20) CKD Flashcards
Define chronic kidney disease:
Irreversibleandsometimesprogressiveloss ofrenalfunctionoveraperiodofmonthstoyears
What effects does renal injury have on renal tissue?
Renaltissueisreplacedbyextracellularmatrix
Get glomerulosclerosis and tubular interstitial fibrosis
List some of the less common causes of CKD:
Immunologic- glomerulonephritis
Infection– pyelonephritis
Genetic- PCK,Alport’s
Obstruction
State the most common cause of CKD:
Unknown, but from combined cardio-metabolic factors: hypertension, diabetes and vascular disease
What is the macroscopic appearance of CKD?
Shrinkage and scarring of kidney
Irregular outline
Decreased cortical thickness
What is the microscopic appearance of CKD?
Glomerulosclerosis
Loss of tubules
What co-morbidities are often present in patients with CKD?
Diabetes, hypertension and ischaemic heart disease
Who is CKD more common in?
Elderly
Multi‐morbid
Ethnicminorities
Sociallydisadvantaged
How many stages are there in the classification of CKD?
5 stages
3 has A and B stage
What are the stages of CKD based on?
GFR: decreasing GFR = increasing stage
Why is it hard to stage people with GFR higher than 60ml/min?
Estimates for GFR above 60 aren’t accurate, so stages 1 and 2 must show symptoms (haematuria) or structural abnormalities on imaging
What sub-classification may be used in staging?
Measurement of proteinuria using albumin:creatinine ratio (ACR)
What is associated with worsening of CKD?
Substantial cardiovascular morbidity and mortality
At what GFR does mortality start to increase?
75ml/min
Why is it important to do a urine dipstick?
Test for proteinuria - predicts development of end-stage renal disease
Why is serum creatinine a poor measure of renal function?
Serum creatinine also determined by muscle mass, which is dependent on age, sex and race. Therefore, if unadjusted serum creatinine may look normal but could have severely reduced renal function
What research tools can be used to measure GFR?
Inulin clearance
51Cr EDTA clearance
Creatinine clearance (24 hour urine)
How is GFR estimated?
Use of MDRD eGFR, which adjusts serum creatinine based on age, gender and ethnicity
What are the limitations of eGFR
Only accurate in adults
Needs a stable GFR, so only used in chronic kidney disease not AKI
What assessments may be used to look for specific causes of CKD?
Auto-Antibodyscreen Complement Immunoglobulin ANCA CRP SPEP/UPEP Renal biopsy
What imaging can be used to look for cause of CKD?
Ultrasound - size, hydronephrosis
CT
MRI
What is a nephrostomy?
Draining of urine from obstructed kidney
List some complications associated with CKD:
Acidosis (eGFR<25)
Anaemia (eGFR<30)
Metabolic bone disease
Non-bone calcification
What systems can acidosis affect and how is it treated?
May affect muscle, bone and renal function
Treated using oral NaHCO3 tablets
What causes anaemia to develop and how is it treated?
Decreasederythropoietinproduction
Resistancetoerythropoietin
DecreasedRBCsurvival
Bloodloss
Inject EPO
Describe the pathway of metabolic bone disease:
Decreased GFR –> increased phosphate conc. so decreased calcium conc. –> PTH release (secondary hyperparathyroidism) –> breakdown of bone (osteitis fibrosis cystica)
Why can you get osteomalacia in CKD?
Less activation of vitamin D
Describe some features of renal osteodystrophy:
Rugger jersey spine - sclerotic end plates of vertebrae
Erosion of terminal phalanges
What causes non-bone calcification and where can it occur?
High phosphate levels causing calcium phosphate deposition
Aorta, small vessels of skin, joints
Describe the management of CKD:
Lifestyle - smoking, obesity, exercise, diet (salt, fat) Treatdiabetes(ifpresent)
Treatbloodpressure
ACEinhibitors/ARBsinproteinuria
When does renal replacement therapy start?
eGFR = 8-10ml/min
What are the indications to start dialysis?
Uraemicsymptoms Acidosis Pericarditis Fluidoverload Hyperkalaemia
