Chronic kidney disease Flashcards
What?
Reduction in kidney function OR structural damage OR both AND present for > 3 months WITH assoc healthcares conditions
When is this diagnosed?
In people with markers of kidney damage and/ or persistent reduction in renal function
Markers of kidney damage?
THE ASS
Transplant
Histological abnormalities
Electrolyte abnormalities (due to tubular disorders)
ACR (urinary albumin: creatinine ration >3mg/ mol)
Sedimen abnormalities in urine (Haematuria/ casts)
Structural abnormalities (imaging)
AND/ or
Persistent reduction in renal function
What is a persistent reduction in renal function?
Serum eGFR <60 ml/ min/ 1.73m2
What can the earliest sign be and who is this commonly seen in?
Low creatinine and inc eGFR
Diabetic kidney disease & obese people
Common causes?
Diabetes
High BP
Polycystic kidney disease
Glomerular disease
Nephrotoxic drugs?
Aminoglycosides
Angiotensin-converting enzyme (ACE) inhibitors
Angiotensin receptor antagonists (ARAs)
Bisphosphonates
Calcineurin inhibitors (such as ciclosporin or tacrolimus)
Diuretics (Loop, Thiazide etc)
Lithium
Mesalazine
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Complications?
Cardiovascular disease AKI Hypertension and dyslipidaemia Renal anaemia Renal mineral bone disorder Peripheral neuropathy and myopathy Malnutrition Malignancy ESRD
Management?
Treat underlying conditions Diabetes - HbA1c target Hypertension - bP targets Multisystemic - Immunosuppression Obstruction -> relieve Nephrotoxic drugs -> stop
What are BP targets?
<140/90 if do not have proteinuric CKD or <130/ 80 if do have significant proteinuric CKD)
Lipid lowering therapy?
Atorvastatin
Dietary advice?
Phsophate restricted diet Salt reduction Potassium restriction Fluid restriction Metabolic acidosis
Renal anaemia?
Presents with eGFR <45ml/ min
Oral iron therapy (ferbinject)
IV iron (if oral fails)
