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Z Year3 Urology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is CKD?

A

Proteinuria or haematuria and/or a reduction in glomerular filtration rate for more than 3 months duration

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2
Q

What are RF for CKD?

A
  1. age >50 year
  2. male sex
  3. black or Hispanic ethnicity
  4. family history
  5. smoking
  6. obesity
  7. long-term analgesic use
  8. diabetes
  9. hypertension
  10. autoimmune disorders
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3
Q

What is the presention of CKD?

A
  1. Fatigue
  2. Oedema
  3. Nausea with/without vomiting
  4. Pruitis
  5. Restless leg
  6. Anorexia
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4
Q

What are the most common cause of CKD?

A
  1. DM
  2. Hypertension
  3. Glomerulonephritis
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5
Q

What will bloods show for CKD?

A
  1. Elevated serum creatinine
  2. Electrolyte abnormalities
  3. GFR <60
  4. Serum cystatin C and cystatin C-based estimation of GFR
  5. Urinalysis
  6. Urinary albumin: increased
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6
Q

What imaging is done in CKD?

A

Renal US

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7
Q

What are DDx for CKD?

A
  1. Diabetic kindey disease
  2. Hypertensive nephrosclerosis
  3. Ischaemic nephropathy
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8
Q

What is the management for CKD?

A

1st Line: ACEi or ARBs
Adjunct: dapagliflozin
2nd line: Non-dihydropyridine CCB

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9
Q

What is the general management for CKD?

A
  1. Glycaemic control and optimisation of BP

2. SGLT-2 and agents than block renin-angiotensin system

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10
Q

What is the 1st line management for GFR category G5 or with uraemia?

A

1st line dialysis

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11
Q

What is the CKD a RF for?

A

CVD

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12
Q

What is G1 class?

A

GFR >90 mL/minute/1.73 m², and evidence of kidney damage based on pathological diagnosis, abnormalities of radiographic imaging, or laboratory findings such as haematuria and/or proteinuria

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13
Q

What is G2 class?

A

GFR 60 to 89: mL/minute/1.73 m²

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14
Q

What is G3a class?

A

GFR 45 to 59: mL/minute/1.73 m² (mild-moderate)

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15
Q

What is G3b class?

A

GFR 30 to 44: mL/minute/1.73 m² (moderate-severe)

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16
Q

What is G4 class?

A

GFR 15 to 29: mL/minute/1.73 m² (severe CKD)

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17
Q

What is the G5 class?

A

GFR <15: mL/minute/1.73 m². (kidney failure)

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18
Q

What is the albumin category based on?

A

documented based on albumin excretion rate (AER) or albumin to creatinine ratio (ACR)

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19
Q

What is A1 category?

A

AER <30 mg albumin/24 hours or ACR <3 mg/mmol (<30 mg/g): normal to mildly increased

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20
Q

What is A2 category?

A

AER 30 to 300 mg albumin/24 hours or ACR of 3 to 30 mg/mmol (30 to 300 mg/g): moderately increased

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21
Q

What is A3 category?

A

AER >300 mg albumin/24 hours or ACR >30 mg/mmol (>300 mg/g): severely increased

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22
Q

What is Low GFR and albuminuria are independently associated with a higher risk of?

A
  1. All cause mortality
  2. Cardiovascular mortality
  3. Progressive Kidney Disease and Kidney Failure
  4. AKI
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23
Q

What is the monitoring in CKD like?

A
  1. GFR and albuminuria should be monitored at least annually according to risk
  2. If high risk, monitor every 6 months
  3. If very high risk monitor at least every 3-4months
  4. Small fluctuations are common but a drop in eGFR stage >25% is significant and rapid progression in drop in eGFR>5/yr
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24
Q

What are different types of RRT?

A
  1. Transplant
  2. Conservative care (v comorbid)
  3. Peritoneal Dialysis
  4. Haemodialysis
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25
Q

What is best for of RRT?

A

pre-emptive live donor renal transplant

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26
Q

When is a patient eligible for transplant?

A
  1. GFR<15ml/min or GFR>15mil/min and likely need RRT in less than 6months
  2. Better for pre-emptive transplantation when GFR around 30ml/min
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27
Q

When is kidney transplant contraindicated?

A
  1. Untreated malignancy
  2. Active infection
  3. Untreated HIV infection
  4. LE under 2 years
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28
Q

What type of donor is better?

A

live donor is better than deceased donor

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29
Q

How are kidneys matched?

A
  1. HLA matching and Cross-match
  2. HLA 3 out of 6 mismatch (1-1-1 mismatch)
  3. Cross-matching and anti-HLA antibodies
  4. Sharing scheme for blood group incompatible or HLA incompatible donors
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30
Q

How does peritoneal dialysis work?

A
  • utilises the peritoneum dialysis membrane
  • Large SFA
  • highlight vascular
  • Based upon exchanges
  • Fluid rained out > new fluid drained in > leave for 1-8 hours
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31
Q

What are different types of peritoneal dialysis?

A
  1. Continuous ambulatory peritoneal dialysis (CAPD)

2. Automated peritoneal dialysis (APD)

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32
Q

What are adv of PD?

A
  1. Easy to travel
  2. Low tech
  3. Flexibility
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33
Q

What are disadv of PD?

A
  1. Need to be continuous therapy
  2. Peritonitis risk
  3. Membrane failure
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34
Q

How does haemodialysis work?

A
  1. Uses and extracorporeal circuit
  2. Usually 3-4 hours x3/week
  3. Predominantly in centre
    Predominantly diffusion using a counter-current
    Needs 120-300: of purified water per patient per dialysis
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35
Q

What are Adv of haemodialysis?

A
  1. Less time than PD

2. No issues with membrane failure

36
Q

What are disadv of haemodialysis?

A
  1. Fixed dialysis session
  2. Dialysis access “achilles heel;”
  3. Expensive
  4. Need large volumes of purified water
37
Q

How do you get access for dialysis for HD?

A

HD arteriovenous fistula: AVF preferred 6-8 weeks to develop

38
Q

What is another way of access for HD dialysis?

A

Tunnel dialysis line – quicker but high risk of infection

39
Q

How do you get dialysis access in PD?

A

ideally 2-4 weeks before starting dialysis

40
Q

When should you start dialysis in chronic renal disease?

A
  1. GFR<8ml/min
  2. Uraemic symptoms
  3. Fluid overload refractory to diuretics
41
Q

What are uraemic symptoms?

A
  • Weight loss
    - Anorexia
    - Fatigue
42
Q

When do you used RRT in AKI?

A
  • Often as part of multi-organ failure
  • Delivered in ICUS
  • Often using Haemofiltration (CVVHF)
43
Q

Why is RRT in AKI not great?

A
  1. Slower and less efficient
  2. Convection rather than diffusion
  3. Continuous therapy but less haemodynamic instability
  4. Expensive
  5. Anticoagulation an issue
44
Q

How does hypertension cause CKD?

A
  1. High BP
  2. Leads to thickening of wall of renal artery
  3. Leads to hypoperfusion
  4. Leads to glomerular ischaemic injury
  5. Leads to glomerulosclerosis (aka scarring)
45
Q

How does Diabetes cause CKD?

A
  1. High blood sugar
  2. Leads to non-enzymatic glycosylation of efferent arterioles
  3. Leads to increased resistance to blood flow
  4. Leads to high pressure state
46
Q

What are the categories for intrarenal causes of CKS?

A
  1. Renal vascular disease
  2. Glomerular disease
  3. Tubulointerstitial disease
  4. Nephrotoxins
47
Q

How does renal vascular disease cause CKD?

A
  1. Hypertension

2. Renal artery stenosis

48
Q

How does glomerular disease cause CKD?

A
  • Nephritic disease

* Nephrotic disease

49
Q

What tubulointerstitial disease cuases CKD?

A

PCKD

50
Q

What nephrotoxins can cause CKD?

A

NSAIDs

51
Q

What are pre-renal causes of CKD?

A
  1. CHF

2. Cirrhosis

52
Q

What are post renal causes of CKD?

A
  1. Prostatic disease
  2. Repeated pyelonephritis
  3. Repeated stones
53
Q

How does oedema present in CKD?

A
  1. swelling
  2. weight gain
  3. SOB (pulm oedema)
54
Q

What are signs of azotemia?

A

N&V, loss of appetite

55
Q

What are signs of encephalitis?

A

asterixis, coma, seizures

56
Q

How can hypocalcaemia present?

A

Renal osteodystrophy (hyperphosphatameia, hypocalcaemia, skeletal abnormalities, extraskeletal calcifications i.e:. Coronary arteries)

57
Q

How can anaemia present in CKD?

A

paleness, tiredness, cold intolerance

58
Q

What are key functions of the kidney?

A
  1. Water regulation
  2. Waste removal
  3. Electrolyte regulation
  4. Hormone production
59
Q

What happens when water regulation is affected?

A

oedema

60
Q

What happens when waste removal probelm?

A

azotemia (high ntriogen and creatintie) - coma, seizures, pericarditis

61
Q

What does electrolyte regulation problem lead to?

A
  1. Increase K+
  2. Increase PO3+
  3. Decrease Na+
  4. Decrease Ca2+
    (acidosis)
62
Q

What does hormone production problem lead to?

A
  1. ACE and Renin: hypertension
  2. 1-alpha hydroxylase: decrease Vit D
  3. EPO: anaemia
63
Q

Why is there fatigue in CKD?

A

2º to anaemia or uraemia

64
Q

Why can there be N and V in CKD?

A

2º to hyponatraemia or uraemia

65
Q

What are the key blood results in CKD?

A
  1. Increase Cr
  2. Decreased eGFR
  3. FBC, ABG, U&Es, PTH
66
Q

What bedside tests are done?

A

Urinalysis (Haematuria? Proteinuria? Albuminuria?)

67
Q

How often are bedside tests and bloods done?

A

Multiple assessments over 3 months to confirm chronicity

68
Q

What imaging is done?

A
  • Renal US (kidney size?, mass lesions?, obstruction?, blood flow?)
  • AXR (kidney stones?)
  • MRI (cancer?)
69
Q

What can USS show in CKD?

A

Small and echogenic kidneys 2º to scarring (some causes of CKD causes normal sized kidneys)

70
Q

What invasive Ix is done in CKD?

A

Kidney biopsy

71
Q

What is the conservative management for CKD?

A
  1. Stop nephrotoxic drugs
  2. Manage underlying cause
  3. Weight management
  4. Diet changes: protein/ sodium/ calcium/ potassium restriction
  5. Smoking cessation
72
Q

What is the medical management for HTN and proteinuria in CKD?

A

ARB or ACEi

Target: 130mmHg > SBP > 110mmHg and DBP< 80mmHg

73
Q

What is the medical management of oedema in CKD?

A

loop diuretic

74
Q

What is the medical management if hyperlipidaemia in CKD?

A

statin

75
Q

What is the interventional management for CKD?

A
  • Renal replacement therapy: Reserved for G5 CKD and patients with refractory complications
    1. Haemodyalisis
    2. Peritoneal dialysis
    3. Kidney transplant
76
Q

What is G1 stage?

A

GFR>90 underlying kidney disease

77
Q

What is G2 stage?

A

GFR 60-89, midly decreased

78
Q

What is G3a stage?

A

45-59, mild-moderate decrease

79
Q

What is G3b stage?

A

30 to 44, moderate-severe disease

80
Q

What is G4 stage?

A

15-29, severely decreased

81
Q

What is G5 stage?

A

GFR<15 end stage renal disease

82
Q

What is A1?

A

AER<30mg underlying kidney disease

83
Q

What is A2?

A

AER 30-300, midly decreased

84
Q

What is A3?

A

AER>300, mild-moderate decrease

85
Q

Why is staging important?

A

higher the stage the higher the risk of rapid CKD progression

86
Q

Why no CT in CKD?

A

as contrast affects kidneys!

Z Year3 Urology (18 decks)

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