Chronic Kidney Disease ✅ Flashcards
How can CKD present in children?
- Faltering growth
- Increased tiredness
- Pallor
- Oliguria
- Oedema
- Hypertension
What can the causes of CKD be divided into?
- Congenital
- Hereditary/metabolic
- Glomerulonephritis
- Others
What are the congenital causes of CKD?
- Urinary tract malformations
- Obstructive nephropathy
- Renal dysplasia/hypoplasia
- Reflux nephropathy
- Congenital anomaly of kidney and urinary tract (CAKUT)
What are the hereditary/metabolic causes of CKD?
- Nephronopthisis
- Cystinosis
- Oxalosis
- Alport syndrome
- Polycystic kidney disease
What are the glomerulonephritic causes of CKD?
- Focal segmental glomerulosclerosis
- Membranoproliferative glomerulonephritis
- Congenital nephrotic syndrome
- IgA nephropathy
- Goodpasture disease
- Haemolytic uraemic syndrome
- Henoch-Schonlein purpura
- Systemic lupus erythematosus
Give 2 types of congenital nephrotic syndrome?
- Finnish type
- Diffuse mesangial sclerosis
What is IgA nephropathy also known as?
Berger’s disease
What is Goodpasture disease also known as?
Antiglomerular basement membrane disease
What are the other causes of CKD?
Bilateral Wilm’s tumour
What are investigations aimed at in CKD?
- Identifying underlying cause
- Differentiating from AKI
- Identifying complications
What features suggest chronic kidney disease?
- Presence of non-haemolytic anaemia
- Small or dysplastic kidneys on ultrasound
- X-ray evidence of rickets
- End-organ damage from hypertension
What is the overall aim of management in CKD?
- Treat any underling disorder and associated conditions
- Support kidney function
What is the limitation of the treatment of CKD?
It is often not possible to reverse the renal damage
What is the result of it often not being possible to reverse renal damage in CKD?
The focus is on preventing further damage
How is further renal damage prevented in CKD?
- Maintaining nutrition and growth
- Controlling hypertension
- Reducing proteinuria
- Treating anaemia
- Treating fluid, electrolyte, and acid-base imbalance
- Relieving any obstruction
- Controlling renal osteodystrophy
How can renal osteodystrophy be controlled?
Keeping calcium, phosphate, alkaline phosphate, and parathyroid hormone in normal range for age
How severe is renal failure?
Varies, from mild renal impairment to severe irreversible end-stage kidney disease
What is required in severe irreversible end-stage kidney disease?
Renal replacement therapy
What is the difficulty of defining when someone needs RRT?
The indications for RRT are complex, and depends on a holistic view of the child rather than specific biochemical values
When is RRT generally started?
When the child becomes symptomatic from renal failure, or when blood biochemistry approaches hazardous levels despite therapy and dietary restrictions
What symptoms of renal failure might indicate a need for RRT?
- Tiredness
- Anorexia
- Vomiting
What is the ultimate aim of therapy in severe irreversible renal failure?
Pre-emptive renal transplantation
Why is the ultimate aim of therapy in severe irreversible renal failure pre-emptive renal transplantation?
- Places far less restriction on normal life
- Associated with lower morbidity and mortality
What is meant by pre-emptive renal transplantation?
Transplantation before dialysis
Give an example of when a child may not be suitable for pre-emptive transplantation?
Those requiring bilateral native nephrectomies for focal and segmental glomerulosclerosis
How is dialysis modality chosen?
Individualised to the child and family
What are the disadvantages of haemodialysis?
- Access issues
- Fluid restriction
What are the problems with accessing haemodialysis?
Haemodialysis for children is based in a few specialist centres, and travel to and from the centre for a 3-5 hour session 3 times a week can be problematic
Is home haemodialysis available?
Yes, but only in a few paediatric centres throughout the world
How does fluid restriction in haemodialysis compare to in peritoneal dialysis?
Fluid restriction is normally more severe when on haemodialysis
What are the practical advantages of haemodialysis?
- Family relieved of some of the stresses and responsibilities of peritoneal dialysis
- Child retains some independence
When is home peritoneal dialysis performed?
Usually overnight
What is the advantage of peritoneal dialysis occurring at home overnight?
It enables normal school attendance
What is the disadvantage of home peritoneal dialysis?
Huge burden on caregivers, and child very dependent on them on a regular basis
What are the advantages of peritoneal dialysis?
- Avoidance of fluid fluid and electrolyte shifts
- Less severe fluid and dietary restrictions
Who is peritoneal dialysis particularly suited to?
Younger patients
What is the preferred treatment for end-stage renal disease?
Renal transplantation
What is the advantage of renal transplantation?
Offers nearest to normal lifestyle
What is the 5 year survival following successful renal transplantation?
Over 95%
What kind of renal transplant has the highest survival rates?
Living donor kidneys
What is required long-term in renal transplantation patients?
Immunosuppression medications
