Chronic kidney disease Flashcards
Describe the chronic decline in kidney function in CKD
- progressive
- permanent
Key difference between underlying cause of AKI vs CKD
CKD is caused by chronic co-morbidities
Examples of causes of CKD (just to be aware of)
- DM
- hypertension
- age-related decline
- glomerulonephritis
- PKD
- NSAIDs/PPIs/lithium
RFs for CKD
Same as AKI
When CKD is symptomatic it can have the following features
- purities
- loss of appetite
- nausea
- oedema
- muscle cramps
- peripheral neuropathy
- pallor
- hypertension
How far apart should the 2 U&Es tests for CKD be to determine impaired eGFR
3 months apart
How is haematuria detected
Blood in urine dipsticks
Indications for renal USS
- accelerated CKD
- haematuria
- FH
- PKD
- obstruction
What G score and A score are needed for a CKD diagnosis
G3a
A2
G3a (based of eGFR) is
45-59
A2 (based on ACR) is
3-30
CKD patient should be referred to a specialist if eGFR is
<30
CKD patient should be referred to a specialist if ACR is
> 70
CKD patient should be referred to a specialist if eGFR decreases by …. in a year which is a sign of a rapidly progressing CKD
25% (15ml/min)
CKD patient should referred to a specialist if their hptn is still uncontrolled despite being on how many antihypertensives
4
How to slow the progression of CKD
- optimise diabetic/hypertensive control
- treat glumerulonephritis
How to reduce risk of CKD complications
- healthy lifestyle
- atrovastatin
Oral medication given to Tx metabolic acidosis due to CKD
Na2CO3
2 components to treat anaemia due to CKD
- iron supplements
- erythropoietin
Vitamin given to treat renal bone disease due to CKD
VitD
End stage RF can be treated with one of the following
- dialysis
- renal transplant
Why does CKD lead to anaemia
— erythropoietin —> — RBCs
1st line to correct iron deficiency prior to EPO Tx
IV Fe
2nd line to correct iron deficiency prior to EPO Tx
PO Fe
Why should blood transfusions to correct anaemia in CKD be limited
Avoid allosensitisation
Diabetic patients with an ACR of …. should be offered ACEi
> 30mg/mmol
Hypertensive patients with an ACR of …. should be offered ACEi
> 30mg/mmol
Any patient with ACR of …. should be offered ACEi
70mg/mmol
Why should serum K be monitored in CKD patients on ACEi
CKD + ACEi —> ++ serum K
Features of rugger spine on XR of CKD-MBD
- sclerosis of end of Vs
- osteomalacia in centre of Vs
Why is there an elavated serum PO4 in CKD-MBD
— PO4 excretion
Why is there low active VitD in CKD-MBD patients
Kidneys activate VitD
Why is there — Ca absorption in CKD-MBD
— PO4 & — VitD
Explain the 2ry hyperPTHism in CKD-MBD
— Ca
Explain the osteomalacia in CKD-MBD
— Ca —> ++ osteoclast activity —> + bone turnover with insufficient Ca
Explain the osteosclerosis in CKD-MBD
+ osteoblast activity (to match osteoclast activity) —> poorly formed tissue (inadequate Ca supply)
RFs for osteoporosis
- age
- steroids
VitD options to correct osteomalacia
- alfacalcidol
- calcitriol
Tx for osteoporosis
Bisphosphonates
Substance to lower in diet to reduce risk of bone issues
PO4 (since prime is PO4 excretion)
