Chronic Kidney Disease Flashcards
What are modifiable risk factors for CKD?
weight, hypertension, smoking and alcohol
What is the prevalence of CKD stages 3 - 5 and what age group is most affected?
~5-7% of the population. >65 yrs
Define 4 key symptoms of CKD?
- Proteinuria
- Abnormal urine sedimentation
- Abnormal blood serum chemistry
- Abnormal imaging (kidneys shrink, and structural changes)
What are common causes of CKD? (10)
- Diabetes
- Interstitial Disease (drug induced, reflux nephropathy)
- Glomerular diseases (IgA nephropathy)
- Hypertension
- Systemic Inflammatory diseases
- Renovascular disease
- Congential and inherited
- Age
-ethnicity - gender
Clinical signs and symptoms of CKD? (12)
- Point and needles in lower limbs (polyneuropathy)
- Impaired formation and maintenance of bones (renal osteodystrophy)
- Nocturne (loss of concentrating ability or urine)/ polyuria
- Nauseas, vomiting, unpleasant taste in mouth
- bruising and bleeding
- fatigue
- confusion, lethargy and seizures (encephalopathy)
- Facial oedema
- hypertension, heart failure and pericarditis
- weakness
- itching skin due to toxin build up
- Muscle twitches and cramps
Describe eGFR for stage 1 CKD and description of implications
eGFR ≥ 90 ml/min/1.73m2
Kidney damage with normal of increased GFR
Describe eGFR for stage 2 CKD and description of implications
60 - 89 eGFR ml/min/1.73m2
Kidney damage with mild decrease in GFR
Describe eGFR for stage 3A CKD and description of implications
45 - 59 eGFR ml/min/1.73m2
Moderate reduction in GFR with or without other evidence of kidney damage
Describe eGFR for stage 3B CKD and description of implications
30 - 44 eGFR ml/min/1.73m2
Describe eGFR for stage 3B CKD and description of implications
30 - 44 eGFR ml/min/1.73m2
Moderate reduction in GFR with or without other evidence of kidney damage
Describe eGFR for stage 4 CKD and description of implications
15 - 29 eGFR ml/min/1.73m2
Severe reduction in GFR with or without other evidence of kidney damage
Someone may be asymptomatic until eGFR <30 ml/min/1.73m2
Describe eGFR for stage 5 CKD and description of implications
< 15 eGFR ml/min/1.73m2
Established kidney failure - need dialysis
What stage of CKD so people get seen by pre-dialysis nurse and kidney care nurses?
3A and 3B - may offer kidney transplant
What tests and investigations would be carried out to assess renal function?
How much drink and passing urine
Patient history and physical exam
Urinalysis - protein and heamaturia (dipstick)
Blood tests - haematology and biochemistry
Urinary protein excretion - creatinine: protein ratio (PCR) and albumin:creatinine ratio (ACR)
Renal imaging
Ultrasound scanning
Renal biopsy
What blood markers would you look for in CKD?
Urea - end product of protein metabolism synthesised by the liver
Creatinine
sodium
potassium - hyperkalaemia and acidosis
calcium + phosphate + 25(OH)D = renal osteodystrophy (CKD complication)
Bicarbonate
albumin
FBC (iron, ferritin, folate and B12) = renal anaemia
Lipids, glucose (HbA1c) = CVD risk (treat aggressively)
When eGFR <15 ml/min/1.73m2 (Stage 5 CKD) what symptoms might they experience?
Symptoms can affect all systems and be non-specific
Tiredness and breathlessness due to renal anaemia or fluid overload
Anorexia and weight loss
Nausea and vomiting
Hiccups
Pruritis (itchy skin)
What signs and symptoms indicate metabolic acidosis?
Very deep breathing (kussmal breathing)
muscular twitching
fits
drowsiness
coma
for PCR testing, what values are indicative of high proteinuria? And why use PCR testing?
PCR testing is better than 24 hour urinary protein measurement
Proteinuria = >45 mg/mmol (which is equivalent to albumin:creatinine ratio >30 mg/mmol)
GFR - What is it and why is it used to assess renal function? How often would you assess to establish CKD?
GFR - glomerular filtration rate
The volume of water filtered out of the plasma through the glomerular capillary walls into the Bowman’s capsule per unit of time
CKD diagnosed using 2 eGFRS 3 months apart. It is not based on a single eGFR measure.
What is MDRD and why is it used?
The Modification of Diet in Renal Disease equation - estimates are based on serum creatinine, age, sex and ethnicity
There are racial differences; African-carribean and African patients have much larger muscle mass naturally therefore eGFR to be multiplied by 1.2
What are the NICE recommendations for follow up for each stage of CKD?
Stage 1 and 2 = annually
Stages £a and 3B = six monthly
Stage 4 = three monthly
Stage 5 - six weekly
Management of CKD - what signs and symptoms would you try to manage (diet and lifestyle)?
Blood pressure <140/90 mmHg (may use blood pressure tablets ACE inhibitors or Angiotensin Receptors)
Diabetes - HbA1c <7% (53 mmol)
Reduce dietary salt <100 mmol/day
Management of CKD - which drugs and biochemical signs would you try to manage? and How?
Use ACE-inhibitors and ARBS
Anaemia (erythropoietin) aim for Hb >10g/dl = EPO is synthetic erythropoietin but need adequate iron status for it to work)
Hyperphosphataemia - <1.9 mmol/l
What is ACE inhibitor - what does it do
Angiotensin converting enzyme inhibitor
Inhibits the conversion of angiotensin 1 to angiotensins 2 therefore reduces blood pressure by limiting constriction feedback loop and therefore relaxing the blood vessels
