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8. Urology (Medical Knowledge) > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

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USMLE® Step 1 flashcards
1
Q

What are some functions of the kidneys?

A

Body fluid homeostasis

Endocrine function

Acid-base homeostasis

Electrolyte homeostasis

Excretory function

Regulation of vascular tone

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2
Q

How do we assess for kidney disease?

A
  • Filtration (excretory) function
    • Remove
    • Tested by using estimates of GFR (eGFR) from creatinine blood test
  • Filtration (barrier) function
    • Retain
    • Tested by checking presence of blood or protein in urine
  • Anatomy
    • Abnormality
    • Tested by histology or imaging
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3
Q

What causes glomerular filtration?

A

Pressure differences

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4
Q

How do you measure excretory renal function?

A
  • Insulin clearance
  • Isotope GFR
  • 24 hour urine collection plus blood test
  • GFR estimating equations (most commonly used in clinical practice)
    • Creatinine
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5
Q

What is a problem with using creatinine to estimate GFR?

A

A problem with using creatinine is it is generated from the breakdown of muscle, and not everyone has the same muscle mass, it also depends on:

  • Age
  • Ethnicity
  • Gender
  • Weight
  • Other issues such as liver disease
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6
Q

What are some different formulae used to estimate GFR from serum creatinine?

A
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7
Q

What is used to stage kidney disease?

A

International chronic kidney disease (CKD) classification

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8
Q

What does CKD stand for?

A

Chronic kidney disease

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9
Q

What % is GFR of normal in stage 1 chronic kidney disease?

A

>90%

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10
Q

What % is GFR of normal in stage 2 chronic kidney disease?

A

60-89%

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11
Q

What % is GFR of normal in stage 3a chronic kidney disease?

A

45-59%

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12
Q

What % is GFR of normal in stage 3b chronic kidney disease?

A

30-44%

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13
Q

What % is GFR of normal in stage 4 chronic kidney disease?

A

15-29%

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14
Q

What % is GFR of normal in stage 5 chronic kidney disease?

A

<15%

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15
Q

What does GBM stand for?

A

Glomerular basement membrane

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16
Q

Do all substances cross the GBM?

A

Not all substances cross the glomerular basement membrane (GBM):

  • Crosses GBM
    • Water
    • Electrolytes
    • Urea
    • Creatinine
  • Crosses GBM but reabsorbed in proximal tubule
    • Glucose
    • Low molecular weight proteins (a2-microglobulin)
  • Does not cross GBM
    • Cells (RBC, WBC)
    • High molecular weight proteins (albumin, globulins)
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17
Q

What are examples of substances that cross the GBM?

A
  • Water
  • Electrolytes
  • Urea
  • Creatinine
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18
Q

What are examples of substances that cross the GBM but are reabsorbed in proximal tubule?

A
  • Glucose
  • Low molecular weight proteins (a2-microglobulin)
19
Q

What are examples of substances that do not cross the GBM?

A
  • Cells (RBC, WBC)
  • High molecular weight proteins (albumin, globulins)
20
Q

Should there be any blood measurable in the urine?

A

There should be no blood or protein measurable in urine if filtering properly

21
Q

What investigations can be done to test the filtering function of the kidneys?

A
22
Q

What investigation is a “dipstick”?

A

Urinalysis

23
Q

What is checked for in urinalysis?

A

Blood

Protein

24
Q

What does PCR stand for?

A

Protein-creatinine ratio

25
Q

What is chronic kidney disease (CKD)?

A

Defined by either presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR <60ml/min/1.73m2 that is present for 3 or more months

26
Q

What are the different categories of albuminuria?

A

A1

A2

A3

27
Q

What is the medical term for excess albumin in urine?

A

Albuminuria

28
Q

What is A1 albuminura?

A

Nomal to mildly increased

<30mg/g

<3mg/mmol

29
Q

What is A2 albuminuria?

A

Moderately increased

30-300mg/g

3-30mg/mol

30
Q

What is A3 albuminuria?

A

Severely increased

>300mg/g

>30mg/mol

31
Q

What is the prevalence of chronic kidney disease (CKD)?

A

About 8-12% in UK

Increases with age

32
Q

Who is renal replacement therapy given to?

A

People for end stage renal disease

33
Q

What is the aetiology of CKD?

A
  • Polycystic kidney disease
  • Diabetes
  • Glomerulonephritis
    • And all the causes of that
  • Hypertension
  • Renovascular disease
34
Q

Explain the clinical approach to CKD?

A
  • Detection of the underlying aetiology
    • Treatment for specific disease
  • Slowing rate of renal decline
    • Generic therapies
  • Assessment of complications related to reduced GFR
    • Prevention and treatment
  • Preparation for renal replacement therapy
35
Q

What is the clinical presentation of CKD?

A
36
Q

What are important parts of the history for CKD?

A
  • Previous evidence of renal disease
  • Family history
  • Systemic diseases
  • Drug exposure
  • Pre/post renal factors
  • Uraemic symptoms
37
Q

What are important parts of the examination for CKD?

A
  • Vital signs
  • Volume status
  • Systemic illness
  • Obstruction
38
Q

What investigations are done for chronic kidney disease (CKD)?

A
  • Blood tests
    • U and Es, FBC
  • Urine tests
    • Urine dip, urine PCR or ACR (24-hour collection)
  • Histology
    • Renal biopsy
  • Radiology
39
Q

What investigations can be done to detect the aetiology of CKD?

A
  • Chemistry
    • Urea, creatinine, electrolytes (Na, K, Cl)
    • Bicarbonate
    • Total protein, albumin
    • Calcium, phosphate
    • Liver function tests
    • Creatine kinase
    • Immunoglobulins, serum protein electrophoresis
  • Haematology
    • Full blood count
      • Hb
      • MCV
      • MCH
      • WBC
      • Platelets
      • % of hypochromic RBCs
    • Coagulation screen
      • PT
      • APPT
      • With or without fibrinogen
  • Urine investigations
    • Urinalysis (“dipstick”
      • Blood
      • Protein
    • Protein quantification
      • Protein creatinine ratio (PCR)
      • Albumin creatinine ratio
      • 24 hour urine collection
  • Imaging
    • US
      • Advantages
        • Non-invasive
        • No ionising radiation
        • May provide information about chronicity of renal disease
      • Disadvantages
        • No functional data
        • Operator dependant
  • Pathology
    • Kidney biopsy
40
Q

What are advantages of an ultrasound scan?

A
  • Non-invasive
  • No ionising radiation
  • May provide information about chronicity of renal disease
41
Q

What are disadvantages of an ultrasound scan?

A
  • No functional data

Operator dependant

42
Q

What are some potential interventions to slow the rate of decline of GFR in CKD?

A
  • BP control (most important)
  • Control protein urea
    • Particular ACE inhibitors/ARBs
  • Treat underlying causes
43
Q

What are some complications related to reduced GFR?

A
  • Acidosis
  • Anaemia
  • Bone disease
  • CV risk
  • Death and dialysis
  • Electrolytes
  • Fluid overload
  • Gout
  • Hypertension
  • Iatrogenic issues
44
Q

What are some ways to prepare patients for end-stage renal disease and renal replacement therapy?

A
  • Education and information
  • Selection of modality
    • HD/PD, transplant, conservative care
  • Planning access
  • Deciding when to start renal replacement therapy (RRT)
  • MDT

8. Urology (Medical Knowledge) (17 decks)

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