Chronic Kidney Disease Flashcards
What is chronic kidney disease?
Permanent + progressive kidney damage - manifested by abnormal albumin excretion or decreased kidney function that persists for more than 3 months
Why is chronic kidney disease normally irreversible?
Renal tissue is replaced by extracellular matrix in response to damage
How is chronic kidney disease measured?
eGFR
Primary causes of chronic kidney disease
Directly affect kidneys
- Polycystic kidney disease
- Acute tubular necrosis
- Recurrent pyelonephritis (regular infections)
- Glomerulonephritis
Secondary causes of chronic kidney disease
Diabetes mellitus (diabetes nephropathy)
Hypertension
Renovascular disease
Autoimmune
Presentation of CKD
- most are asymptomatic
- oedema
- foamy urine
- pruritus
- hypertension
- loss of appetite
- pallor (due to anaemia)
Investigations of CKD
- eGFR
- ACR
- urinedipstick + microscopy
- USS KUB
- HbA1c
- blood pressure
- lipid profile
What investigations could you do to work out the cause of CKD?
- urinalysis (protein/blood)
- USS KUB
- kidney biopsy
- HbA1c - diabetes
- ANCA - vasculitis
- anti-GBM + ANA - lupus
How do you stage chronic kidney disease?
using eGFR
- stage 1: >90
- stage 2: 60-89
- stage 3a: 45-59
- stage 3b: 30-44
- stage 4: 15-29
- stage 5: <15 (kidney failure)
How do you stage chronic kidney disease using ACR?
Albumin-creatinine ratio
- stage 1: <3
- stage 2: 3-30
- stage 3: >30
Why are the kidneys smaller in kidney damage?
Loss of kidney tissue (cortex)
Management of CKD
- treat underlying disease
- treat complications e.g. EPO, dietary advice, vitamin replacement
- ACEi/ARBs - hypertension + proteinurai
- statin
- weight loss advice + exercise
- smoking cessation
- plan for future - discuss options for if they reach ESRF (RRT)
How do we control blood pressure in chronic kidney disease?
Patients with CKD will almost always mean hypertension
- antihypertensives e.g. ACEi, angiotensin receptor blockers
- diuretics
- fluid restriction
Complications of chronic kidney disease
- anaemia: EPO not produced by kidneys
- fluid overload + oedema
- metabolic acidosis
- bone mineral disease: lack of active form of vit D > reduced calcium absorption
- non-bone calcification
- uraemia > uraemic pericarditis + encephalopathy
- hyperphosphatemia + hypocalcaemia (secondary hyperparathyroidism)
- hypertension
- accelerated atherosclerosis | cardiovascular disease
Why is anaemia a complication of CKD?
- decreased EPO produced by kidneys
- decreased erythropoiesis
- decreased RBC production