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FINALS: Nephrology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney disease?

A

chronic reduction in kidney function sustained over three months

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2
Q

What causes CKD?

A
  • Diabetes
  • HTN
  • Medications such as NSAIDs and lithium
  • Glomerulonephritis
  • PKD
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3
Q

How does CKD present?

A
  • Asymptomatic
  • Pallor/Fatigue if anaemic
  • Nausea
  • Foamy urine(due to protein)
  • Oedema
  • HTN
  • Pruritus
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4
Q

How is CKD investigated?

A
  • EGFR
  • Proteinuria: urine albumin:creatinine ratio
  • Haematuria with urinalysis or microscopy
  • Renal ultrasound
  • HbA1c/Lipid profile/BP check
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5
Q

How is CKD classified?

A

Stage 1: > 90
Stage 2: 60-89
Stage 3a: 45-59
Stage 3b: 30-44
Stage 4: 15-29
Stage 5: <15

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6
Q

What are some complications of CKD?

A
  • Anaemia (less EPO production)
  • Renal bone disease (calcium + phosphorus imbalance)
  • CVD (IHD)
  • Peripheral neuropathy
  • Dialysis complications
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7
Q

What risk score can be used to estimate 5 year risk of kidney failure requiring dialysis?

A

Kidney Failure Risk Equation

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8
Q

What is the referral criteria for CKD to secondary care?

A
  • eGFR less than 30 mL/min/1.73 m2
  • Urine ACR more than 70 mg/mmol
  • Accelerated progression (a decrease in eGFR of 25% or 15 mL/min/1.73 m2 within 12 months)
  • 5-year risk of requiring dialysis over 5%
  • Uncontrolled hypertension despite four or more antihypertensives
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9
Q

What is the treatment for CKD?

A
  • Optimise diabetes, BP
  • Reduce nephrotoxic drugs
  • Treat glomerulonephritis
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10
Q

What are targets for patients with CKD < 80 years old?

A

BP < 130/80
ACR > 70

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11
Q

What medications are used in CKD?

A

Slow disease progression: ACE/ARB, SGLT-2 inhibitors (dapaglioflozin)
Atorvastatin 20mg for primary prevention

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12
Q

How are CKD complications managed?

A
  • Oral sodium bicarbonate for metabolic acidosis
  • Iron and EPO for anaemia
  • Vitamin D, low phosphate and phosphate binders e.g sevelamer for renal bone disease
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13
Q

What is the cause of anaemia in CKD?

A
  • Lower EPO production results in lower RBC production causing normocytic, normochromic anaemia
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14
Q

What is the order of treatment in anaemia in CKD?

A
  • Iron deficiency treated first then use EPO
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15
Q

What are some side effects of EPO?

A
  • HTN
  • Bone aches
  • Flu like symptoms
  • Iron deficiency
  • Skin rashes
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16
Q

What is the triad of renal bone disease?

A
  • High serum phosphate
  • Low vit D
  • Low serum calcium
17
Q

What is the pathophysiology of renal bone disease?

A
  • Reduced phosphate excretion results in high serum phosphate
  • CKD causes less vitamin D activity and so less calcium is reabsorbed from intestines and kidneys leading to PTH glands exreting more PTH (secondary hyperparathyroidism) which stimulates osteoclast activity
  • This causes osteomalacia (increased turnover of bones with inadequate calcium) and osteosclerosis (osteoblastis increase their activity to make new bone but this is not mineralised)
18
Q

How is proteinuria managed?

A
  • ACE/ARB should be used first line for patients with HTN and CKD if ACR > 30
  • SGLT2 inhibitors as they block reabsorption of glucose in the proximal tubule which lowers renal glucose threshold
  • SGLT2 also reduce sodium reabsorption which reduces intraglomerular pressure
19
Q

How can you differentiate between CKD and AKI?

A

Hypocalcaemia is an indication that kidney disease is chronic and not acute (due to low vit d)

20
Q

What can alter an individuals eGFR?

A

pregnancy
muscle mass (e.g. amputees, body-builders)
eating red meat 12 hours prior to the sample being taken

21
Q

What is a potential complication of dialysis?

A

Dialysis disequilibrium syndrome is a rare but serious complication of haemodialysis

22
Q

How do you prevent contrast-induced nephropathy?

A

IV 0.9% fluid pre and post procedure

23
Q

Most common causative organism of peritonitis secondary to peritoneal dialysis

A

Staphylococcus epidermidis (Coagulase-negative Staphylococcus)

FINALS: Nephrology (20 decks)

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