20 Chronic Kidney Disease Flashcards
Define chronic kidney disease.
Progressive and irreversible loss of renal function over months/years
- Functioning renal tissue replaced by extracellular matrix
- Glomerulosclerosis
- Tubular interstitial fibrosis
What are the 2 main clinical signs that indicate chronic renal failure?
Proteinuria
Hypertension
How prevalent is CKD (what % of world population estimated to have CKD and what % of Uk population)?
World: 11-13%
UK: 6.1%
List some common causes of CKD:
- Diabetes (most common- UK)
- Arteriopathic renal disease
- Hypertension
- Autoimmune eg glomerulonephritis
- Myeloma, lupus
- Infection
- Obstructive nephropathies
- Genetic, family history, polycystic kidneys
What are some risk factors for developing chronic kidney disease?
- Diabetes
- Obesity (hyperlipidaemia)
- Cardiovascular disease
CKD has an effect on all of the systems in the body. Give an effect that CKD has on the following body systems:
- CVS
- Endocrine
- Metabolic
- CNS
- Bone
List some symptoms of CKD:
- Fatigue
- Breathlessness
- Restless legs
- Aches and pains
- Nausea and vomiting (uraemia)
- Loss of appetite
- Itchy skin
- Chest pain
- Seizures
- Nocturia
What options does a patient have when their kidneys fail?
- Haemodialysis
- Peritoneal dialysis
- Transplant
- Conservative treatment
What are the advantages and disadvantages of peritoneal dialysis and haemodialysis?
What are the advantages and disadvantages of getting a kidney transplant?
What is adult polycystic kidney disease? (APCKD)
- Autosomal dominant
- PKD 1 or PKD 2 gene
- Cysts grow with age, present in adulthood
- Diagnosed with ultrasound
What complications can the cysts cause?
How is APCKD managed?
- Treat hypertension- block RAAS
- Diet- drink plenty of fluid, low salt
- 4 litres water+ per day- fluid flushing- slows cyst growth
- Tolvaptan
- Vasopressin II receptor antagonist- stops water reabsorption
What are the stages of chronic kidney disease?
Each kidney contains about 1,000,000 nephrons. What would the number of nephrons have to decrease to until there was an insufficient numebr for survival?
If a patient is suspected to have chronic kidney disease, what blood tests should be carried out?
What blood tests can be carried out to determine the cause of CKD?
Apart from blood tests, what other tests can be carried out to investigate chronic kidney disease causes?
Explain why a patient with CKD is likely to have nocturia
Small GFR but still need to get rid of same amount of solute so osmotic diuresis
Reduced concentratin ability of kidney
CKD may result in hyperkalaemia ( if the eGFR falls below 20mls/min) What can be done to treat this?
- Stop ACE-inhibitor/ANgiotensin receptor blocker
- Avoid drugs that increase K+ (amiloride)
- Avoid high potssium foods
CKD may cause acidosis- how can this be treated?
Oral NaHCO3 tablets
Explain how CKD can cause anaemia:
How should anaemia caused by CKD be treated?
- Check- sufficient iron in body
- Then give EPO
Why should patients with chronic kidney disease aim to reduce their phosphate intake and potentially take phosphate binders?
Kidneys can’t excrete sufficient phosphate
Can get phosphate deposits in joints, skin and blood
List some of the symptoms of end stage renal disease:
