6. Chronic Kidney Disease Flashcards
What can CKD result in?
Progressive loss of renal function over months to years
Usually irreversible
Why is CKD usually irreversible?
Because renal tissue has been replaced by extracellular matrix (scar tissue) in response to damage
Who is CKD more common in?
Elderly
Ethnic minorities
Multi-morbidities
Social deprivation
What are the causes of CKD?
Diabetes - 45% Hypertension - 33% Immunologic - glomerulonephritis Infection - pyelonephritis Genetic
Who should be offered CKD screening?
Diabetes Hypertension CVD Structural renal tract disease Multi systemic diseases with potential kidney involvement Family history Patients on nephrotoxic drugs
How do you investigate CKD in general terms?
Define degree and cause of renal impairment
Provide patient with diagnosis and prognosis
Identify complications of CKD
Plan long term treatment
What are the 2 key things that need to be measured if CKD is suspected?
BP
Urine analysis
What are the general blood tests done to investigate CKD?
Urea and electrolytes eGFR Bone biochemistry Liver function tests (albumin) FBC CRP
What are some other investigations for CKD?
Ultrasound scan - kidney size, obstruction Kidney biopsy CT scan (stones/mass) MRI scan (mass) MR angiogram (renal artery stenosis)
What are the modifiable risk factors for CKD?
Lifestyle Smoking Obesity Exercise Control diabetes, hypertension Reduce proteinuria
How are CKD patients with hypertension managed?
Anti-hypertensives
Diuretics
Fluid restriction
What happens to water handling in the kidney in patients with CKD?
Reduced GFR
- lose ability to maximally dilute and concentrate urine
- small glomerular filtrate but same solute load causes osmotic diuresis, nocturia
- low volume of filtrate reduces maximum ability to excrete urine therefore maximum urine volume much smaller
What needs to be done in patient with CKD develops hyperkalaemia?
Stopping ACE-inhibitor/angiotensin receptor blocker
Avoidance of other drugs that can increase K+
Altering diet to avoid foods with high K+.
What do you treat patients with CKD that go on to develop acidosis with?
Oral NaHCO3 tablets
How do you treat anaemia in CKD?
Always check iron stores
If iron low, replace iron first
When iron supplies ok, re-check haemoglobin
If haemoglobin low, start erythropoietin stimulating agent
