Chronic Kidney Disease Flashcards
How would you define CKD?
CKD implies longstanding (more than 3 months), and usually progressive, impairment in renal function. In many instances, no effective means are available to reverse the primary disease process
What ethnic groups are more likely to develop CKD?
African, Hispanics, and South Asians, particularly those from Pakistan, Sri Lanka, Bangladesh, and India, are at high risk of developing CKD
How does treatment efficacy differ between ethnic groups?
Administration of antihypertensive drugs generally halts disease progression in white populations but has little effect in slowing kidney disease among black people, and additional treatment such as bicarbonate therapy is often required
How does renal perfusion relate to cell injury?
The rate of renal blood flow of approximately 400 ml/100g of tissue per minute is much greater than that observed in other well perfused vascular beds such as heart, liver and brain.
As a consequence, renal tissue might be exposed to a significant quantity of any potentially harmful circulating agents or substances.
How does disruption of the electrostatic barrier relate to kidney damage?
The glomerular filtration membrane has negatively charged molecules which serve as a barrier retarding anionic macromolecules. With disruption in this electrostatic barrier, as is the case in many forms of glomerular injury, plasma protein gains access to the glomerular filtrate
What are the three main causes of CKD?
Diabetes, hypertension, atherosclerosis
What are non-main causes of CKD?
- glomerulonephritis
- pyelonephritis
- polycystic kidney disease
- Long term use of NSAIDs or lithium
- Interstitial Nephritis
What are risk factors for CKD?
- Diabetes
- High blood pressure
- Heart (cardiovascular) disease
- Smoking
- Obesity
- Being Black, Native American or Asian American
- Family history of kidney disease
- Abnormal kidney structure
- Older age
- Frequent use of medications that can damage the kidneys
What is the clinical presentation for someone with early CKD?
The early stages of CKD are often completely asymptomatic, despite the accumulation of numerous metabolites
When do symptoms of CKD present?
Urea > 40 mmol/L
What are the symptoms of CKD?
- Malaise and lethargy
- Loss of appetite
- Insomnia
- Nocturia and polyuria due to impaired concentrating ability
- Itching
- Nausea, vomiting, diarrhoea
- Paraesthesiae due to polyneuropathy
- Restless legs syndrome
- Bone pain due to metabolic bone disease
- Paraesthesiae and tetany due to hypocalcaemia
- Peripheral and pulmonary oedema
- Symptoms of anaemia
- Amenorrhoea in women; erectile dysfunction in men
What are the symptoms in severe/late-stage CKD?
- Mental slowing, clouding of consciousness and seizures
2. Myoclonic twitching.
How is CKD diagnoses?
Diagnosis of CKD is largely based on history serum creatinine level and urine dipstick.
How do you differentiate between CKD and AKI?
- One diagnostic clue that helps differentiate CKD from AKI is a gradual rise in serum creatinine (over several months or years) as opposed to a sudden increase in the serum creatinine (several days to weeks).
- In many people with CKD, previous kidney disease or other underlying diseases are already known.
What investigations would you do for CKD?
Urea and creatinine (eGFR)
Albumin
What are the 5 stages of kidney damage?
Stage 1 - Slightly diminished function; kidney damage with normal or relatively high GFR and persistent albuminuria
Stage 2 - Mild reduction in GFR with kidney damage
Stage 3 - Moderate reduction in GFR (30–59 ml/min/1.73 m2)
- UK guidelines distinguish between stage 3A (GFR 45–59) and stage 3B (GFR 30–44) for purposes of screening and referral
Stage 4 - Severe reduction in GFR. Preparation for kidney replacement therapy
Stage 5 - Established kidney failure, permanent kidney replacement therapy, or end-stage kidney disease
What does ACR in CKD stand for and what does it relate to?
ACR = albumin/creatinine ratio
Increased ACR is associated with increased risk of adverse outcomes
What are the GFRs for different stages of CKD?
Stage 1 > 90 Stage 2 60-89 Stage 3 30-59 Stage 4 15-29 Stage 5 < 15
What are complications that can occur due to CKD?
- Anaemia
- Bone disease
- Pruritis (itching) due to high nitrogenous waste
- Nephrogenic systemic fibrosis (NSF)
- Gastrointestinal complications
- Gout
- Cardiovascular disease
How would you treat CKD?
Treatment is with the control of risk factors as well as the treatment of hypercalcaemia and hyperparathyroidism
What is the prognosis for CKD?
CKD tends to progress inexorably to ESKD, although the rate of progression may depend upon the underlying nephropathy. Patients with chronic glomerular diseases tend to deteriorate more quickly than those with chronic tubulointerstitial nephropathies.
Hypertension and heavy proteinuria are bad prognostic indicators.
What is the leading cause of death in CKD?
The leading cause of death in chronic kidney disease is cardiovascular disease, regardless of whether there is progression to stage 5
