3: Chronic kidney disease Flashcards
What is chronic kidney disease?
Abnormal kidney function AND/OR structure
U&Es may be normal
CKD significantly increases your chances of ___ to other diseases.
mortality
CKD is closely linked to which two other diseases?
Cardiovascular disease
Diabetes
Your risk of developing CKD (increases / decreases) with age.
increases with age
What is the difference between acute kidney injury and chronic kidney disease?
AKI has an onset of less than 48h
Prolonged - two samples indicating abnormal kidney function, 90 days apart
How long does kidney function need to be abnormal for a patient to be given a diagnosis of chronic kidney disease?
90 days
What is the difference between GFR and eGFR?
eGFR is modified based on creatinine, age, sex and race
How is CKD staged?
Stages G1 to G5 (including G3a and G3b)
Learn the egfr thresholds and descriptions
An eGFR of > ___ is normal.
> 90
average is 125
An eGFR of < ___ is abnormal.
< 90
How is proteinuria actually measured?
Albumin/creatinine ratio
ACR measured alongside eGFR to quantify degree of kidney disease
How is ACR classified?
A1 to A3
>300 is nephrotic
What two values are used to classify CKD?
eGFR
ACR
Is eGFR used for AKI?
Only used for CKD
What is measured to quantify the degree of an AKI?
Creatinine only
eGFR not useful
People who have had an AKI need to be monitored for several years afterwards.
How?
Why?
eGFR
AKI massively increases CKD risk (loss of nephrons, remaining nephrons have to work really hard and burn out quicker)
Why is eGFRcystatinC more accurate than eGFR?
eGFR value is modified by creatinine levels
Creatinine is cleared by kidneys AND bowels
So technically eGFR can OVERESTIMATE kidney function
People with which particular diseases should have their CKD and ACR checked?
AKI
CKD
Cardiovascular disease
Diabetes
loads but existing renal disease, cvd and diabetes are the main ones
How can you tell if haematuria has come from the kidneys or bladder?
Microscopy
Kidneys - red cells will be dysmorphic from being squeezed through tract
Bladder - red cells will be intact
What is the definition of accelerated CKD progression?
eGFR decrease in 25% within a year
OR
Consistent decrease by 15 units per year
What is the difference between ACR and PCR?
ACR picks up kidney damage due to extra-renal stuff e.g hypertension diabetes
PCR also factors in tubular damage and stuff
?!?!?!?!
Which common drugs are nephrotoxic?
NSAIDs
Elderly patients with advanced CKD and extensive co-morbidities (will / won’t) benefit from treatment.
probably won’t
criteria for CKD referral for treatment
gfr < 30
ACR > 70 (>30 with haematuria)
resistant hypertension
genetic stuff
renal artery stenosis
What are the blood pressure targets in CKD?
140 / 90 if no proteinuria
130 / 80 if protein/haematuria
Anti-hypertensives like ACE inhibitors are nephrotoxic, but also reduce glomerular BP.
When should they be withdrawn?
Significant enough decrease in eGFR / ACR
check slides
What prevention drug should be offered to all patients with CKD?
Statin
look up side effects of these
2/3rds of CKD are caused by which diseases?
Diabetes
Hypertension (i.e CVD)
What are some vascular causes of CKD?
Renal artery stenosis (for a variety of reasons, fools kidney into thinking systemic BP is low, so produces renin, but no effect, vicious cycle, systemic hypertension damages OTHER kidney)
Small-vessel vasculitis
(like GWP, EGWP and microscopic polyangiitis)
What are some glomerular / tubular causes of CKD?
Glomerulonephritis
Tubulonephritis
v complicated so come back to this
What are some urological signs of CKD?
Renal calculi
clinical signs of ckd
produced by anaemia (haematuria plus kidneys can’t produce erythropoietin)
weight loss (nutrients filtered)
and uraemia (build up of urea in the blood) - loads of these
kussmaul breathing (caused by metabolic acidosis)
Symptoms of CKD are produced by what blood abnormalities?
Uraemia
Anaemia
Metabolic acidosis
People with CKD tend to be in ___ for a lot of different reasons.
pain
How is end-stage CKD treated?
Haemodialysis
Peritoneal dialysis (try and figure out how these work)
Kidney transplant (put BACK in the iliac fossa, not retroperitoneal) - either deceased* donors or live donors
Conservatively - 20% of patients treated symptomatically, palliatively
People with CKD are at greatly increased risk of ___ disease.
cardiovascular
What eGFR level and urinary sign predicts greatly increased CVD risk in people with CKD?
< 50
Microalbuminuria
What process drives the cardiovascular complications of CKD?
Atherosclerosis
People on dialysis are at hugely increased risk of CVD - why?
Because they have end-stage CKD
What are modifiable risk factors for cardiovascular disease?
Smoking
Alcohol
Weight
Exercise
Diet (particularly salt)
What should be prescribed to reduce CVD risk in people with CKD?
Antihypertensives if needed
Statin
Why are people with CKD at risk of pathological fracture?
Affects bone composition, causing
pain
fracture
CVD……
What endocrine disease can be caused by disordered calcium metabolism in CKD?
Hyperparathyroidism
either secondary - physiological due to hypocalaemia (it’s all being filtered)
or tertiary - prolonged secondary, glands don’t respond anymore
What nutrient should be restricted to prevent bone disease in people with CKD?
Phosphate
hyperphosphataemia common in people with CKD
What dietary supplement should be given to people with CKD?
Vitamin D supplements
What distinct spinal appearance can be seen on X-ray in people with CKD?
What causes it?
Rugger-jersey spine - sclerosis and lucency of consecutive vertebrae
Caused by hyperparathyroidism - minerals stripped from bone
What blood disorder can CKD cause?
Anaemia
How is anaemia secondary to CKD treated?
Check VitB12 and folic acid
Iron supplements
amputations due to peripheral vascular disease
calcium/po3/pth –> calciphylaxis, skin death, can’t be grafted because dermis wiped out
sclerosis of peritoneum
when i say cvd i mean cardiovascular disease
not cerebrovascular disease
