chronic kidney disease Flashcards
how is chronic kidney disease defined?
a reduction in kidney function
or structural damage
or both
has to be present for more than 3 months with associated health implications
what are the markers of kidney damage for a CKD diagnosis?
transplant
histological abnormalities
electrolyte abnormalities
ACR (urinary albumin:creatinine ratio) greater than 3mg/mmol
sediment abnormalities in the urine (haematuria/casts)
structural abnormalities detected by imaging
“THE ASS”
and/or a persistent reduction in renal function with an eGFR of less than 60
what is the definition of an accelerated progression of CKD?
a persistent decrease in eGFR of 25% or more and a change in CKD category within 12 months
or
a persiseant decrease of eGFR by 15 within 12 months
what is the most common cause of CKD?
diabetes
what are some potentially nephrotoxic drugs?
aminoglycosides
ACEi
ARBs
bisphosphonates
diuretics
NSAIDs
lithium
what are some causes of obstructive uropathy?
calculi
prostate
bladder
malignancy
strictures/stenosis
what are some complications of chronic kidney disease?
AKI
hypertension and dyslipidaemia
renal anaemia
renal mineral and bone disorder
what are the features of renal mineral and bone disorder
may present with bone pain, increased bone fragility and extra skeletal calcification
what causes renal mineral and bone disorder?
caused by disturbed vit D, calcium, PTH and phosphate metabolism
leads to secondary or tertiary hyperparathyroidism seen in progressive CKD
which organ activates vitamin D?
kidneys
what is the best way to treat CKD?
treat underlying cause
what is target BP in CKD?
<140/90
what is target BP in people with CKD and diabetes?
<130/80
when is ACEi/ARB dose altered?
if eGFR decrease from pre treatment is more than 25%
if serum creatinine increased from baseline by more than 30%
how are lipid levels lowered in CKD?
atorvastatin 20mg for primary/secondary prevention
increase dose if there is not a 40% reduction in non HLD cholesterol
