Chronic Kidney Disease Flashcards
What defines CKD?
reduction in kidney function or structural damage (or both) present for >3 months, with associated health implications
List 6 unmodifiable risk factors for CKD
Age
Male
Black/ hispanic
FH
AI diseases e.g. SLE
Chronic NSAIDs use
List 2 modifiable risk factors for CKD
Smoking.
Obesity
List 3 conditions that are risk factors for CKD
Cardiovascular disease
SLE
Vasculitis
List 5 common causes of CKD
Diabetic nephropathy
Chronic glomerulonephritis
Chronic pyelonephritis
HTN
Adult polycyctic kidney disease
What is kidney function assessed on?
GFR + albumin:creatinine ratio (ACR)
What formula is most commonly used to calculate eGFR? Which variables does this account for?
Modification of Diet in Renal Disease (MDRD) equation
Serum creatinine
Age
Gender
Ethnicity
What is stage 1 CKD?
Kidney injury with normal or elevated GFR
eGFR >90
What is stage 2 CKD?
Mild reduction in GFR
eGFR 60-89
What is stage 3 CKD?
Moderate reduction in GFR
3a eGFR 45-59
3b eGFR 30-44
What is stage 4 CKD?
Severe reduction in GFR
eGFR 15-29
What is stage 5 CKD?
End-Stage Renal Failure
eGFR <15
List 5 examples of evidence of chronic kidney damage
Persistent microalbuminuria.
Persistent proteinuria.
Persistent haematuria
Structural abnormalities of the kidneys eg, PKD, reflux nephropathy.
Biopsy: proven chronic glomerulonephritis.
List 5 symptoms that may present in late-stage CKD
Fatigue
N+V
Pruritus
Anorexia
Restless legs
What 4 signs of CKD may be found on examination?
Oedema: ankle swelling, weight gain
HTN
Peripheral neuropathy
Pallor
Why are both serum urea and creatinine not good assessments of renal function?
Urea: varies with hydration + diet, is not produced constantly + is reabsorbed by the kidney.
Creatinine: can remain within the normal range despite loss of >50% of renal function.
What is the gold standard assessment of renal function? What is used in practice?
Isotopic GFR (expensive + not widely available.) eGFR used in primary care
Which serum electrolytes are tested in CKD? What are the levels seen
Na: N/ L K: HIGH HCO3: LOW. Ca: N, L or H Phosphate HIGH
What other biochemical markers are tested in suspected CKD? What may levels of these indicate?
Plasma glucose: identify/ assess diabetes
ALP: high when bone disease develops.
PTH: high with declining renal function.
Cholesterol + triglycerides: dyslipidaemia common.
Albumin: hypoalbuminaemia in nephrotic +/or malnourished
What is the haematological picture in CKD?
Normochromic normocytic anaemia; Hb falls with progressive CKD.
White cells + platelets usually normal.
What is checked for in serology in suspected CKD?
Autoantibodies: ANA (SLE), c-ANCA (granulomatosis with polyangiitis), Anti-GBM (Goodpasture’s syndrome)
Hepatitis serology
HIV serology
What is checked for in urinalysis in CKD? Why?
Proteinuria + haematuria
Degree of proteinuria correlates with rate of progression of underlying kidney disease + is the most reliable prognostic factor in CKD.
Why perform serum and urine protein electrophoresis in suspected CKD?
to screen for multiple myeloma.
What imaging investigations may be performed in CKD? What can be detected in each?
US: small/ large kidneys, structural abnormalities
CT/MRI: renal stones/ renal artery stenosis
X-Ray: renal stones
Describe 7 features in management of CKD
eGFR monitoring
BP control
Lifestyle: Exercise, Lose weight, Smoking cessation
Good glycaemic control in DM
Review all prescribed medication
Avoidance of nephrotoxins: eg, NSAIDs, aminoglycosides.
Immunise against influenza + pneumococcus.
In decreasing order, what are the most common causes of CKD in the UK?
Diabetes 24%
Glomerulonephritis 13%
High BP/ renovascular disease 11%
