Chronic Kidney Disease Flashcards
Causes of CKD?
Diabetes HTN Age related decline Glomerulonephritis Polycystic kidney disease
Drugs: NSAIDs, PPIs, lithium
Risk factors for CKD
Older age HTN Diabetes Smoking Use of medications that affect the kidneys
Clinical presentation of CKD?
Usually asymptomatic but some signs may suggest disease: Priuritus Loss of appetite Nausea, oedema Muscle cramps Peripheral neuropathy Pallor HTN
Investigations for CKD and diagnosis?
eGFR- 2 tests required 3 months apart to confirm diagnosis
Proteinuria (urine albumin:creatinine ratio): >3mg is significant
Haematuria by urine dipstick
Renal USS used to assess those with accelerated CKD, haematuria, family hx of polycystic kidney disease or evidence of obstuction
Need at least eGFR of <60 or protinuria for diagnosis
Stages of eGFR?
Based on eGFR: G1 = >90 g2 = 60-89 G3a= 45-59 G3b = 30-44 G4 = 15-29 G5 = <15 (end stage renal failure
What is the A Score?
Based on albumin:creatinine ratio:
A1 = <3 A2= 3-30 A3 = >30
Complications of CKD?
Anaemia Renal bone disease CVS disease Peripheral neuropathy Dialysis related problems
When to refer to a specialist regarding CKD?
eGFR <30
ACR >70
Accelerated progression
Uncontrolled hypertension despite >4 antihypertensives
Management for CKD?
Optimise hypertensive and diabetic control
Exercise, stop smoking, special dietary advice
ACEi 1st line for HTN in CKD
Diagnostic criteria for CKD?
eGFR <60
OR
markers of kidney damage (albuminuria, structural or histological abnormalities- for example biopsy proven chronic glomerulonephritis, or persistent haematuria electrolyte abnormalities)
WHICH ARE PRESENT FOR >3 MONTHS
What electrolyte abnormality is more common in AKI?
Hyperkalaemia
What electrolyte abnormalities are common in CKD?
Hyperphosphataemia impaired kidneys can’t promote renal phosphate excretion)
Metabolic acidosis
Hypocalcaemia (kidneys convert vit D to its active form which increases serum calcium by promoting Ca absoprtion- in CKD this is impaired)
Hyponatraemia may occur in both chronic and acute, due to failure of Na reabsorption in PCT
