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Renal and Urology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

definition of chronic kidney disease

A

GFR<60ml/min for >90 days

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2
Q

causes of CKD

A

diabetes
hypertension
glomerulonephritis
cystic kidney disease
renovascular disease

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3
Q

what is the equation for calculating creatinine clearance

A

cockcroft and gault equation
men
GFR = ([140-age] x LBW x 1.22)/creatinine

women
GFR = ([140-age] x LBW x 1.04)/creatinine

LBW = lean body weight

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4
Q

what does the MDRD equation calculate

A

eGFR

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5
Q

what type of urine sample is required for creatinine clearance test

A

24 hour

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6
Q

is serum creatinine a good marker of renal function

A

no

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7
Q

what are the creatinine clearance/GFR values for the five stages of CKD

A

Stage 1 - 120-90
Stage 2 - 89-60
Stage 3 - 59-30
Stage 4 - 29-15
Stage 5 - 15-0

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8
Q

what is required for the diagnosis of CKD

A

stage 1 and 2 - abnormal ultrasound/radiology or biopsy or hypertension or proteinuria in addition to moderately reduced GFR
stage 3 to 5 - only need low GFR

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9
Q

strategies for prevention of progression of CKD

A

control of BP (renin-angiotensin system inhibition)
reduce proteinuria (RAS inhibition)
if diabetes - optimise glycaemic control (SGLT2 inhibitors)

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10
Q

what two markers indicate prognosis of CKD

A

GFR
albuminuria

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11
Q

is proteinuria a marker or a cause of CKD

A

both

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12
Q

what happens when too much protein passes through the renal filter into the tubule

A

tubule cells are overloaded and die
macrophages try to repair the damage which leads to scarring and fibrosis

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13
Q

how do ACEis help prevent progression of CKD

A

cause vasodilation of the efferent arteriole
which mean less protein passes through the filter into the tubule
so the tubular cells don’t get overloaded
so there is less fibrosis

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14
Q

what drug should be avoided in those with CKD

A

NSAIDs
contrast (when GFR <30)
gentamicin
phosphate enemas

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15
Q

how does drug dosing change in CKD

A

many drugs need to be given at lower doses

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16
Q

what drugs need to be given in lower doses in those with CKD

A

many but especially chemotherapy and antibiotics

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17
Q

where can you get info on drug dosing in CKD

A

BNF

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18
Q

what percentage of elderly patients have CKD

A

> 25%

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19
Q

complications of end stage kidney disease

A

hypertension which can lead to:
left ventricular hypertrophy
stroke
end organ damage - e.g. eyes and kidneys

20
Q

what are the BP treatment goals in CKD

A

130/80
or 125/75 in diabetes or proteinuria

21
Q

what effect does good hypertension control have on GFR compared to uncontrolled hypertension

A

uncontrolled - GFR will decrease much more rapidly

22
Q

treatment of hypertension

A

low salt diet
exercise
reduce alcohol
reduce smoking
drugs (ACEi, ARB, BB, CCB, alpha blockers)

23
Q

what ion is it important to monitor in CKD

A

K+

24
Q

at what GFR is hyperkalaemia common

A

<25

25
Q

when might hyperkalaemia occur in GFR>25

A

diabetes
type 4 renal tubular acidosis
ACEi use
high K diet

26
Q

what commonly happens to K levels in stage 5 CKD patients

A

hyperkalaemia

27
Q

what are the management options for hyperkalaemia

A

reduce K+ dietary intake
potassium binders - short term as expensive

28
Q

name foods high in K

A

‘student diet’

orange juice
bananas
beer
wine
coffee
chocolate
crisps
nuts
baked potatoes
chips
beans

29
Q

what is the cause of acidosis in CKD

A

animal protein in food
and inability to acidify urine

30
Q

what is the cause of acidosis in CKD

A

animal protein in food
and inability to acidify urine

31
Q

treatment of acidosis in CKD

A

sodium bicarbonate replacement

32
Q

what type of anaemia is normally seen in CKD patietns

A

normochromic normocytic anaemia

33
Q

causes of aneamia in CKD patients

A

decrease response of erythropoetin to hypoxic stimulus of the kidney
RBCs surviving for less time
iron deficiency
blood loss - dialysis, blood samples
hyperparathryoidism
B12 and folate deficiencies

34
Q

treatment for anaemia in CKD

A

for those with Hb <10.5 and and adequate iron stores they should be on Epo

35
Q

how does CKD cause renal osteodystrophy

A

kidneys can hydroxylate vit D
so Ca not absorbed as much from diet
which can lead to osteomalacia/rickets
also low Ca prompts PTH to increase - secondary hyperPTHism
increases Ca phosphate resorption from bones
causing bone disease
kidneys can’t get rid of excess phosphate

36
Q

foods with high phosphate

A

meat
dairy
scones

37
Q

treatment of rneal osteodystrophy

A

phosphate restriction
vitamin D therapy
monitor PTH
parathroidectomy may be required

38
Q

what are the consequences of hyperphosphataemia

A

vessel calcification which leads to
- non compliant vessels
- systolic hypertension -> left ventricular hypertrophy
- diastolic hypotension -> myocardial ischaemia
calciphylaxis (ulceration)
calcification of joints

39
Q

what type of vascular calcification occurs due to hyperphosphataemia

A

medial
(within wall of blood vessel and encircling whole width)
intimal calcification is atherosclerosis

40
Q

what is calciphylaxis

A

when calcium accumulates in small blood vessels of the fat and skin tissues which causes blood clots, painful skin ulcers and may cause serious infections that can lead to death

41
Q

what happens to risk of death when on haemodialysis`

A

increases significantly
25 yo on haemodialysis has same irks of death as a healthy 75 yo

42
Q

why are CKD patients at risk of malnutrition

A

decreased protein intake due to dietary restrictions
decrease appetite
low albumin possibly due to inflammation and infection

43
Q

is low protein diet beneficial in end stage kidney disease

A

no

44
Q

who should you refer to the renal clinic

A

those with a rapid increase in creatinine or hypertension
stage 3 CKD with hypertension, proteinuria, haematuria or rising creatinine
stage 4/5 CKD who are suitable for treatment
late stage signs of kidney disease if not already been picked up (should be picked up earlier than this though)

45
Q

what type of dialysis can be done at home

A

peritoneal

46
Q

what does peritoneal dialysis involve

A

draining used dialysate solution from peritoneal cavity
filling with new solution
allowing the cleaning to happen
repeating

47
Q

what creatinine clearance value should you start dialysis

A

9-14

Renal and Urology (16 decks)

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