AKI Flashcards
give the stage and plan for eGFR >90
1 - Kidney damage or normal
> treat co-morbities
give the stage and plan for eGFR 60-89
2- Mild
> estimate progression
give the stage and plan for eGFR 30-59
3- moderate
> eval and tx complications
give the stage and plan for eGFR 15-29
4- severe
> prep for renal replacement
give the stage and plan for eGFR <15
5 - kidney failure
> dialysis
define CKD
Chronic kidney disease (CKD) is currently defined as either functional or structural kidney damage or a glomerular filtration rate (GFR) less than 60 mL/min per 1.73m2 for at least 3 months
epidemiology of CKD in SA
African related to APOL Gene 1 polymorphism
what drives CKD
- DMT2
- HPT
- HIV
risk in DM
estimated that about 20-40% of patients with type 2 diabetes are at risk for nephropathy, at least greater 10years (usually 15-25years) after onset of diabetes
given that 5% of the adult population has type 2 diabetes, the estimated number of people at risk is quite staggering
HIV+ plus proteinuria
HIVAN stands for HIV-associated nephropathy, which is a type of kidney disease that occurs in people with HIV (Human Immunodeficiency Virus) infection. It is a form of focal segmental glomerulosclerosis (FSGS), a condition where scar tissue forms in the kidneys, leading to progressive kidney damage.
is CKD easily detectable
no - silent until 75% function lost
primary prevention
Implementation of healthy lifestyles
Many common risk factors for cardiac disease, stroke and CKD:
Obesity
Smoking
Hypertension
Lack of exercise
Type 2 diabetes mellitus
Introduction of educational programmes to prevent these diseases of lifestyle will not only reduce CKD but cardiac disease as well
Testing and detection
- BP
Goal BP should be < 140/90 mm Hg and < 130/80 in diabetics and other high risk patients - Glucose
Diabetics should have their glycaemia optimally managed with diet and oral agents with a target HBA1C < 7% and fasting glucose < 7 mmol/L - LDL
Statin therapy should be considered in most patients with hypertension and diabetes and optimal LDL cholesterol should be < 3 mmol/L or total cholesterol < 5.0 mmol/L or lower. - HIV Rx
What tests should all patients attending community health centers undergo?
A urine dipstick test for blood, protein, and glucose.
Which high-risk patients need to be tested annually for kidney function?
Diabetics, hypertensives, HIV-positive individuals, and those over 65 years of age.
What should diabetics with a negative urine dipstick for proteinuria undergo?
Spot urine testing for microalbuminuria.
What indicates chronic kidney disease (CKD)?
An estimated GFR < 60 mL/min and/or overt proteinuria/hematuria.
