265 - CKD Flashcards
what are the leading causes of chronic kidney disease (CKD)?
diabetes and hypertension
what is another name for diabetic kidney disease (DKD)?
diabetic nephropathy
what are the microvascular complications associated with DM?
DKD diabetic neuropathy retinopathy sexual dysfunction cerebrovascular complications
pathophysiology of DKD?
prolonged hyperglycaemia causes capillaries in glomeruli to malfunction → less able to filter waste and remove fluid from the body → albumin leaks into urine
as DKD progresses kidney tissue becomes scarred →decreased GFR → compensatory HTN → more glomerular damage → vicious cycle
early clinical indicator of DKD?
elevated albumin in urine
later clinical indicator of DKD?
decreased GFR
non-modifiable risk factors for DKD?
age
ethnicity
genetic predisposition
modifiable risk factors for DKD?
sub-optimal glycaemic control
hypertension
hyperlipidaemia
smoking
progression of DKD?
normoalbuminuria → microalbuminuria (incipient DKD) → proteinuria (overt DKD) → chronic renal failure
what is prevention/management of DKD dependent on?
good control of BGL and BP
what is the IDF recommended target for BP for someone with DM?
< 130/80mmHg
normal GFR?
> 90
“severely decreased” GFR?
> 30
GFR indicating renal failure?
> 15
when would a urine sample for ACR ideally be taken?
early morning
what factors may increase albuminuria?
exercise
infections
menstruation
pregnancy
what percentage of people with type 2 DM had evidence of microvascular complications related to diabetes at the time of diagnosis?
about 50%
which diabetes meds are excreted via the renal route and should therefore be used with caution in pts with DKD?
sulfonylureas alpha-glucosidase inhibitors SGLT2-inhibitors DPP4-inhibitors GLP-1 analogues insulin
why should diabetes meds excreted via the renal route be used with caution in pts with DKD?
renal excretion may lead to enhanced action when kidneys are impaired
why should metformin be discontinued if GFR < 30?
risk of lactic acidosis
what is the treatment for microalbuminuria?
why?
ACE inhibitor or ARB, regardless of blood pressure, as they help protect renal function
chain of meds for CKD? (via NICE)
ACE-inhibitor or ARB (but not both)* → if BP still suboptimal, add CCB → if BP still suboptimal, add thiazide-type diuretic → if BP still suboptimal, consider a further diuretic or alpha-blocker or beta-blocker
*if pt > 55 years, consider starting with CCB
when do clinical features of CKD begin to show?
usually not until late in the disease (GFR < 15ml/min)
what are the two main types of dialysis?
peritoneal dialysis (PD) haemodialysis (HD).
when should people with type 2 diabetes be screened for DKD?
from diagnosis
how is GFR calculated?
serum creatinine and ethnicity, body surface area and age
what confirms a diagnosis of microalbuminuria?
2 separate elevated ACR above 3mg/mmol
first line medication for microalbuminuria in afro-Caribbean patients should be what?
CCB
dialysis is indicated for people with GFR of what?
< 15 mls/min
