Case 10 - Chronic renal failure Flashcards
What is the definition of chronic kidney disease?
An estimated or measured glomerular filtration rate (GFR) <60 mL/min/1.73m2 that is present for at least 3 months, with or without evidence of kidney damage.
OR
Evidence of kidney damage, with or without decreased GFR that is present at least 3 months, as evidenced by:
- Albuminuria
- Haematuria
- Structural abnormalities (eg on kidney imaging tests) or
- Pathological abnormalities (eg on kidney biopsy)
What are the 2 most common cause of end-stage kidney disease in Australia?
Diabetes
Chronic hypertension
What is the typical presentation of someone with CKD?
Usually asymptomatic.
HTN or CKD complications (e.g. elevated serum creatinine) may be discovered during a routine evaluation or as tests for another issue
What is the timeline demarcating AKI vs. CKD?
AKI = <3 months
CKD = >3 months
Why are patients usually asymptomatic until they reach the later stages of CKD?
Kidneys have exceptional compensatory ability
Name 5 risk factors for CKD
- Diabetes
- HTN
- Smoking
- Obesity
- Advanced age (>60)
- AKI
- FHx of CKD
The presence of certain abnormalities/clinical markers are required for >3 months in order to diagnose someone with CKD. Name these abnormalities.
- Albuminuria (measured using ACR)
- Electrolyte imbalances
- Retention of nitrogenous wastes (urea, creatinine, ammonia, etc)
- Acid-base imbalances
- Decreased EPO production
- Imaging showing structural abnormalities (e.g. polycystic kidneys)
Name the 2 CATEGORIES of clinical manifestations that patient with CKD may develop
- Manifestations of Na+ / H2O retention
2. Manifestations of uraemia
Describe the early, nonspecific manifestations which may appear in CKD
- Weakness
- Fatigue
- Anorexia
List the manifestations of Na+ / H2O retention that may appear in CKD
- Pulmonary oedema
- Peripheral oedema
- Hypertension
- Heart failure
What is uraemia?
The constellation of signs/symptoms that manifest in ESKD
Describe the constitutional symptoms of uraemia
- Headache
- Weakness
- Fatigue
Describe the GIT manifestation of uraemia
- NV
- Anorexia
- Uraemic fetor (ammonia / urine-like breath odour)
Describe the dermatological manifestations of uraemia
- Pruritus
- Skin colour changes (e.g. hyperpigmentation or pallor due to anaemia)
- Uraemic frost
What is uraemic frost?
High levels of urea in the blood leading to urea being secreted in sweat. Once it evaporates there may be tiny crystallised yellow-white urea deposits on the skin
Describe the serous manifestations of uraemia
Serositis causing:
- Uraemic pericarditis
- Pleuritis
Describe the neurological manifestations of uraemia
- Encephalopathy (coma, seizures, somnolence)
- Asterixis
- Parasthesia (caused by peripheral neuropathy)
Describe the haematological manifestations of uraemia
- Anaemia (due to increased destruction of RBCs)
- Leukocyte dysfunction (frequent infections, easy bleeding)
What are the 4 most common causes of CKD in Australia?
- Diabetes
- Hypertension
- Glomerulonephritis
- Polycystic Kidney Disease
Can you have a normal GFR but still be diagnosed with CKD?
YES - in this case, urine albumin excretion will be abnormal
Evidence of kidney damage for >3 months is one of the definitions of CKD. List the parameters used to define kidney damage
- Albuminuria
- Haematuria after exclusion of urological causes
- Structural abnormalities (eg on kidney imaging tests)
- Pathological abnormalities (eg on kidney biopsy - not routinely done)
Which lab abnormalities are most common in CKD?
- Increased serum creatinine
- Increased blood urea & nitrogen
What is the most frequently assessed marker of kidney damage in clinical practice?
Albuminuria, as measured using the ACR / Albumin-creatinine ratio
What are the definitions of a normal ACR, microalbuminuria, and macroalbuminuria?
NORMAL ACR: <2.5 in males, <3.5 in females
MICROALBUMINURIA: <2.5-25 in males, <3.5-35 in females
MACROALBUMINURIA: >25 in males, >35 in females
units: mg/mmol