Chronic Kidney Disease Flashcards

1
Q

what is CKD

A

reduction in kidney function or structure or both present for >3months

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2
Q

stages of CKD

A

GFR- G1-G5, ACR- A1-A3

G5= GFR <15
ACR: A1= <3, A3= >30

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3
Q

what is accelerated progression CKD

A

persistent dec in eGFR of 25% and change in CKD category within 12 months

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4
Q

aetiology of CKD

A
intrinsic kidney damage- HT, DM
AKI bouts 
nephrotoxic drugs
obstructive uropathy: calculi 
multisystem: SLE, vasculitis 
CVD
obesity
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5
Q

some nephrotoxic drugs?

A

amionglycosides, ACEI/ARBs, bisphosphonates, calcineurin inhibitors, diuretics, lithium, mesalazine, NSAIDs

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6
Q

s/s of chronic renal disease

A

thirst, loss of interest in food, vitamin imbalance, malnutrition, anaemia

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7
Q

ix for CKD

A
urinary albumin: Cr ratio
urinary sediment abnormalities 
electrolyte imbalance 
histology 
imaging
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8
Q

mx for CKD

A

lifestyle: fluid restirocton, K+ restriction

RRT: ESRD

treat underlying condition

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9
Q

what are 2 complications of CKD

A

renal anaemia: due to reduced production of erythropoietin by kidney, diabetes inc risk, tiredness, fatigue. mx- iron supplements

renal mineral and bone disorder: bone pain/fragility due to disturbed VitD, Ca, PTH and phosphate metabolism

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10
Q

glomerulonephritis is…

A

immune mediated disease of the kidneys affecting glomeruli with 2y tubulointerstitial damage. chronic Gn is most common cause of ESRD

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11
Q

what are the 2 histologic types of Gn

A

damage to endothelial or mesangial cells- proliferative lesion- RBCs in urine

damage to podocytes- non-proliferative lesion- protein in urine

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12
Q

what does it mean if lesion is crescentic

A

presence of crescents ie. epithelial cell extra-capillary proliferation

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13
Q

types of Gn

A

1y idiopathic:

  • minimal change
  • FSGS
  • Membranous
  • Membranoproliferative
  • IgA nephropathy

2y

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14
Q

minmal change Gn…

A

commonest Gn in kids, non progressive renal failure

oral steroids

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15
Q

FSGS Gn..

A

commonest cause of nephrotic syndrome in adults, oral steroids (50% progress to ESRF after 10yrs)

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16
Q

membranous…

A

2nd most common cause of nephrotic syndrome in adults
1y or 2y (hep B, SLE, malignancies)
mx: steroids, B-cell monoclonal ABs
30% progress to ESRF

17
Q

IgA nephropathy…

A

commonest Gn in the world, HSP, colitis, arthritis association
asymptomatic
renal biopsy: mesangial cell proliferation and IgA deposits in mesangium on light microscopy
mx: BP control/ACEi, 25% progress to ESRF

18
Q

2y causes of Gn

A

infection, malignancy, systemic- ANCA vasculitides, lupus, good pasture’s, HSP

19
Q

ix for Gn

A

bloods, urine (urinalysis- haematuria, proteinuria, urine microscopy (RBC, granular casts, lipiduria), urine protein: cR ratio))
kidney biopsy
light microscopy/ IF/ EM used for classifying

20
Q

s/s of Gn

A

include haematuria, proteinuria, impaired renal function, hypertension, nephrotic/ nephritic syndrome

21
Q

tx for Gn

A

non-IS: statins, ACEI/ARBs, diuretics

immunosuppression: corticosteroids, azathioprine, calcineurin inhibitors (cyclosporin)

22
Q

what is rapidly progressive GN

A

rapid deterioration in renal function in days/weeks

23
Q

aetiology of RPGN

A

vasculitis, ANCA +ve- GPA, ANCA -ve- goodpasture’s, HSP, SLE

24
Q

ix for RPGN

A

urinary sedament (RBCs, granular casts), crescents present on biopsy

25
Q

mx for RPGN

A

immunosuppression- azathioprine

plasmapheresis