Chronic Kidney Disease* Flashcards
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
What drug is contraindicated in AKI but used for CKD Management
ACE inhibitors
