22. CKD ZTF Flashcards
define CKD
chronic reduction in kidney function
• presence of kidney damage for more than 3 months, with kidney damage defined as pathological abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies and/or
• GFR <60ml/min/1.73m2 for more than 3 months with or without kidney damage
how is evidence of damaged renal parenchyma demonstrated
active urinary sediment and/or evidence of decreased kidney function as demonstrated by a reduced GRF and chronicity to distinguish it from AKI
Name the causes of CKD
- Diabetes
- Hypertension
- Age-related decline
- Glomerulonephritis
- Polycystic kidney disease
- Medications such as NSAIDS, proton pump inhibitors and lithium
name the risk factors for CKD
- Older age
- Hypertension
- Diabetes
- Smoking
- Use of medications that affect the kidneys
usually CKD is asymptomatic and diagnosed on routine testing however there are a number of signs and symptoms that may suggest CKD
(hint; relate it to the complications)
- Pruritus (itching)
- Loss of appetite
- Nausea
- Oedema
- Muscle cramps
- Peripheral neuropathy
- Pallor
- Hypertension
what are the main investigations in someone with CKD
- Estimated glomerular filtration rate (eGFR) can be checked using a U&E blood test. Two tests are required 3 months apart to confirm a diagnosis of chronic kidney disease.
- Proteinuria can be checked using a urine albumin: creatinine ratio (ACR). A result of ≥ 3mg/mmol is significant.
- Haematuria can be checked using a urine dipstick. A significant result is 1+ of blood. Haematuria should prompt investigation for malignancy (i.e. bladder cancer).
- Renal ultrasound can be used to investigate patients with accelerated CKD, haematuria, family history of polycystic kidney disease or evidence of obstruction.
what is the staging classification of CKD (don’t need to know the specifics just the two main test results)
G1-5 score based on eGFR
A1-3 score based on albumin:creatinine ratio
note that patient doesn’t have CKD if they score an A2 combined with G1 or G2 as they need to have at least an eGFR of less than 60 or proteinuria for diagnosis of CKD
what are the main complications in regards to CKD
- Anaemia
- Renal bone disease
- Cardiovascular disease
- Peripheral neuropathy
- Dialysis related problems
NICE suggest a referral to a specialist under what conditions
- ?eGFR
- ?ACR
- ? HTN
- eGFR < 30
- ACR ≥ 70 mg/mmol
- Accelerated progression defined as a decrease in eGFR of 15 or 25% or 15 ml/min in 1 year
- Uncontrolled hypertension despite ≥ 4 antihypertensives
what are the aims of management of CKD
- Slow the progression of the disease
- Reduce the risk of cardiovascular disease
- Reduce the risk of complications
- Treating complications
how can you slow the progression of CKD
- Optimise diabetic control
- Optimise hypertensive control
- Treat glomerulonephritis
how can you reduce the risk of complications of CKD
- Exercise, maintain a healthy weight and stop smoking
- Special dietary advice about phosphate, sodium, potassium and water intake
- Offer atorvastatin 20mg for primary prevention of cardiovascular disease
How do you treat the following complications associated with CKD;
- metabolic acidosis
- anaemia
- renal bone disease
- end stage renal failure
- Oral sodium bicarbonate to treat metabolic acidosis
- Iron supplementation and erythropoietin to treat anaemia
- Vitamin D to treat renal bone disease
- Dialysis in end stage renal failure
- Renal transplant in end stage renal failure
what are the first line HTN treatment for patients with CKD and what are the indications
ACE inhibitors
• Diabetes plus ACR > 3mg/mmol
• Hypertension plus ACR > 30mg/mmol
• All patients with ACR > 70mg/mmol
in patients with CKD what figure do we aim to keep their BP between
<140/90 (or < 130/80 if ACR > 70mg/mmol).
