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renal > chronic kidney disease > Flashcards

chronic kidney disease Flashcards

1
Q

CKD definition

A

presence of kidney damage (abnormal blood, urine, x-ray findings)
or
GFR <60 that is present 3+ months

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2
Q

causes of CKD

A 
diabetes
htn
age-related decline 
glomerulonephritis
polycystic kidney disease
medications e.g. NSAIDs, 
PPIs, lithium
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3
Q

CKD risk factors

A 
age 
htn 
diabetes
smoking
use of medicines that affect kidneys
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4
Q

CKD presentation

A 
pruritus 
loss of appetite
nausea
oedema 
muscle cramps 
peripheral neuropathy 
pallor
htn
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5
Q

CKD investigations

A

eGFR
albumin:creatitine ratio (3+ is signif)
urine dipsitx - haematuria
renalUSS

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6
Q

Staging CKD: G score and A score

A

G score is based on eGFR

A score is based on albumin: creatinine ratio

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7
Q

staging of CKD: G1

A

eGFR >90

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8
Q

staging of CKD: G2

A

eGFR 60-89

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9
Q

staging of CKD: G3a

A

eGFR 45-59

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10
Q

staging of CKD: G3b

A

eGFT 30-44

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11
Q

staging of CKD: G4

A

15-29

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12
Q

staging of CKD: G5

A

eGFR<15

known as end-stage renal failure

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13
Q

staging of CKD: A1

A

<3mg/mmol

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14
Q

staging of CKD: A2

A

3-30mg/mmol

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15
Q

staging of CKD: A3

A

> 30mg/mmol

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16
Q

what does patient need for diagnosis of CKD

A

eGFR of <60 or proteinuria

17
Q

CKD complications

A 
anaemia 
renal bone disease
CVS disease
peripheral neuropathy 
dialysis-related problems
18
Q

aims of CKD management

A

slow disease progression
reduce risk of CVS disease
reduce risk of complications
treat complications

19
Q

CKD management: slowing progression of disease

A

optimise diabetic control
optimise htn control
treat glomerulonephritis

20
Q

CKD management: reducing risk of complications

A

excersice, healthy weight, stop smoking
dietary adivce re phosphate, sodium, potassium, water intake
atorvastatin 20mg

21
Q

CKD management: treating complications

A 
metabolic acidosis: sodium bicarbonate
iron supplementation 
vitamin D
dialysis 
renal transplant
22
Q

CKD: treating htn

A

ACE-I first line

must monitor serum potassium as ACEI and CKD cause hyperkalamemia

23
Q

why does anaemia occur w CKD

A

damaged kidney cells in CKD no longer produce erythropoetin –> drop in RBC –> anaemia

24
Q

how is anaemia in CKD managed

A

erythropoiesis stimulating agents - exogenous erythropoeitin

iron

25
Q

renal bone disease is also known as

A

chronic kidney disease - mineral and bone disorder

CKD-MBD

26
Q

features of renal bone disease

A

osteomalacia (softening of bone)
osteoporosis (brittle bones)
osteosclerosis (hardening of bones)

27
Q

renal bone disease X-ray changes

A

spine shows sclerosis of both vetrerba ends (denser white) and osteomalacia in centre (less white)

classicaly known as ‘rugger jersey’ spine after stripes found on rugby shirts

28
Q

pathophysiology of renal bone disease

A

high P due to reduced excretion. Low active vitD (kidney vital for metabolising to active form)

active VitD is needed for calcium absorption and regulates bone turnover

2ry hyperparathyroidism as parathyroid glands react to low Ca2+ and high P by inc PTH. —> inc osteoclast activity

29
Q

pathophysiology of renal bone disease: osteomalacia

A

due to increased turnover of bones without adequate Ca suppluy

30
Q

pathophysiology of renal bone disease: osteosclerosis

A

osteoblasts respond by inc their activity to match osteoclasts by creating new tissue in bone, however due to low Ca the new tissue is not properly mineralised

31
Q

pathophysiology of renal bone disease: osteoporosis

A

can exist alongside renal bone disease due to other risk factors e.g. age, steroid use

32
Q

management of renal bone disease

A
  • active forms of VitD e.g. calcitriol
  • low phosphate diet
  • bisphosphonates for osteoporosis
33
Q

htn in CKD: ACEI offered to all patients with

A

diabetes + ACR > 3
htn + ACR > 30
ACR >70

34
Q

what needs to be monitored when giving ACEI to pt w CKD

A

potassium as both cause hyperkalaemia

renal (29 decks)

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