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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
What is azotaemia?
Nitrogenous metabolic waste products in blood sue to renal failure
26
What is uraemia?
A clinical syndrome resulting in failing kidneys and progressive azotaemia
27
Wha non-modifiable risk factors are there for CKD?
Age FH Reduced kidne mass Low birth weight ethnicity - south asian due to diatbeties low income
28
What modifiable risk factors are there for CKD?
Drirect kidey damage HTN Autoimmune Sepsis UTI urethral stones and obstruction Drug toxicity - NSIADS, ACE-i, diuretics
29
What are the normal blood pressure targets?
140/90 mmHg
30
What are the blood pressure targets for those with CKD?
130/80 mmHg
31
When is renal replacement started?
CKD stage 4
32
When should metformin be avoided?
With a GFR \< 30
33
What is contraindicated for statins?
Many Antifungals Erythromycin and clarythromycin avoid grapefriut
34
What interaction of statins and CCB?
With verapamil and amlodapine do not exceed 20mg of simvastatin daily. Also the same for amiodarone
35
Indication for renal replacement treatement during CKD?
Fliud overlaod refractory hyperkalaemia Ureamic conditison - N&V, neurological symptoms and percarditis
36
Indication dor dialysis?
**AEIOU** **A**cidosis **E**lectorlyte imbalance **I**ntoxication **O**ver filled **U**reamia - percarditis
37
Absolute contraindiation for heamodialysis?
inability to have vascular access relative - dementia, psychosis, CCF low BP, bleeding risk
38
Absolute contraindiation for peritoneal dialysis?
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
How does Cylopsporin work?
immuno supression via inhibiting the activation of T cells
40
How does aziophyorpine work?
Immuno supression: stops cell cycle proliferation of B and T cells
41
What infection are unique to imunosupressed patients?
pneumocystis jirovecii pneumonia CMV colitits There is also an incrasde risk of deforated diverticulitis
42
What complications can occur due to immuno supression?
increased infection increased chance of malignancy increased risk of cardiovacsular disease interaction with CP450 drugs
43
IgA nephropathy
commonest cause of glomerulonephritis diagnosis of biopsy common in children
44
Most common causes of end stage renal disease?
Diabetes Glomerulonephritis HTN Polycystic kidney disease Renovascular disease Plyenephritis
45
Common cancers in the immuno supressed?
Squamous cell (skin) cancer heamatological cancer Also atypical infections
46
What need to be matched for transplant?
Same blood group HLA compatibilty for live donors Time patient has spent on the watinign list
47
What is primary hyperparathyroidism?
Causes increased Ca and decreased phosphate. Usually due to an parathyroid gland tumour.
48
What is secondary hyperparathyroidism?
Has low serum Ca and increased phosphate. Usually caused by low Vit. D or CKD.
49
What is tertiary hyperparathyroidism?
Results in hypercalcaemia. From secondary hyperparathyroidism or CKD where there is autonamous PTH is produced.
50
What type of hyperparathyroidism is caused by CKD?
Secondary hyperparathyroidism as Vit. D is produced n the kidneys. After a while this can turn into tertiary hyperparathyroidism.
51

YEAR 3 Manchester Medicine (34 decks)

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