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Week 12 - Nephrology and urology > Chronic kidney disease > Flashcards

Chronic kidney disease Flashcards

1
Q

What is the definition of chronic kidney disease?

A

Kidney damage or eGFR<60ml/min per 1.73m^2 for 3 months or more

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2
Q

Describe creatinine clearance

A
  • Serum creatinine is a product of muscle metabolism
  • Production and serum levels are fairly constant
  • 24hr creatinine clearance is often inaccurate
  • It is freely filtered but there is tubular secretion
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3
Q

What are the problems with using serum creatinine to calculate GFR?

A
  1. Exponential relationship lead to a slow recognition of the loss of the first 70% of renal function i.e. lag time and surprise at the sudden rise of creatinine with a late renal referral
  2. Effect of muscle mass leads to the overestimation of function in low muscle groups e.g. amputees, RA, elderly
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4
Q

What are the problems with eGFR?

A
  • Only validated in whites and African Americans
  • Mean age 50 so is not validated in the elderly
  • Values above 60ml/min are not distinguishable so reported as eGFR>59ml/min
  • Drug dosing - doesn’t take weight into account
  • Not valid in AKI as creatinine must be steady state
  • Not validated in pregnancy
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5
Q

Explain the NKF classification

A

2 measurements taken over 1 month apart
•Stage 1: GFR>90: Normal or increased eGFR with other evidence of kidney damage
•Stage 2: GFR 60-89: Slight decrease in eGFR with other evidence of kidney damage
•Stage 3a: eGFR 45-59: moderate decrease in eGFR
•Stage 3b: eGFR 30-44: moderate decrease in eGFR
•Stage 4: eGFR 15-29: severe decrease in eGFR
•Stage 5: Established renal failure

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6
Q

What can cause a 1+ protein result on a dipstick?

A
  • Fever
  • exercise
  • normal
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7
Q

What can we use to quantify proteinuria?

A
  • 24 hour urine collection
  • PCR
  • ACR
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8
Q

What is a normal ACR?

A

<2.5

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9
Q

What is a normal PCR?

A

<20

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10
Q

What is a normal albuminuria:ACR?

A

> 30

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11
Q

What is the nephrotic range proteinuria?

A

PCR>300

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12
Q

Describe the appearance of diabetic nephropathy on histology

A

Kimmelstien-Wilson nodules

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13
Q

What is the aetiology of reflux nephropathy/chronic pyelonephritis?

A
  • Valve between the bladder and ureter remains open
  • Urine refluxes up the ureter
  • Kidney becomes scarred, inflammation response
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14
Q

What are the symptoms of advanced chronic kidney disease?

A
  • Pruritus
  • Nausea, anorexia, weight loss
  • Fatigue
  • Leg swelling (due to salt and fluid clearance)
  • Breathlessness
  • Nocturia
  • Joint/bone pain
  • Confusion
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15
Q

What are the signs of advanced CKD?

A
  • Peripheral and pulmonary oedema
  • Pericardial rub and pericarditis
  • Rash/excoriation
  • Hypertension
  • Tachypnoea
  • Cachexia
  • Pallor and/or lemon yellow tinge
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16
Q

What are the general principles for the mangement of CKD?

A
  • Targeted screening for CKD
  • Interventions to slow the rate of progression of CKD and reduce cardiovascular risk
  • Medicines to replace impaired individual functions of the kidney
  • Advanced planning for future renal replacement therapy (RRT)
  • Renal replacement therapy
17
Q

How do you slow the progression of chronic kidney disease?

A
  • Aggressive BP control
  • Good diabetic control
  • Smoking cessation
  • Diet
  • Lowering cholesterol
  • Treat acidosis
18
Q

Which drugs should you use for hypertension in CKD?

A
  • ACEi/ARBs but caution if bilateral renal artery stenosis

* All BP lowering drugs will reduce the rate of progression

19
Q

Explain anaemia in CKD and its management

A
  • Common, especially when eGFR<30
  • Iron absorption and utilisation suboptimal
  • Replace iron, B12 and folate first if low
  • ESA e.g. darbepoietin alfa every 2 weeks
  • Target Hb 100-120g/l
20
Q

Describe the pathophysiology of secondary hyperparathyroidism

A
  • Chronic kidney disease results in increased phosphorus due to reduced clearance and decreased vitamin D
  • This causes a reduction in calcium resulting in the thyroid increasing production of PTH
21
Q

What is the treatment of CKD-MBD?

A
  • Activated vitamin D
  • Occasionally Mg supplements
  • Phosphate binders : calcium based and non calcium based
  • Calcimimetic
  • Partathyroidectomy
22
Q

What are the phosphate binders?

A
  • Calcium based: calcium carbonate/acetate

* Non-calcium: sevelamer, lanthanum, aluminium

23
Q

What are the types of RRT?

A
  • Conservative care
  • Transplant
  • Hospital based therpaies
  • Home based therapies
24
Q

When should you start dialysis?

A
  • Individual approach based on symptoms
  • Most start with eGFR 6-8ml /min
  • Weight loss, persistent nausea, persistent hyperkalaemia, acidosis, severe hyperphosphataemia or pruritis
  • Problematic fluid overload
  • Best to have permanent access

Week 12 - Nephrology and urology (14 decks)

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