6. Chronic Kidney Disease Flashcards
What are the classes of chronic kidney disease?
1- >90 eGFR 2- 60-89 3 a- 45-59, b- 30-44 4- 15-29 5<15- kidney failure
What are the most common causes of CKD in Britain?
Diabetes
Glomerulonephritis
BP/renovascualr disease
How do you examine someone with CKD?
Peripheries- Peripheral oedema, neuropathy, vasculitis rash, joint disease, atriovenous fistula. Ureamic flap
Face- anaemia, xanthalasma, yellow tinge, Cushingoid, facial Lipodystrophy
Cardio-JVP, BP, right sided HF/triscuspid regurg
Resp- pulmonary oedema or effusion
What investigations do you do on those with CKD?
Blood- U&E’s, Hb, glucose, PTH, vasculitis screen
Urine- dipstick, microscopy and culture. P:CR
Imaging- USS or isotope scan
Histology- renal biopsy
What are the treatments to slow renal disease progression?
BP< 140mmHg, <90mmHg
Glycaemic control: Target HBA1c of 53mmol/mol (7.0%)
Lifestyle- exercise, healthy weight, smoking cessation
Salt intake should be reduced to <2g of sodium/day
What are the systemic side effects of renal disease?
Anaemia- check regularly when Hb<60
Acidosis- sodium bicarbonate supplants if EGFR<30
Oedema- restrict fluid and sodium intake. May lead to pulmonary oedema
CKD bone marrow disorders- bones can become misformed
Restless leg/cramps- exclude iron deficiency. Can give gabapentin
What cardiovascular problems are associated with CKD?
Increased BP
Vascular stiffness (calcium deposits)
Inflammation
Oxidative stress
Affects troponin and BNP values
What cardiac treatments are given to those with CKD?
Antiplatelets
Atorvastatin
What is true about prescribing in CKD?
Check BNF for how GFR can be altered
Best guide- renal drug database/handbook
