Chronic Kidney Disease Flashcards
What is the timeframe for CKD to be CKD?
3+ months
of damaged kidney / reduced function
What are the Risk Factors for CKD? (5 things)
- Age
- HTN
- DM
- Smoking
- Nephrotoxic meds
How does HTN cause CKD? (7 steps)
- High BP
- Hypertrophy / Sclerosis of Renal Arteries
- Hypoperfusion –> Ischaemic Injury to Kidney
- MAC secrete GF
- Mesangial cells regress –> Mesangioblasts –> secrete ECM
- Glomerulosclerosis
- Loss of kidney function (CKD)
How does DM cause CKD? (6 steps)
- High glucose
- Non-enzymatic glycosylation of Efferent arterioles
- Hyperinflation
- Mesangial cells secrete Structural Matrix
- Nodular Glomerulosclerosis
- Loss of kidney function (CKD)
What 3 things classify CKD into groups? (3 things)
- GFR category
- Albuminuria (kidney damage marker)
- Cause of damage
What is GFR Group G1? (2 things)
- GFR = 90+
- Only classed as CKD if other evidence of kidney damage:
- Proteinuria / Haematuria
- Biopsy / Imaging pathology
- Tubule disorder
- Transplant
What is GFR Group G2? (2 things)
- GFR = 60 - 89
- Only classed as CKD if other evidence of kidney damage:
- Proteinuria / Haematuria
- Biopsy / Imaging pathology
- Tubule disorder
- Transplant
What is GFR Group G3a? (2 things)
- GFR = 45 - 59
- Mild - Moderate CKD
What is GFR Group G3b? (2 things)
- GFR = 30 - 44
- Moderate - Severe CKD
What is GFR Group G4? (2 things)
- GFR = 15 - 29
- Severe CKD
What is GFR Group G5? (2 things)
- GFR = 15-
- Kidney Failure
What is Albuminuria Class A1? (2 things)
- Albumin Secretion: 30-
- Albumin:Creatine Ratio: 3-
What is Albuminuria Class A2? (2 things)
- Albumin Secretion: 30-300
- Albumin:Creatine Ratio: 3-30
What is Albuminuria Class A3? (2 things)
- Albumin Secretion: 300+
- Albumin:Creatine Ratio: 30+
What are the Glomerular causes of CKD? (2 Primary + 2 Systemic things)
Primary:
- Minimal Change Disease
- Membranous
Systemic:
- DM
- Amyloid
What are the Tubulointerstitial causes of CKD? (3 Primary + 2 Systemic things)
Primary
- UTI
- Pyelonephritis
- Stones
Systemic
- Drugs
- Toxins
What are the Blood flow / Vessels causes of CKD? (1 Primary + 1 Systemic things)
Primary: Renal Limited Vasculitis
Systemic: HF
What are the Cystic / Congenital causes of CKD? (1 Primary + 1 Systemic things)
Primary: Renal dysplasia
Systemic: Alport syndrome
What are the Transplant causes of CKD? (1 Primary + 2 Systemic things)
Primary: Recurrence of renal disease
Systemic:
- Rejection
- Calcineurin toxicity
What are the most common cause of CKD in the UK? (3 things)
- DM
- GN
- HTN
What are the CF of CKD? (10 things)
- Asymptomatic (but dev symptoms later @ eGFR 45-)
- Pallor
- N+V
- LOA
- HTN
- Muscle cramps
- Pruritus (itching) (2ndary to uraemia)
- Oedema
- Peripheral neuropathy
- Polyuria
Why do you get HTN in CKD?
Low GFR –> High Renin –> HTN
Why do you get Hypocalcaemia in CKD?
Low vit D activation –> Reduced intestinal absorption of Ca –> Hypocalcaemia
Why do you get anaemia in CKD?
Bc reduce erythropoietin (EPO) which is made in kidney
Why can you get Encephalopathy in CKD? (5 steps)
- Reduced GFR
- Reduced waste prod excretion
- Build up of nitrogenous compounds (BUN aka Blood Urea Nitrogen / Urea / Creatinine)
- Interferes with neurotransmitter metabolism
- Encephalopathy
Why can you get Uraemic Pericarditis in CKD? (4 steps)
- Reduced GFR
- Reduced waste prod excretion
- Build up of nitrogenous compounds (BUN aka Blood Urea Nitrogen / Urea / Creatinine)
- Inflammation (pericarditis)
Why do you get Hyperparathyroidism in CKD?
Low vit D –> -ve fdbck causes increase PTH secretion
What investigations should you do for sus CKD? (4 things)
- Bloods
- Urinalysis
- Imaging
- ECG (bc high risk of CVS disease)
- Biopsy (to identify intrinsic CKD causes)
What bloods should you do in sus CKD and what will the results show? (7 things)
- UnE: Low eGFR
- FBC + Hb: Normochromic Normocytic Anaemia (normal colour + size)
- Glucose (if DM)
- Low Ca
- High Phosphate
- High PTH (renal osteodystrophy)
- AI screen: high ANCA / ANA / anti-GBM = GN
What are you looking for in Urinalysis of sus CKD? (2 things)
- Proteinuria (High Urine Albumin:Creatine Ratio aka ACR)
- Haematuria (in urine dipstick)
If you have Haematuria in sus CKD, what’s your next step?
Prompt investigation for bladder cancer
What imaging can you do for sus CKD? (4 things)
- Renal US
- MRA
- Echo
What are the indications for a Renal US? (5 things)
- Visible / Persistent invisible Haematuria
- Obst uropathy
- FHx of PCKD (PolyCystic Kidney Disease)
- eGFR = 30-
- Accelerated CKD progression
What will you see in US of CKD? (3 things)
- Small kidney (under 9cm) (EXCEPT in Amyloid / Myeloma / DM / APKD)
- Asymmetrical kidneys = Renovascular disease
- Scarring
When should you refer a CKD patient to a specialist aka nephrologist? (NICE) (4 things)
- eGFR = 30- (aka Stage G4 / G5)
- Proteinuria (ACR: 70+)
- Accelerated progression (15-25% decrease in eGFR in 1 year)
- Uncontrolled HTN despite 4+ anti-HTN
What are the aims of CKD management? (3 things)
- Slow disease progression
- Reduce complications risk
- Treat complications
What is the FIRST LINE treatment for CKD?
Who qualifies for this treatment? (3 things)
ACE inhibitors
- DM + ACR: 3+
- HTN + ACR: 30+
- ACR 70+
What is the BP aim in CKD? (2 things)
- Under 140 / 90
- 130 / 80 if ACR: 70+
Why does Serum K need to be monitored when CKD pt are on ACEi?
Both CKD + ACEi cause Hyperkalaemia (med emergency)
What are the complications of CKD? (7 things)
- CVS disease
- Anaemia
- Renal Bone disease
- Dialysis related problems
- Metabolic Acidosis
- End Stage Renal Failure (ESRF)
- Peripheral Neuropathy
CARD MEP
What are the management options for Slowing disease progression in CKD? (3 things)
- DM control
- HTN control
- Treat GN
What are the management options for Reducing complications risk in CKD? (3 things)
- Atorvastatin (to prevent CVS diseases)
- Antiplatelets (aspirin) (to prevent CVS diseases)
- Low P / Na / K / diet
- Lifestyle (exercise + X smoking)
How should you treat Metabolic Acidosis (CKD complication)?
Oral Sodium Bicarbonate
How should you treat Anaemia (CKD complication)? (2 things)
- Iron supplementation
- Erythropoietin
How should you treat Renal Bone Disease (CKD complication)? (4 things)
Reduce Phosphate + PTH levels:
- FIRST LINE: Reduce dietary intake of Phosphate
- Phosphate binders
- Vit D (calcitriol)
- Parathyroidectomy (sometimes)
How should you treat End Stage Renal Failure (ESRF) (CKD complication)? (2 things)
- Dialysis
- Renal Transplant
What are the features of Renal Bone Disease (CKD complication)? (3 things)
- Osteomalacia (bone softening)
- Osteoporosis (brittle bones)
- Osteosclerosis (bone hardening)
What investigation should you for for sus Renal Bone Disease (CKD complication)?
XR
What will you see on a XR of Renal Bone Disease (CKD complication)?
Sclerosis of both Ends of each Vertebra (denser white)
Osteomalacia @ Centre of each Vertebra (less white)
= Rugger Jersey Spine (named after rugby shirt stripes)
