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#Phase 2.1: GI > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is the timeframe for CKD to be CKD?

A

3+ months

of damaged kidney / reduced function

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2
Q

What are the Risk Factors for CKD? (5 things)

A
  1. Age
  2. HTN
  3. DM
  4. Smoking
  5. Nephrotoxic meds
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3
Q

How does HTN cause CKD? (7 steps)

A
  1. High BP
  2. Hypertrophy / Sclerosis of Renal Arteries
  3. Hypoperfusion –> Ischaemic Injury to Kidney
  4. MAC secrete GF
  5. Mesangial cells regress –> Mesangioblasts –> secrete ECM
  6. Glomerulosclerosis
  7. Loss of kidney function (CKD)
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4
Q

How does DM cause CKD? (6 steps)

A
  1. High glucose
  2. Non-enzymatic glycosylation of Efferent arterioles
  3. Hyperinflation
  4. Mesangial cells secrete Structural Matrix
  5. Nodular Glomerulosclerosis
  6. Loss of kidney function (CKD)
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5
Q

What 3 things classify CKD into groups? (3 things)

A
  1. GFR category
  2. Albuminuria (kidney damage marker)
  3. Cause of damage
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6
Q

What is GFR Group G1? (2 things)

A
  1. GFR = 90+
  2. Only classed as CKD if other evidence of kidney damage:
    • Proteinuria / Haematuria
    • Biopsy / Imaging pathology
    • Tubule disorder
    • Transplant
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7
Q

What is GFR Group G2? (2 things)

A
  1. GFR = 60 - 89
  2. Only classed as CKD if other evidence of kidney damage:
    • Proteinuria / Haematuria
    • Biopsy / Imaging pathology
    • Tubule disorder
    • Transplant
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8
Q

What is GFR Group G3a? (2 things)

A
  1. GFR = 45 - 59
  2. Mild - Moderate CKD
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9
Q

What is GFR Group G3b? (2 things)

A
  1. GFR = 30 - 44
  2. Moderate - Severe CKD
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10
Q

What is GFR Group G4? (2 things)

A
  1. GFR = 15 - 29
  2. Severe CKD
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11
Q

What is GFR Group G5? (2 things)

A
  1. GFR = 15-
  2. Kidney Failure
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12
Q

What is Albuminuria Class A1? (2 things)

A
  1. Albumin Secretion: 30-
  2. Albumin:Creatine Ratio: 3-
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13
Q

What is Albuminuria Class A2? (2 things)

A
  1. Albumin Secretion: 30-300
  2. Albumin:Creatine Ratio: 3-30
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14
Q

What is Albuminuria Class A3? (2 things)

A
  1. Albumin Secretion: 300+
  2. Albumin:Creatine Ratio: 30+
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15
Q

What are the Glomerular causes of CKD? (2 Primary + 2 Systemic things)

A

Primary:

  1. Minimal Change Disease
  2. Membranous

Systemic:

  1. DM
  2. Amyloid
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16
Q

What are the Tubulointerstitial causes of CKD? (3 Primary + 2 Systemic things)

A

Primary

  1. UTI
  2. Pyelonephritis
  3. Stones

Systemic

  1. Drugs
  2. Toxins
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17
Q

What are the Blood flow / Vessels causes of CKD? (1 Primary + 1 Systemic things)

A

Primary: Renal Limited Vasculitis

Systemic: HF

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18
Q

What are the Cystic / Congenital causes of CKD? (1 Primary + 1 Systemic things)

A

Primary: Renal dysplasia

Systemic: Alport syndrome

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19
Q

What are the Transplant causes of CKD? (1 Primary + 2 Systemic things)

A

Primary: Recurrence of renal disease

Systemic:

  1. Rejection
  2. Calcineurin toxicity
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20
Q

What are the most common cause of CKD in the UK? (3 things)

A
  1. DM
  2. GN
  3. HTN
21
Q

What are the CF of CKD? (10 things)

A
  1. Asymptomatic (but dev symptoms later @ eGFR 45-)
  2. Pallor
  3. N+V
  4. LOA
  5. HTN
  6. Muscle cramps
  7. Pruritus (itching) (2ndary to uraemia)
  8. Oedema
  9. Peripheral neuropathy
  10. Polyuria
22
Q

Why do you get HTN in CKD?

A

Low GFR –> High Renin –> HTN

23
Q

Why do you get Hypocalcaemia in CKD?

A

Low vit D activation –> Reduced intestinal absorption of Ca –> Hypocalcaemia

24
Q

Why do you get anaemia in CKD?

A

Bc reduce erythropoietin (EPO) which is made in kidney

25
Q

Why can you get Encephalopathy in CKD? (5 steps)

A
  1. Reduced GFR
  2. Reduced waste prod excretion
  3. Build up of nitrogenous compounds (BUN aka Blood Urea Nitrogen / Urea / Creatinine)
  4. Interferes with neurotransmitter metabolism
  5. Encephalopathy
26
Q

Why can you get Uraemic Pericarditis in CKD? (4 steps)

A
  1. Reduced GFR
  2. Reduced waste prod excretion
  3. Build up of nitrogenous compounds (BUN aka Blood Urea Nitrogen / Urea / Creatinine)
  4. Inflammation (pericarditis)
27
Q

Why do you get Hyperparathyroidism in CKD?

A

Low vit D –> -ve fdbck causes increase PTH secretion

28
Q

What investigations should you do for sus CKD? (4 things)

A
  1. Bloods
  2. Urinalysis
  3. Imaging
  4. ECG (bc high risk of CVS disease)
  5. Biopsy (to identify intrinsic CKD causes)
29
Q

What bloods should you do in sus CKD and what will the results show? (7 things)

A
  1. UnE: Low eGFR
  2. FBC + Hb: Normochromic Normocytic Anaemia (normal colour + size)
  3. Glucose (if DM)
  4. Low Ca
  5. High Phosphate
  6. High PTH (renal osteodystrophy)
  7. AI screen: high ANCA / ANA / anti-GBM = GN
30
Q

What are you looking for in Urinalysis of sus CKD? (2 things)

A
  1. Proteinuria (High Urine Albumin:Creatine Ratio aka ACR)
  2. Haematuria (in urine dipstick)
31
Q

If you have Haematuria in sus CKD, what’s your next step?

A

Prompt investigation for bladder cancer

32
Q

What imaging can you do for sus CKD? (4 things)

A
  1. Renal US
  2. MRA
  3. Echo
33
Q

What are the indications for a Renal US? (5 things)

A
  1. Visible / Persistent invisible Haematuria
  2. Obst uropathy
  3. FHx of PCKD (PolyCystic Kidney Disease)
  4. eGFR = 30-
  5. Accelerated CKD progression
34
Q

What will you see in US of CKD? (3 things)

A
  1. Small kidney (under 9cm) (EXCEPT in Amyloid / Myeloma / DM / APKD)
  2. Asymmetrical kidneys = Renovascular disease
  3. Scarring
35
Q

When should you refer a CKD patient to a specialist aka nephrologist? (NICE) (4 things)

A
  1. eGFR = 30- (aka Stage G4 / G5)
  2. Proteinuria (ACR: 70+)
  3. Accelerated progression (15-25% decrease in eGFR in 1 year)
  4. Uncontrolled HTN despite 4+ anti-HTN
36
Q

What are the aims of CKD management? (3 things)

A
  1. Slow disease progression
  2. Reduce complications risk
  3. Treat complications
37
Q

What is the FIRST LINE treatment for CKD?

Who qualifies for this treatment? (3 things)

A

ACE inhibitors

  1. DM + ACR: 3+
  2. HTN + ACR: 30+
  3. ACR 70+
38
Q

What is the BP aim in CKD? (2 things)

A
  1. Under 140 / 90
  2. 130 / 80 if ACR: 70+
39
Q

Why does Serum K need to be monitored when CKD pt are on ACEi?

A

Both CKD + ACEi cause Hyperkalaemia (med emergency)

40
Q

What are the complications of CKD? (7 things)

A
  1. CVS disease
  2. Anaemia
  3. Renal Bone disease
  4. Dialysis related problems
  5. Metabolic Acidosis
  6. End Stage Renal Failure (ESRF)
  7. Peripheral Neuropathy

CARD MEP

41
Q

What are the management options for Slowing disease progression in CKD? (3 things)

A
  1. DM control
  2. HTN control
  3. Treat GN
42
Q

What are the management options for Reducing complications risk in CKD? (3 things)

A
  1. Atorvastatin (to prevent CVS diseases)
  2. Antiplatelets (aspirin) (to prevent CVS diseases)
  3. Low P / Na / K / diet
  4. Lifestyle (exercise + X smoking)
43
Q

How should you treat Metabolic Acidosis (CKD complication)?

A

Oral Sodium Bicarbonate

44
Q

How should you treat Anaemia (CKD complication)? (2 things)

A
  1. Iron supplementation
  2. Erythropoietin
45
Q

How should you treat Renal Bone Disease (CKD complication)? (4 things)

A

Reduce Phosphate + PTH levels:

  1. FIRST LINE: Reduce dietary intake of Phosphate
  2. Phosphate binders
  3. Vit D (calcitriol)
  4. Parathyroidectomy (sometimes)
46
Q

How should you treat End Stage Renal Failure (ESRF) (CKD complication)? (2 things)

A
  1. Dialysis
  2. Renal Transplant
47
Q

What are the features of Renal Bone Disease (CKD complication)? (3 things)

A
  1. Osteomalacia (bone softening)
  2. Osteoporosis (brittle bones)
  3. Osteosclerosis (bone hardening)
48
Q

What investigation should you for for sus Renal Bone Disease (CKD complication)?

A

XR

49
Q

What will you see on a XR of Renal Bone Disease (CKD complication)?

A

Sclerosis of both Ends of each Vertebra (denser white)

Osteomalacia @ Centre of each Vertebra (less white)

= Rugger Jersey Spine (named after rugby shirt stripes)

#Phase 2.1: GI (29 decks)

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