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Urinary > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney disease?

A

Reduction in kidney function that is permeant and progressive

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2
Q

What are the 2 main characteristics of chronic kidney disease?

A

Impaired renal function for more than 3 months

GFR <60ml/min/1.73m2 for more than 3 months

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3
Q

What are the main risk factors of chronic kidney disease?

A
  • Diabetes
  • Hypertension
  • Smoking
  • Chronic use of NSAID’s
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4
Q

What are the main causes of chronic kidney disease?

A
  • Hypertensive renal vascular disease
  • Diabetic nephropathy
  • Glomerulonephritis
  • Polycystic kidney disease
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5
Q

What is the main cause of chronic kidney disease?

A

Diabetic nephropathy

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6
Q

How does polycystic kidney disease present?

A

Bilateral flank mass which are ballotable and don’t move with respiration

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7
Q

When do symptoms of chronic kidney disease present?

A

Stage 4

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8
Q

How many stages of chronic kidney disease are there?

A

6 stages (stage 3a and 3b)

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9
Q

What are the stages of chronic kidney disease based on?

A

GFR

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10
Q

What is stage 1 GFR?

A

More than 90

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11
Q

What is stage 2 GFR?

A

60-89

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12
Q

What is stage 3a GFR?

A

45-59

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13
Q

What is stage 3b GFR?

A

30-44

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14
Q

What is stage 4 GFR?

A

15-29

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15
Q

What is stage 5 GFR?

A

Less than 15

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16
Q

How does chronic kidney disease present?

A
  • Hypertension
  • Loss of appetite
  • Itching (urea)
  • Pallor (anaemia)
  • Restless legs
  • Peripheral/pulmonary oedema (fluid overload)
  • Bone pain (metabolic bone disease)
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17
Q

How is proteinuria diagnosed?

A

Albumin: Creatinine ratio >3

18
Q

How is chronic kidney disease diagnosed?

A

GFR

Proteinuria

19
Q

How is GFR diagnosed?

A

2 tests 3 months apart

20
Q

What is chronic kidney disease the most common cause of?

A

Normocytic anaemia

21
Q

What 2 electrolyte disturbances can chronic kidney disease cause?

A

Hyperkalaemia
hypocalcaemia
Hyperphophataemia

22
Q

What are the complications of chronic kidney disease?

A

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.

23
Q

When would someone with a GFR of 60 not be diagnosed with CKD?

A

If their albumin creatinine ratio was normal- so no proteinurina

24
Q

What can the electrolyte disturbances lead to?

A

Secondary hyperparathyroidism

Low calciuma nd high phosphate triggers PTH

25
Q

What nephrotoxic drug can cause chronic kidney disease?

A

Naproxen

26
Q

When would someone with a GFR of 60 be diagnosed with CKD?

A

Biopsy proven chronic glomerulonephritis

27
Q

What is the medical management of raised albumin/creatinine with CKD?

A

ACE inhibitor e.g. ramipril

28
Q

What would you give to someone with CKD and a raised blood pressure?

A

Start atorvastatin

29
Q

What would you give to someone with CKD and a history of fractures?

A

Alendronic

30
Q

What is the management of the oedema?

A

Fluid and salt restriction

Diuretics- Furosemide

31
Q

What is the management of anaemia?

A

Monthly subcutaneous erythropoietin (with target haemoglobin of 10-12 g/dL).

If there is iron deficiency correct it first

32
Q

What is the management of hypocalcaemia and hyperphosphotaemia?

A

Restrict dietary potassium
Prescribe sevelamer- a phosphate binder
Prescribe alfacalcidol- a 1-hydroxylated vitamin D analogue

33
Q

When would you carry out a parathyroidectomy?

A

Tertiary hyperparathyroidism (PTH >28 mmol/L).

34
Q

What is the most common cause of death in someone with CKD?

A

Cardiovascular disease

35
Q

What are the features of renal osteodystrophy?

A

Reduced bone density (Osteoporosis)
Reduced bone mineralisation (Osteomalcia)
Secondary/Tertiary Hyperparathyroidism

36
Q

How would the kidneys appear on a USS of someone with CKD?

A

Bilaterally smaller kidneys

37
Q

What are exceptiosn when the kidneys appear larger rather than smaller in someone with CKD?

A

Inital stage of diabetic nephropathy
HIV associated

38
Q

What medication should all patients with CKD be started on?

A

Atorvostatin (Statin)

39
Q

What might indicate CKD rather than an AKI?

A

Hypocalcaemia

40
Q

How can hyperphophataemia be managed in someone with CKD?

A

Low phosphate diet
Phosphate binders if diet doesn’t reduce phosphate levels- calcium acetate or

41
Q

What symptoms can anaemia in CKD present with?

A

Aortic flow murmur- Soft ejection systolic murmur
Tachycardia
Fatigue
Pallor

Urinary (38 decks)

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