the UK?
- Usually asymptomatic or just proteinuria/hypertension
- 6.1% of the population had CKD in 2001 in the UK. Worldwide 11-13% most in stage 3
What are the common causes of CKD?
- Diabetes (most common)
- Hypertension
- Arteriopathic renal disease
- Immunologic e.g glomerulonephritis
- Infection e.g pyelonephritis
- Myeloma, lupus
- Genetics e.g PKCD or history of kidney disease
What are some risk factors of developing CKD?
- Hyperlipidaemia
- Proteinuria
- Any form of AKI
What are some effects that CKD has on the body, e.g haemotologic and CNS?
What are some of the symptoms of CKD?
- Tiredness
- Breathlessness
- Restless legs
- Sleep reversal
- Aches and pains
- Itching
- Chest pain
- Seizures
How do we treat end stage renal disease?
- Lower life expectancy and quality of life
- Transplant
- Nocturnal HD comes close
What are the advantages and disadvantages of peritoneal and haemodialysis?
What are the advantages and disadvantages of having a kidney transplant to treat CKD?
- Better quality of life
- Malignancy and infection risk
What are the different stages of CKD?
What groups is CKD more common in?
- Elderly
- Multimorbidities
- Ethnic minorities
- Social deprivation
What are the first things you should measure if you suspect CKD?
- Also measure creatinine and eGFR
- eGFR measures CKD, creatinine AKI
What investigations should you do into CKD?
- Blood tests e.g U and Es, CRP, PTH, iron levels
- Antibody levels for different diseases
How can we prevent the progression of CKD?
- Lifestyle
- Stop smoking
- Obesity lose weight
- Exercise
- Control diabetes and hypertension
How can we stop someone with CKD being hypertensive, and why are they hypertensive?
- They retain Na and fluid
- Fluid restrict
- Diuretics
- Antihypertensives
At what point in CKD do we get hyperkalaemia and how do we manage this?
- When eGFR goes below 20 mls/min
- Stop ACE inhibitors
- Avoid drugs that increase K+ e.g amilioride
- Avoid foods high in potassium
How do we treat metabolic acidosis in CKD?
Why do you get anaemia in CKD and how do you fix this?
- Check iron stores and replace them orally or IV
- If iron stores fine give EPO
Why do you get bone disease in CKD and how can this be managed?
- Get thin bones and bony deposits
- Reduce phosphate intake, take phosphate bindes
What can happen to drug metabolism in CKD?
- Reduced metabolism and excretion so need to alter dose
- Side effects more likely, e.g statins
What is the definition of end stage established renal failure?
- When death is likely without renal replacement therapy
- eGFR< 15 mls/min
When should you consider renal replacement therapy?
- eGFR <15mls/min or symptomatic
What are some of the risk factors of acute tubular injury?
Hypotension, obstetric complications, obstructive jaundice, sepsis, medications, toxins
