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YEAR 3 Manchester Medicine > 22 - chronic kidney disease > Flashcards

22 - chronic kidney disease Flashcards

1
Q

What types of renal replacement therapy are there?

A

Heamo and peritoneal dialysis

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2
Q

What causes proteinuria?

A

CKD Orthostatic proteinurea Nephoritc/ nephritic syndrome UTI illness and pregnancy

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3
Q

What is the biggest to effect affecting cardiovascular risk?

A

BP

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4
Q

What is ACR?

A

Ratio of albumin to creatinine in urine

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5
Q

What is PCR?

A

Ration of protein to creatine in urine

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6
Q

When is ACR used?

A

Detection of protein in urine at low levels (more sensitive), used specially for diabetes

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7
Q

When is PCR used?

A

monitoring and classification of protienurea

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8
Q

What is a spot urine collection?

A

ACR used to extrapolate protein loss from the kidneys over 24 hour period

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9
Q

How to investigate non-visible haematuria?

A

Perform urine culture, if negative perform 2 more to exclude UTI. Then refer to nephrology.

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10
Q

How much protein is secreted naturally each day?

A

150mg due to uromodulin: a glycoprotein relapsed from the renal tubules

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11
Q

What are the causes for heamaturia?

A

ONNIT

Obstrucitve calculi

Neoplasm

Nephritic syndrome

Inflammtion - UTI

Trauma

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12
Q

What is the definition of CKD?

A

Abnormality in the stucture of funciton of the kideny for greater than 3 months

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13
Q

How is CKD diagnosed?

A

eGFR < 60 on morethan 2 months greater than 90 days apart

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14
Q

Why are ACE-i used in diabeties?

A

Proved reno-protective effects

Hyperglycaemia causes activation of angiotensin I to II

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15
Q

Side effects of ACE-i?

A

Dry cough - 10%

angioedema 1/2 in 1000

Hyperkalaemia

Hypotension

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16
Q

What do you have to measure when starting an ACE-i?

A

Creatinine and then compare in 2 weeks. There should not be an increase greater than 25-30%

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17
Q

When can you not used ACE-i in pregnancy?

A

Can be used during the first timerster however after is a contraindication

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18
Q

Why dose Bone density decrease in CKD?

A

Failure to metabolise Vit. D3 leading to low Ca triggering Ca relaese from bones from PTH

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19
Q

Why can CKD lead to anaemia?

A

Can lead to Nephritic syndrome however decreased EPO production is also a cause.

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20
Q

How is CKD mineral bone disease (CKDBD) treated?

A

Calcitriol +/- phosphate binders

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21
Q

How is renal anemaia treated?

A

IV Iron

EPO

Aim for ferratin of 200

22
Q

Treatmetn of metabolic acidosis due to CKD?

A

Oral alkaline

Sodium bicarbonate

23
Q

Treatment of hyperkalaemia due to CKD?

A

Dietary restriction and cessation/ reduction of ACE-i or ARB

24
Q

How is fluid volume managed in CKD?

A

FLiud and salt restriction as well as use of diuretics

25
Q

What is azotaemia?

A

Nitrogenous metabolic waste products in blood sue to renal failure

26
Q

What is uraemia?

A

A clinical syndrome resulting in failing kidneys and progressive azotaemia

27
Q

Wha non-modifiable risk factors are there for CKD?

A

Age

FH
Reduced kidne mass

Low birth weight

ethnicity - south asian due to diatbeties

low income

28
Q

What modifiable risk factors are there for CKD?

A

Drirect kidey damage

HTN

Autoimmune

Sepsis

UTI

urethral stones and obstruction

Drug toxicity - NSIADS, ACE-i, diuretics

29
Q

What are the normal blood pressure targets?

A

140/90 mmHg

30
Q

What are the blood pressure targets for those with CKD?

A

130/80 mmHg

31
Q

When is renal replacement started?

A

CKD stage 4

32
Q

When should metformin be avoided?

A

With a GFR < 30

33
Q

What is contraindicated for statins?

A

Many Antifungals

Erythromycin and clarythromycin

avoid grapefriut

34
Q

What interaction of statins and CCB?

A

With verapamil and amlodapine do not exceed 20mg of simvastatin daily.

Also the same for amiodarone

35
Q

Indication for renal replacement treatement during CKD?

A

Fliud overlaod

refractory hyperkalaemia

Ureamic conditison - N&V, neurological symptoms and percarditis

36
Q

Indication dor dialysis?

A

AEIOU

Acidosis

Electorlyte imbalance

Intoxication

Over filled

Ureamia - percarditis

37
Q

Absolute contraindiation for heamodialysis?

A

inability to have vascular access

relative - dementia, psychosis, CCF low BP, bleeding risk

38
Q

Absolute contraindiation for peritoneal dialysis?

A

IBD, ischaemic bowel, diverticulitis, abdmonial abcess and 3rd trimester pregnancy

Also consider relative contraindications: abdominal hernia, previous abdo surfery, blind, dementia, poor hygiene, nephrotic syndrome, airway obstruction

39
Q

How does Cylopsporin work?

A

immuno supression via inhibiting the activation of T cells

40
Q

How does aziophyorpine work?

A

Immuno supression: stops cell cycle proliferation of B and T cells

41
Q

What infection are unique to imunosupressed patients?

A

pneumocystis jirovecii pneumonia

CMV colitits

There is also an incrasde risk of deforated diverticulitis

42
Q

What complications can occur due to immuno supression?

A

increased infection

increased chance of malignancy

increased risk of cardiovacsular disease

interaction with CP450 drugs

43
Q

IgA nephropathy

A

commonest cause of glomerulonephritis

diagnosis of biopsy

common in children

44
Q

Most common causes of end stage renal disease?

A

Diabetes

Glomerulonephritis

HTN

Polycystic kidney disease

Renovascular disease

Plyenephritis

45
Q

Common cancers in the immuno supressed?

A

Squamous cell (skin) cancer

heamatological cancer

Also atypical infections

46
Q

What need to be matched for transplant?

A

Same blood group

HLA compatibilty for live donors

Time patient has spent on the watinign list

47
Q

What is primary hyperparathyroidism?

A

Causes increased Ca and decreased phosphate. Usually due to an parathyroid gland tumour.

48
Q

What is secondary hyperparathyroidism?

A

Has low serum Ca and increased phosphate. Usually caused by low Vit. D or CKD.

49
Q

What is tertiary hyperparathyroidism?

A

Results in hypercalcaemia. From secondary hyperparathyroidism or CKD where there is autonamous PTH is produced.

50
Q

What type of hyperparathyroidism is caused by CKD?

A

Secondary hyperparathyroidism as Vit. D is produced n the kidneys. After a while this can turn into tertiary hyperparathyroidism.

YEAR 3 Manchester Medicine (34 decks)

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