Chronic Kidney Disease Flashcards
Define chronic kidney disease
Abnormalities in kidney structure or function for more than 3 months with implications to health.
Implications to health is indicated by the following:
eGFR < 60 or markers of kidney damage such as proteinuria, albuminuria, urine sediment abnormalities (e.g. haematuria), el;ectrolyte abnormalities due to tubular disorders.
What are some of the markers of kidney damage?
Proteinuria
Albuminuria
Haematuria
Electrolyte abnormalities (due to tubular disorders)
Chronic kidney disease is interchangeable with which other terminology?
Chronic renal failure
What are the two most common causes of CKD?
Diabetes (most)
Hypertension
What GFR indicates kidney failure?
GFR < 15
What is a typical presentation of chronic kidney disease?
Tend to mostly be asymptomatic until later stages
What are the two main laboratory findings suggestive of CKD?
Reduced GFR
Elevated serum creatinine
List the main risk factors for CKD (9)
- Diabetes
- Hypertension
- Age >50
- Male sex
- Black or Hispanic ethnicity
- Long-term analgesic use
- Obesity
- Smoking
- Family history
- History of childhood renal disease (e.g. pyelonephritis)
- Pmx of systemic diseases such as SLE or gout
What are the main signs/symptoms of CKD? (7)
Presence of risk factors
Fatigue (due to uremia or anemia)
Oedema (salt and water retention alongside hypoalbuminaemia)
Nausea with or without vomitting (Accumulation of toxic waste)
Pruritis (toxic waste buildup under the skin)
Restless legs (symptom of uraeamia)
Anorexia (toxic waste)
Suggest 2 reasons why some patients with CKD present with fatigue
Due to aneamia (Kidney cant produce erythropoietin needed for RBC formation)
Ureamia
Why can kidney disease result in anaemia?
Kidneys are needed to produce erythropoietin which is required for RBC formation so if the kidneys are damaged this will affect production.
Give an example of a toxic waste that accumulates in the body due to kidney dysfunction.
Urea
List 4 symptoms that present in kidney disease due to buildup of urea and other toxic wastes in the body
Pruritis
Nausea with or without vomitting
Anorexia
Restless legs
What investigations should be ordered in patients suspected of CKD? (5)
Renal chemistry/Renal function tests (U&Es and bicarbonate ect)
Serum creatinine to calculate eGFR
Urinalysis (to look for mainly haematuria [proteinuria mya be seen but must do urine ACR to confrim])
Urine ACR (to look for proteinuria)
Renal ultrasound: Only if criterion are met
What investigation findings may be seen in patients with CKD
RFTs: Elevated serum creatinine, electrolyte abnormalties
Urinalysis: Protienuria and haematuria
eGFR: Less than 60
urine ACR: Increased ACR [Albumin to creatinine] ratio suggesting albuminuria
What criteria of CKD patients are indicated for renal ultrasound? (6)
CKD patients with any of the following:
Accelerated progression of CKD
Have visible haematuria or persistent microscopic haematuria
Family history of polycystic kidney disease
Have symptoms of urinary obstruction
Have eGFR less than 30
Are in need of a renal biopsy by a nephrologist
Frequency of monitoring for CKD patients depends on which factors?
Severity of eGFR
Severity of ACR
What lifestyle changes should be encouraged in patients diagnosed with chronic kidney disease?
Exercise
Dietary changes (cut on salt, pottasium, phosphate and calories) [DO NOT encourage a low protein diet].
Smoking cessation
What is the management plan for patients with CKD?
Offer an ACE or ARB in patients with CKD and hypertension with an ACR > 30
Offer ACE or ARB in diabetics with a ACR >3 regardless of if hypertensive or not.
Give statin to all patients (E.g., atorvastatin)
For ACR <70: BP should be lower than 140/90 (target range:120-139)
For ACR >70: BP should be lower than 130/80 (target range 120-129)
CONSIDER offering anticoagulant for secondary cardioprotective effects but beware of increased risk of bleeding.
What is the management plan for a patient with severe CKD/Kidney failure (eGFR < 15) with uraemia? (4)
Renal dialysis
2nd line: Kidney transplant
Dietary modification
Phosphate binding drugs
Other causes of anemia should be considered in which type of CKD patients?
If eGFR
