chronic kidney disease Flashcards
CKD definition
presence of kidney damage (abnormal blood, urine, x-ray findings)
or
GFR <60 that is present 3+ months
causes of CKD
diabetes htn age-related decline glomerulonephritis polycystic kidney disease medications e.g. NSAIDs, PPIs, lithium
CKD risk factors
age htn diabetes smoking use of medicines that affect kidneys
CKD presentation
pruritus loss of appetite nausea oedema muscle cramps peripheral neuropathy pallor htn
CKD investigations
eGFR
albumin:creatitine ratio (3+ is signif)
urine dipsitx - haematuria
renalUSS
Staging CKD: G score and A score
G score is based on eGFR
A score is based on albumin: creatinine ratio
staging of CKD: G1
eGFR >90
staging of CKD: G2
eGFR 60-89
staging of CKD: G3a
eGFR 45-59
staging of CKD: G3b
eGFT 30-44
staging of CKD: G4
15-29
staging of CKD: G5
eGFR<15
known as end-stage renal failure
staging of CKD: A1
<3mg/mmol
staging of CKD: A2
3-30mg/mmol
staging of CKD: A3
> 30mg/mmol
what does patient need for diagnosis of CKD
eGFR of <60 or proteinuria
CKD complications
anaemia renal bone disease CVS disease peripheral neuropathy dialysis-related problems
aims of CKD management
slow disease progression
reduce risk of CVS disease
reduce risk of complications
treat complications
CKD management: slowing progression of disease
optimise diabetic control
optimise htn control
treat glomerulonephritis
CKD management: reducing risk of complications
excersice, healthy weight, stop smoking
dietary adivce re phosphate, sodium, potassium, water intake
atorvastatin 20mg
CKD management: treating complications
metabolic acidosis: sodium bicarbonate iron supplementation vitamin D dialysis renal transplant
CKD: treating htn
ACE-I first line
must monitor serum potassium as ACEI and CKD cause hyperkalamemia
why does anaemia occur w CKD
damaged kidney cells in CKD no longer produce erythropoetin –> drop in RBC –> anaemia
how is anaemia in CKD managed
erythropoiesis stimulating agents - exogenous erythropoeitin
iron
