Chronic Kidney Disease* Flashcards
(25 cards)
What is CKD
eGFR is lower than 60ml/min/1.73m2 for >3 months
Normal =120
How can CKD be classified by eGFR
1 = 90+ w/ renal Sx 2= 60-90 w renal Sx 3a = 45-60 3b = 30-45 4 = 15-30 5 = <15
What are the 4 parameters used to stage CKD
CAGE -Creatinie -Age -Gender -Ethnicity
What are the best readings used to quantify CKD
eGFR
ACR (albumin-creatinine ratio)
What are the RF of CKD
DM HTN GN PKD NSAIDs
Which diabteic drug is CI in CKD
Metformin when eGFR <30
-Below stage 4
What is the pathology of CKD
Damaged nephrons decrease GFR
Increased Burden on working nephrons
Compensatory RAAS - increase GFR and Increase transglomerular pressure
Increase sheering and loss of selecetive permeability
Proteinuria and haematuria
Mesangial scarring (Angiotensin 2 activates TGF-B and Plasminogen activator-inactivator)
What mechanism in CKD causes increased GFR but also Increased Transglomerular pressure
Compensatory RAAS
What is the result of increased Transglomerular pressure
Sheering and loss of Basement membrane selective permeability = heamaturiea and preoteinurea
What is activated to cause Mesnagial scarring
TGF-B and Plasminogen activ/inactivator
Why do most patients present aymptomatic w/ CKD
Compensatory effect of working nephrons
What are the presentations of CKD
early = ASx
substance accumulation and renal damage (Diabetic nephropathy)
What are the complications of CKD (CCANOU)
CCANOU
- CVD
- Contrast induced AKI
- Anaemia (Low EPO)
- Neuropathy
- Osteodystrophy (low Vit D)
- Urea = protein/haem
In Anaemia 2nd to CKD, what causes it
Low EPO
How is CKD investigated
FBC (Anaemia of chronic) U+E Urine Dipstick (proteinurea) USS (Bilateral small kidneys) GFR function staging ACR >3 shows proteinuria
CKD has no cure but how can its complications be managed
Anaemia? Fe + EPO Osteodystrophy? Vit D CVD? ACE and statins (Decrease HTN) Oedema? Diuretics Kidney transplant
At what stage should there be an RRT referral
Stage 5
-<15
What is difference in what you look at between AKI and CKD
AKI = serum creatine/ urea and urine output CKD = eGFR and ACR
Do both AKI and CKD present w/anaemia
Only CKD (Anaemia of chronic)
What does USS show on CKD vs AKI
AKI = normal CKD = Bilateral small kidneys
Describe the process of mesangial scarring
Angiotensin 2 increases TGF-B and plasminogen activator 1
How can contrast induced AKI be treated
IV Saline 0.9% before and after use
Are there any early presentations of CKD
NO asymptomatic
What is the normal eGFR Value
120
