Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Y4 - CCC & PC > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

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

A

a reduction in kidney function or structural damage (or both)

that is present for more than 3 months

and has associated health implications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What test results would lead to a diagnosis of CKD?

A

people with a persistently reduced renal function - shown by an eGFR < 60 ml/min/1.73m2

and/or the presence of markers indicating structural kidney damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the potential markers of kidney damage that might be identified?

A
  • proteinuria
  • urine sediment abnormalities (e.g. haematuria)
  • electrolyte abnormalities (due to tubular disorders)
  • abnormalities detected by histology
  • structural abnormalities detected by imaging
  • history of kidney transplantation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is proteinuria detected?

A

there is a urinary albumin:creatinine ratio (ACR) > 3mg/mmol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is significant about the diagnosis of CKD in most patients?

A

it is often asymptomatic and is picked up through routine investigations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How common is CKD?

A

9 - 13% of the adult population worldwide has CKD

prevalence related to aging population and increase in diabetes + HTN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Why is it important to try and recognise CKD in the early asymptomatic stages?

A
  • it is often unrecognised until the most advanced stages
  • it is mostly irreversible and progressive in nature
  • detecting CKD in the early stages prevents it from advancing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the most significant implications of CKD on the patient?

A
  • there is a high risk of complications + reduction in life expectancy
  • it impacts the management and investigations of other conditions
  • renal replacement is expensive + resource heavy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the most common and second most common RF & cause of CKD?

A

diabetes is the most common cause of CKD - 1/3 of diabetics will develop it

HTN is the second most common cause

HTN is also a consequence of CKD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are other causes of CKD?

A
  1. glomerulonephritis
  2. systemic disease (e.g. SLE, amyloid, myeloma, vasculitis)
  3. renal artery stenosis
  4. heart failure
  5. hereditary (e.g. polycystic kidney disease)
  6. urinary tract obstruction (e.g. prostatic disease)
  7. chronic pyelonephritis / vesicoureteric reflux
  8. nephrotoxic drugs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the most readily available nephrotoxic drug?

A

NSAIDs

patients use these independently without knowing about the damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some other common nephrotoxic drugs?

A
  • lithium
  • diuretics
  • ACE inhibitors
  • angiotensin-II receptor antagonists
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some less common nephrotoxic drugs?

A
  • bisphosphonates
  • aminoglycosides
  • ciclosporin or tacrolimus
  • mesalazine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What mnemonic can be used to remember the common nephrotoxic drugs?

A

DAMN

D - diuretics
A - ACEi / ARBs / antibiotics (gentamicin)
M - metformin
N - NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the typical signs and symptoms someone may present with?

A

CKD is usually asymptomatic until the advanced stages

signs are likely to be vague, such as:
* restless legs
* tiredness / fatigue
* nausea / vomiting
* peripheral oedema
* pruritis

these are uraemic symptoms as they are commonly caused by retention of waste products

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the urinary symptoms of advanced CKD?

A
  • nocturia
  • increased urinary frequency
  • oliguria
  • persistently frothy urine is a sign of proteinuria

this happens as the kidneys fail to concentrate urine, causing production of a larger volume or dilute urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the cognitive effects of CKD?

A
  • increased risk of cognitive impairment by 65%
  • cognition is affected early, but different skills decline at different rates
  • language and attention particularly affected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What changes in appearance may occur?

A
  • pallor due to secondary anaemia
  • HTN is common either as a primary or secondary effect
  • SOB can occur due to fluid overload, anaemia, ischaemic HD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What changes in the kidney shapes on imaging may give clues to the causes of CKD?

A
  • bilaterally small kidneys with thinned cortices suggests intrinsic disease
  • a unilateral small kidney can indicate renal arterial disease
  • enlarged cystic kidneys suggest cystic kidney disease
  • clubbed calyces and cortical scars suggest reflux with chronic infection / ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why does peripheral oedema occur in CKD?

A

due to renal sodium retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What general non-specific symptom is common in advanced CKD?

A

itch and cramps

  • cramps are worse at night - likely to be due to neuronal irritation as a result of uraemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are the 4 different clinical effects of advanced uraemia?

A
  • uraemia-induced platelet dysfunction

presents with easy bruising + increased GI bleeding

  • uraemic pericarditis

presents with chest pain + pericardial friction rub

  • uraemic neuropathy

presents with distal sensorimotor polyneuropathy

  • uraemic encephalitis

presents with headache, confusion, seizures + coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the resuts of an abnormal renal excretory function?

A
  • fluid retention

resulting in HTN, peripheral oedema + pulmonary oedema

  • potassium retention - leading to hyperkalaemia
  • acid retention - resulting in metabolic acidosis
  • phosphate retention - hyperphosphataemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the effects on calcium levels that may occur in CKD?

A

decreased production of calcitriol (active metabolite of vit D) results in HYPOCALCAEMIA

this presents with bone pain, hyperphosphataemia, fractures, osteomalacia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the initial blood tests for CKD investigation?

What advice is given prior to the test?

A
  • U&Es
  • eGFR
  • FBC - to look for signs of renal anaemia
  • HbA1c + lipids - to manage CVD risk and look for other conditions

Do not eat meat for 12 hours before - this can falsely raise creatinine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What other investigations are performed as part of the initial investigation for CKD?

A
  • early morning urine for urinary albumin:creatinine ratio (ACR)
  • urine dipstick - to look for haematuria
  • assess cardiovascular risk - BMI, BP & lifestyle
27
Q

How can eGFR and ACR be used to diagnose and classify CKD?

A
  • if results are abnormal, they must be repeated within 3 months to confirm the diagnosis
  • UNLESS it is clear that reduced renal function has already been present for 3 months
  • eGFR and ACR are used to classify the CKD stage
28
Q

What additional tests may be performed when suspicious of bone disease?

A

serum calcium, phosphate, vitamin D & parathyroid hormone

also performed when there is unexplained hypo/hypercalcaemia

29
Q

When might imaging be performed as an intial investigation for CKD?

A

renal tract USS performed when suspicious of urinary tract stones / obstruction, structural abnormalities or FH of polycystic kidney disease

30
Q

How is eGFR used to stage CKD?

stage 1 and 2 only

A

Stage 1:
eGFR > 90 with other evidence of kidney damage

Stage 2:
eGFR mildly reduced 60 - 89, with other evidence of kidney damage

G1 & G2 ARE NOT CKD UNLESS THERE ARE OTHER SIGNS OF KIDNEY DAMAGE

31
Q

How is eGFR used to stage CKD?

stage 3 - 5

A

Stage 3:
moderate reduction in eGFR with/without other signs of kidney damage

3a: eGFR 45-59
3b: eGFR 30-44

Stage 4:
severe reduction in eGFR 15-29 with/without other signs of kidney damage

Stage 5:
end-stage renal failure with eGFR < 15

32
Q

How is urinary ACR used to stage CKD?

A

Stage A1:
ACR < 3 - may be normal or mildly reduced

Stage A2:
ACR 3-30 - moderately increased

Stage A3:
ACR > 30 - severely increased

proteinuria is an important marker for progression of CKD

eGFR + ACR are combined to classify CKD
33
Q

How is eGFR calculated?

Why is it important to have repeated tests for diagnosis?

A
  • calculated from serum creatinine, gender, age + ethnicity
  • eGFR is an ESTIMATE and there is a degree of error relating to muscle mass
  • inaccuracy is particularly important at borderline normal eGFR
34
Q

Why can there be a degree of error relating to muscle mass when calculating eGFR?

A
  • serum urea and creatinine can be falsely raised/low related to protein intake, muscle mass, dehydration + acute illness

repeated tests are needed - without recent high protein intake and over a 3 month period

35
Q

What is the main goal of management of CKD?

A

as it is often irreversible, the main goal is to slow progression of the disease + limit loss of kidney function

36
Q

What are the main ways in which management appraoches can slow progression of CKD?

A
  • maintainence of good BP control
  • lifestyle + diet advice
  • reduction of cardiovascular risk
  • optimise diabetic / hypertensive control
  • treat any underlying cause
37
Q

Why is it important to control BP in CKD?

What are the targets?

A

BP control reduces cardiovascular complications and slows progression of CKD

for non-diabetics, BP < 140/90 mmHg

for diabetics AND when ACR > 70mg/mmol, BP < 130/80 mmHg

38
Q

What medication is often given first line to control BP in CKD?

A

ACE inhibitors - offered first line to patients with:

  1. diabetes + ACR > 3mg/mmol
  2. hypertension + ACR > 30mg/mmol
  3. ALL patients with ACR > 70mg/mmol
39
Q

What must be done when starting a patient on an ACEi?

A

check U&Es within 2 weeks of starting an ACEi or changing the dose

ACEi can cause renal impairment + hyperkalaemia

40
Q

What dietary advice is offered alongside ACEi in control of high BP?

A

dietary salt restriction to </= 6g daily

this is important in BP control and reducing fluid overload

41
Q

What other lifestyle advice may be given to someone with CKD?

A
  • weight loss, limiting alcohol & smoking cessation
  • avoid OTC NSAIDs + herbal remedies
  • there is a risk of acute kidney injury if there is severe intercurrent illness (e.g. dehydration)
42
Q

What other medication may be offered to someone with a new diagnosis of CKD?

A

a statin is offered for primary prevention of CVD

this is usually atorvastatin 20mg

43
Q

What immunisations are offered in CKD?

A

influenza - for CKD 3, 4 + 5

pneumococcal disease - for CKD 4 + 5

44
Q

What advice is given to diabetics with CKD?

A

tight blood glucose control can reduce progression of CKD

patients with insulin-dependent diabetes may find insulin requirements decrease as CKD progresses - insulin clearance slows with progressive renal dysfunction

45
Q

When might a diuretic be needed in CKD?

A

when dietary salt reduction is not sufficient to limit fluid overload

furosemide is often used

the effectiveness of diuretics is reduced in renal failure

thiazide diuretics are ineffective when eGFR < 30 - loop diuretic needed in this situation

46
Q

How is anaemia as a result of CKD treated?

A

subcutaenous injections of erythropoietin

haematinics are checked before treatment + supplements given if needed (vit B12, folate, ferritin)

47
Q

What is the treatment for renal bone disease in early CKD and why?

A
  • in early CKD - 1,25-dihydroxyvitamin D is low

and parathyroid hormone is high

  • treatment is with vitamin D supplementation
48
Q

What is the treatment for renal bone disease in advanced CKD and why?

A
  • in advanced CKD, there is hyperphosphataemia
  • this is managed with dietary restriction and phosphate binders

after starting vitamin D and phosphate binders, calcium + phosphate levels are monitored every 3-4 months

49
Q

What is the treatment for metabolic acidosis as a result of CKD?

A

oral sodium bicarbonate supplementation

50
Q

When might you refer someone with CKD for specialist care?

A
  • suspicion of urological cancer
  • severe reduction in kidney function / accelerated progression of CKD
  • uncontrolled HTN
  • suspected / confirmed rare or genetic cause
  • suspected renal artery stenosis
  • suspected urinary tract obstructions
51
Q

What is meant by end-stage renal disease?

A

chronic kidney damage that has progressed to such an extent that renal replacement therapy is required for survival

renal replacement therapy includes transplant or dialysis

52
Q

What are the four options for treatment of ESRD?

When are these discussed with the patient?

A
  1. haemodialysis
  2. peritoneal dialysis
  3. kidney transplantation
  4. conservative care

dialysis is not usually needed until eGFR < 10, but options are discussed when eGFR < 20

53
Q

What is the purpose of dialysis?

A
  • it replaces the excretory role of the kidney and allows for diffusion of solutes between the blood & dialysis fluid
  • it removes excess salt + water
  • still need fluid + dietary restrictions + medications
54
Q

How does haemodialysis work?

A
  • the patient’s blood is filtered through an artificial kidney, which removes waste products + extra fluids
  • the clean blood is then returned to the body
55
Q

How often does haemodialysis need to be performed?

How is access to the circulation acheived?

A

it is performed 3 times a week for 4 hours

usually in hospital, but occasionally can be performed at home

it requires access to the circulation through an arteriovenous fistula / graft or central venous catheter

56
Q

How does peritoneal dialysis work?

What is a major benefit to this method?

A
  • there is diffusion of solutes between the patient’s blood in peritoneal capillaries and dialysis fluid within the peritoneal cavity
  • a catheter is used to fill the abdomen with dialysis solution
  • the waste products + fluid pass through the peritoneum from the blood and into the solution, which is then drained and removed after 30 to 40 minutes

many patients prefer this method as it can be used at home

57
Q

What is CAPD and APD?

A

continuous ambulatory peritoneal dialysis (CAPD):
there are 4x 1.5-2.5 litre exchanges per day

automated peritoneal dialysis (APD):
there are several exchanges made by the machine whilst asleep at night

58
Q

What are the benefits of kidney transplantation?

Where does the transplant come from?

A
  • it has the best improvements in survival + quality of life
  • kidney may be from a deceased donor, or a live donor who is related or altruistic
59
Q

What are the drawbacks of kidney transplantation?

A
  • lifelong immunosuppression is needed to prevent rejection
  • transplant failure can occur after some time
  • many patients are not suitable for transplants due to other conditions
  • transplants are not readily available
60
Q

Where is the kidney transplant inserted?

A

the person’s original kidneys are left in place

the 3rd kidney is situated in the lower left side of the abdomen

61
Q

Why might someone opt for conservative care over dialysis/transplantation?

A
  • these patients are often elderly / have multiple comorbidities and the benefits do not outweight the impact on quality of life
62
Q

What are the complications associated with haemodialysis?

A
  • hypotension
  • bleeding
  • loss of vascular access due to clotting
  • risk of bacteraemia from line contamination
63
Q

What are the complications of peritoneal dialysis?

A
  • bacterial peritonitis
  • hyperglycaemia (as dialysis solution has a high glucose concentration)

Y4 - CCC & PC (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions