Chronic Kidney Disease Flashcards
What is chronic kidney disease?
Reduction in kidney function that is permeant and progressive
What are the 2 main characteristics of chronic kidney disease?
Impaired renal function for more than 3 months
GFR <60ml/min/1.73m2 for more than 3 months
What are the main risk factors of chronic kidney disease?
- Diabetes
- Hypertension
- Smoking
- Chronic use of NSAID’s
What are the main causes of chronic kidney disease?
- Hypertensive renal vascular disease
- Diabetic nephropathy
- Glomerulonephritis
- Polycystic kidney disease
What is the main cause of chronic kidney disease?
Diabetic nephropathy
How does polycystic kidney disease present?
Bilateral flank mass which are ballotable and don’t move with respiration
When do symptoms of chronic kidney disease present?
Stage 4
How many stages of chronic kidney disease are there?
6 stages (stage 3a and 3b)
What are the stages of chronic kidney disease based on?
GFR
What is stage 1 GFR?
More than 90
What is stage 2 GFR?
60-89
What is stage 3a GFR?
45-59
What is stage 3b GFR?
30-44
What is stage 4 GFR?
15-29
What is stage 5 GFR?
Less than 15
How does chronic kidney disease present?
- Hypertension
- Loss of appetite
- Itching (urea)
- Pallor (anaemia)
- Restless legs
- Peripheral/pulmonary oedema (fluid overload)
- Bone pain (metabolic bone disease)
How is proteinuria diagnosed?
Albumin: Creatinine ratio >3
How is chronic kidney disease diagnosed?
GFR
Proteinuria
How is GFR diagnosed?
2 tests 3 months apart
What is chronic kidney disease the most common cause of?
Normocytic anaemia
What 2 electrolyte disturbances can chronic kidney disease cause?
Hyperkalaemia
hypocalcaemia
Hyperphophataemia
What are the complications of chronic kidney disease?
Waste excretion - Uraemia and hyperphosphataemia
Regulation of fluid balance - Hypertension and peripheral/pulmonary oedema.
Acid-base balance - Metabolic acidosis.
Erythropoietin production - Anaemia.
Activation of vitamin D - Hypocalcaemia.
When would someone with a GFR of 60 not be diagnosed with CKD?
If their albumin creatinine ratio was normal- so no proteinurina
What can the electrolyte disturbances lead to?
Secondary hyperparathyroidism
Low calciuma nd high phosphate triggers PTH
What nephrotoxic drug can cause chronic kidney disease?
Naproxen
When would someone with a GFR of 60 be diagnosed with CKD?
Biopsy proven chronic glomerulonephritis
What is the medical management of raised albumin/creatinine with CKD?
ACE inhibitor e.g. ramipril
What would you give to someone with CKD and a raised blood pressure?
Start atorvastatin
What would you give to someone with CKD and a history of fractures?
Alendronic
What is the management of the oedema?
Fluid and salt restriction
Diuretics- Furosemide
What is the management of anaemia?
Monthly subcutaneous erythropoietin (with target haemoglobin of 10-12 g/dL).
If there is iron deficiency correct it first
What is the management of hypocalcaemia and hyperphosphotaemia?
Restrict dietary potassium
Prescribe sevelamer- a phosphate binder
Prescribe alfacalcidol- a 1-hydroxylated vitamin D analogue
When would you carry out a parathyroidectomy?
Tertiary hyperparathyroidism (PTH >28 mmol/L).
What is the most common cause of death in someone with CKD?
Cardiovascular disease
What are the features of renal osteodystrophy?
Reduced bone density (Osteoporosis)
Reduced bone mineralisation (Osteomalcia)
Secondary/Tertiary Hyperparathyroidism
How would the kidneys appear on a USS of someone with CKD?
Bilaterally smaller kidneys
What are exceptiosn when the kidneys appear larger rather than smaller in someone with CKD?
Inital stage of diabetic nephropathy
HIV associated
What medication should all patients with CKD be started on?
Atorvostatin (Statin)
What might indicate CKD rather than an AKI?
Hypocalcaemia
How can hyperphophataemia be managed in someone with CKD?
Low phosphate diet
Phosphate binders if diet doesn’t reduce phosphate levels- calcium acetate or
What symptoms can anaemia in CKD present with?
Aortic flow murmur- Soft ejection systolic murmur
Tachycardia
Fatigue
Pallor
