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2nd Year - Urinary Diseases > 3.2. Kidney Injury - Chronic Kidney Disease > Flashcards

3.2. Kidney Injury - Chronic Kidney Disease Flashcards

1
Q

What is Chronic Kidney Disease?

A

The irreversible and significant loss of Renal Function

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2
Q

What causes Chronic Kidney Disease?

A

Recurrent bouts of Acute Kidney Injury, causing irreversible damage to the Kidneys Function

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3
Q

What function of the Kidneys is also characteristic of Chronic Kidney Disease?

A

A Glomerulofiltration Rate of less than 60ml/min/1.73m^2 for more than 3 months (90ml/min/1.73m^2 being normal)

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4
Q

What is the main predisposing factor for Chronic Kidney Disease?

A

Age - it is found in 8-12% of the population

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5
Q

What are the 3 classes of contributing factors to Chronic Kidney Disease?

A
  1. Pre-Renal
  2. Renal
  3. Post-Renal
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6
Q

What is included in the Pre-Renal Class of contributing factors to Chronic Kidney Disease?

A
  1. Renovascular Disease causing Ischemic Nephropathy
  2. Persistently decreased Renal Perfusion
  3. Hypertension
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7
Q

What is included in the Renal Class of contributing factors to Chronic Kidney Disease?

A
  1. Diabetic Nephropathy
  2. Polycystic Kidney Disease
  3. Glomerulonephritis
  4. Chronic Nephrotoxin Exposure
  5. Rare Causes
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8
Q

What is included in the Post-Renal Class of contributing factors to Chronic Kidney Disease?

A
  1. Reflux Nephropathy and Scarring

2. Chronic Obstructive Nephropathy

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9
Q

What are some examples of Nephrotoxins, which can lead to Chronic Nephrotoxin Exposure, in the Renal Class of contributing factors to Chronic Kidney Disease?

A
  1. NSAID’s
  2. Lithium
  3. Lead
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10
Q

What are some examples of Rare Causes, which can lead to Renal Class of contributing factors to Chronic Kidney Disease?

A
  1. Myelome
  2. Sarcoidosis
  3. Nephrocalcinosis
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11
Q

What are some examples of Chronic Obstructive Nephropathy, in the Post-Renal Class of contributing factors to Chronic Kidney Disease?

A
  1. Prostatic Disease
  2. Metastatic Cancer
  3. Pelvi-Ureteric Junction Obstruction
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12
Q

What are the Clinical Features of Chronic Kidney Disease?

A
  1. Loss of Glomerular Filtration
  2. Loss of Tubule Function
  3. Retention of Urea
  4. Retention of Creatinine
  5. Oliguria
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13
Q

What investigations are necessary for Chronic Kidney Disease?

A
  1. Detailed History / Examination
  2. Blood Tests
  3. Urinalysis (Urine Dipstick)
  4. Renal Radiography
  5. Renal Biopsy
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14
Q

What can be determined by a detailed history / examination?

A
  1. Previous Renal Disease
  2. Drug Exposure
  3. Ensure the vitals are non-life threatening
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15
Q

What blood tests will be done?

A
  1. Serum Creatinine
  2. Urea and Electrolytes including Bicarbonate, Immunoglobulins, Total Protein etc.
  3. Full Blood Count
  4. Coagulation Screen
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16
Q

What is the purpose of testing for a Serum Creatinine?

A

To assess the secretory function of the Kidney / Glomerular Filtration Rate (GFR)

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17
Q

What will be looked for in the Urinalysis (Urine Dipstick)?

A
  1. Haematuira

2. Proteinuria (including Protein-Creatinine ratio, and the Albumin-Creatinine ratio)

18
Q

What is included in the Renal Radiography?

A
  1. Ultrasound
  2. CT Scan
  3. MRI Scan
19
Q

Why is a Renal Biopsy done?

A

To assess the anatomical / structural damage

20
Q

When should Glomerulonephritis be tested for?

A

When there is a clinical suspicion that this could be contributing to the Chronic Kidney Disease

21
Q

How many stages are there in the KDIGO (Kidney Disease; Improving Global Outcomes) classification of Chronic Kidney Disease?

A

6 (1., 2, 3a, 3b, 4, 5)

22
Q

What is the description of “Stage 1” disease, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification of Chronic Kidney Disease?

A

Kidney Damage / Normal or High Glomerular Filtration Rate (Greater than 90 ml/min/1.73m^2)

23
Q

What is the description of “Stage 2” disease, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification of Chronic Kidney Disease?

A

Kidney Damage / Mild reduction in Glomerular Filtration Rate (Between 60-90 ml/min/1.73m^2)

24
Q

What is the description of “Stage 3a” disease, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification of Chronic Kidney Disease?

A

Moderately Impaired Kidney

A Glomerular Filtration Rate of 45 - 59 ml/min/1.73m^2

25
Q

What is the description of “Stage 3b” disease, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification of Chronic Kidney Disease?

A

Moderately Impaired Kidney

A Glomerular Filtration Rate of 30 - 44 ml/min/1.73m^2

26
Q

What is the description of “Stage 4” disease, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification of Chronic Kidney Disease?

A

Severely Impaired Kidney

A Glomerular Filtration Rate of 15 - 29ml/min/1.73m^2

27
Q

What is the description of “Stage 5” disease, in the KDIGO (Kidney Disease; Improving Global Outcomes) classification of Chronic Kidney Disease?

A

Advanced Kidney Impairment or on Dialysis

A Glomerular Filtration Rate of Less than 15ml/min/1.73m^2

28
Q

What are the 2 types of treatment?

A
  1. Slow the Rate of Renal Decline
  2. Prevent / Control Complications
  3. Renal Replacement Therapy
29
Q

What is included in the Slowing the Rate of Renal Decline part of treatment?

A
  1. Treating the Underlying Aetiology
  2. Blood Pressure control with Anti-hypertensive Medication
  3. Proteinuria control with ACE inhibitors / ARB’s
30
Q

What KDIGO Stage do you tend to be in before you experience complications?

A

4

31
Q

What is a way to help you remember the complications of Chronic Kidney Disease?

A

A, A, B, C, D, E, F, G, H, I

A, A-I

32
Q

What complications can occur?

A 
Acidosis
Anaemia
Bone Disease
Cardiovascular Risk
Dialysis / Death
Electrolyte Dysfunction
Fluid Overload
Gout
Hypertension
Iatrogenic Issues
33
Q

How is the Acidosis Complication treated?

A

With Oral Sodium Bicarbonate

34
Q

How is the Anaemia Complication treated?

A

With Iron Erythropoietin Replacement

35
Q

How is the Bone Disease Complication treated?

A
  1. Diet
  2. Phosphate Binders
  3. Vitamin D Analogues
36
Q

How is the Cardiovascular Risk Complication treated?

A
  1. Blood Pressure Control
  2. Aspirin
  3. Statins
  4. Cholesterol Management
  5. Weight change
37
Q

How is the Dialysis Complication treated?

A

Counsel and Prepare

38
Q

How is the Electrolyte Dysfunction Complication treated?

A

The Hyperkalaemia is treated with Diet and potentially with Drugs

39
Q

How is the Fluid Overload Complication treated?

A
  1. Sodium Restriction

2. Fluid Restriction

40
Q

How is the Gout Complication treated?

A

Optimize +/- medication

41
Q

How is the Hypertension Complication treated?

A
  1. Weight
  2. Diet
  3. Fluid Balance
  4. ACE inhibitors
  5. Other Anti-hypertensives
42
Q

How is the Iatrogenic Complication treated?

A

Nephrotoxic Medication Cessation

2nd Year - Urinary Diseases (16 decks)

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