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Year Two - Urinary System > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is another term for chronic kidney disease?

A

Chronic kidney failure

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2
Q

What is chronic kidney disease?

A

It describes a gradual loss of kidney function over a period of more than three months

This reduction in kidney function tends to be permanent and progressive

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3
Q

What is the general function of the kidneys?

A

They filter waste and excess fluids from the blood, which are then excreted in the urine

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4
Q

What occurs if chronic kidney disease is left untreated?

A

Patients will eventually develop end stage kidney disease (ESKD), in which dangerous levels of fluid, electrolytes and waste can build up in the body

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5
Q

What are the six risk factors of chronic kidney disease?

A

Age, with the risk increasing with increasing age

Ethnicity, with individuals of an African-America, Native American or Asian-American having an increased risk

Family History

Drugs, which affect the kidneys

Obesity

Medical Conditions, such as hypertension and diabetes

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6
Q

What is the general cause of chronic kidney disease?

A

It can be caused by any condition that impairs kidney function, causing kidney damage to worsen over several months or years

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7
Q

What are the six causes of chronic kidney disease?

A

Diabetes Mellitus

Glomerulonephritis

Hypertension

Polycystic Kidney Disease

Renal Vascular Disease

Recurrent Pyelonephritis

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8
Q

How does chronic kidney disease most commonly present?

A

Asymptomatic and it is therefore diagnosed with routine testing

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9
Q

What are the three main clinical features of chronic kidney disease?

A

Oedema, which can be peripheral and pulmonary

Hypertension

Muscle Cramps

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10
Q

What are the three clinical features of advanced stages of chronic kidney disease (stage five)?

A

Oliguria, which is a decreased urine output < 0.5ml/kg/hr

Chest Pain, which occurs if fluid builds up in the lining of the heart

Shortness of Breath, which occurs if fluid builds up tin the lungs

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11
Q

What four investigations are used to diagnose chronic kidney disease?

A

Blood tests

Urine dipstick test

Ultrasound scan

Renal biopsy

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12
Q

What four specific blood tests are used to diagnose chronic kidney disease?

A

eGFR

Serum creatinine

Serum urea

Serum bicarbonate

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13
Q

What is eGFR?

A

The estimated glomerular filtration rate and is the amount of blood passing through the glomeruli each minute

It therefore measures the kidney’s function in filtering blood

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14
Q

How do we calculate eGFR?

A

We measure the patient’s serum creatinine levels and apply it in estimating equation

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15
Q

What eGFR estimating equation is most commonly used in clinical practice?

A

MDRD 4 variable equation

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16
Q

What eGFR indicates a diagnosis of chronic kidney disease?

A

eGFR < 60ml/min/1.73m^2

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17
Q

What three reasons explain why an eGFR can be inaccurate?

A

A reduction in GFR by more than 50% is required before a rise in creatinine levels occurs

The GFR estimating equations only report a GFR number if it is less than 60ml/min/1.73m^2

Creatinine is the breakdown product of muscle. It can cause inaccurate eGFR measurements due to the fact that its normal physiological level is dependent upon various factors, such as muscle mass, age, ethnicity, gender, weight, liver disease, etc.

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18
Q

What is a urine dipstick test?

A

It involves collecting a midstream sample of urine from the patient

A dipstick – a thin, plastic stick with strips of chemicals on it – is then placed in the urine to detect abnormalities.

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19
Q

How does a urine dipstick test generally detect chronic kidney disease?

A

This investigation is used to assess the kidney’s function in retaining large molecules, such as albumin and haemoglobin, during filtration

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20
Q

What three urine dipstick results indicate a diagnosis of chronic kidney disease?

A

Haematuria, which is defined as a dipstick positive result of 1+ blood

Proteinuria, which is the presence of more than 1.5g (150mg) of protein within urine per day

Albumin: Creatinine Ratio (ACR), with a result of > 3mg/mmol being significant. This result allows us to identify the quantity of protein that is leaking from the kidneys.

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21
Q

What investigation is required to confirm a diagnosis of CKD?

A

Urine ACR

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22
Q

When should urinary ACR be conducted? Why?

A

Morning

The ACR can be affected by factors such as dehydration, certain drugs, and vigorous exercise, which can cause elevated results and give false positives

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23
Q

How do renal ultrasound scans diagnose chronic kidney disease?

A

It is used to assess the kidney’s structure and size

A diagnosis of chronic kidney disease is indicated by asymmetrical, shrunken kidneys

24
Q

What is a renal biopsy?

A

A renal biopsy involves using a special needle to extract small pieces of kidney tissue for light and electron microscopic examination

25
Q

What are the two classifications of chronic kidney disease?

A

G score

A score

26
Q

How do we determine a patient’s G score?

A

eGFR

27
Q

What is stage one (G1)?

A

GFR > 90

28
Q

What is stage two (G2)?

A

GFR between 60 and 89

29
Q

What is stage three a (G3a)?

A

GFR between 45 and 59

30
Q

What is stage three b (G3b)?

A

GFR between 30 and 44

31
Q

What is stage four (G4)?

A

GFR between 15 and 29

32
Q

What is stage five (G5)?

A

GFR < 15

33
Q

How do we determine a patient’s A score?

A

Albumin: creatinine ratio

34
Q

What is stage A1?

A

ACR < 3mg/mmol

35
Q

What is stage A2?

A

ACR between 3 and 30mg/mmol

36
Q

What is stage A3?

A

ACR > 30mg/mmol

37
Q

What is the diagnostic criteria for chronic kidney disease?

A

eGFR less than 60, which is a G score greater than 3

Albumin: creatinine ratio > 3mg/mmol, which is an A score greater than 2

38
Q

Why can the classification of chronic kidney disease indicate?

A

it indicates the patient’s risk of developing cardiovascular disease and end stage kidney disease

The higher stages of chronic kidney disease, the greater the patient’s risk of developing these complications

39
Q

When is a chronic kidney disease patient classified as having a complication risk?

A

They have a G score greater than 3b with any level of proteinuria

40
Q

What is the aim of chronic kidney disease management?

A

It aims to slow the progression of the disease and reduce the risk of complications

41
Q

In what four ways do we manage chronic kidney disease?

A

Conservative Management

Hypertension Management

Anaemia Management

Renal Bone Disease Management

42
Q

When is conservative management of chronic kidney disease recommended?

A

It is the first line management option

43
Q

How do we conservatively manage chronic kidney disease?

A

It involves encouraging patients to adapt a lower protein diet

This diet is used to minimise the waste products in blood and therefore it reduces the amount of work the kidneys conducts

44
Q

How do we manage hypertension in CKD patients?

A

ACE inhibitors

45
Q

In what three circumstances do we prescribe hypertensive agents in CKD patients?

A

A diabetic patient with an ACR > 3mg/mmol

A hypertensive patient with an ACR > 30mg/mmol

All patients with an ACR > 70mg/mmol

46
Q

What blood pressure do we aim for in CKD patients?

A

Less than 140/90mmHg

47
Q

Why does CKD result in anaemia?

A

In a healthy patient, renal cells are involved in the production of erythropoietin, which is the hormone that stimulates production of RBCs

Chronic kidney disease therefore results in a reduced production of erythropoietin, thus leading to the development of anaemia

48
Q

How do we treat anaemia in CKD patients?

A

Erythropoiesis stimulating agents, such as exogenous erythropoietin

49
Q

What is renal bone disease?

A

It results in patients developing osteomalacia, osteoporosis and osteosclerosis

50
Q

What is another name for renal bone disease?

A

Renal bone disease is also known chronic kidney disease mineral and bone disorder (CKD-MBD)

51
Q

How do we treat renal bone disease in CKD patients?

A

The prescription of calcium supplements, vitamin D supplements and bisphosphonates

52
Q

In CKD, which four opioids are preferred to administer for pain relief? Why?

A

Alfentanil

Buprenorphine

Fentanyl

Oxycodone

They are most appropriate given impaired renal function

53
Q

What are the six complications of CKD?

A

Normocytic Anaemia

Renal Bone Disease

Cardiovascular Disease

Oedema

Peripheral Neuropathy

Hyperkalaemia

54
Q

What is the most prevalent complication of CKD? How do we prevent this complication?

A

Cardiovascular disease

The prescription of statins (atorvastatin 20mg) and the encouragement of weight loss and exercise

55
Q

What urinary casts are associated with CKD?

A

Waxy casts

56
Q

When should urinary ACR be conducted? Why?

A

Morning

The ACR can be affected by factors such as dehydration, certain drugs, and vigorous exercise, which can cause elevated results and give false positives.

Year Two - Urinary System (15 decks)

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