Chronic Kidney Disease Flashcards

1
Q

CKD

How do we define it?

A

an abnormality in kidney function and/or structural damage, present for at least three months, with associated health implications

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2
Q

CKD

What are 4 medical reasons/conditions that are risk factors?

A

Glomerular disease, such as glomerulonephritis

Nephrotoxic drugs, such as aminoglycosides

Systemic disorders, such as myeloma or systemic lupus erythematosus

Obstructive uropathy, such as structural disease or urinary tract calculi

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3
Q

CKD

What are some clinical features?

A
  • Uraemic foetor – odour of urine on the breath, owing to ammonia in the saliva
  • Cachexia
  • Pruritis – itchy skin owing to the accumulation of urea
  • Restless legs
  • Periorbital and peripheral oedema
  • Nausea and vomiting

anaemia may or may not be present

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4
Q

CKD

Why is anaemia a comon problem in pts with CKD?

A

reduced production of erythropoietin by the kidneys

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5
Q

CKD

Investigations:
What bloods do we take?

A
  • creatinine
  • eGFR
  • electrolytes
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6
Q

CKD

How do we calculate eGFR?

A

Cockcroft-Gault or MDRD

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7
Q

CKD

What is the creatinine measurement like in CKD pts?

A

A raised serum creatinine is found in most patients with CKD, but the reading may be falsely low in patients with low muscle mass or the elderly.

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8
Q

CKD

What is the eGFR cut off value to diagnose CKD?

A

60ml/min/1.73m² for more than three months

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9
Q

CKD

How do we describe the acid-base status of the blood typically in end stage CKD?

A

metabolic acidosis

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10
Q

CKD

What do we typically find on urinalysis?

A
  • haematuria (cola-coloured)
  • proteinuria (frothy)
  • albuminuria
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11
Q

CKD

Other than eGFR, what measurement do we need to classify CKD? Why?

A

urinary albumin

so that we can calculate the ACR

urinary albumin: creatinine ratio

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12
Q

CKD

How is the ACR in more severe disease?

A

raised

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13
Q

CKD

Patient A has an eGFR of 45 and an ACR of 25. What is the stage of his CKD?

A

G3aA2

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14
Q

CKD

Patient B has an eGFR of 60 and an ACR of 2. What is the stage of his CKD?

A

G2A1

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15
Q

CKD

Patient C has an eGFR of 90 and an ACR of 2. What is the stage of his CKD?

A

G1A1 (no CKD in the absence of markers of kidney damage)

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16
Q

CKD

Patient D has an eGFR of 10 and an ACR of 30. What is the stage of his CKD?

A

G5A3
Kidney failure

17
Q

CKD

Patient E has an eGFR of 30 and an ACR of 20. What is the stage of his CKD?

A

G3bA2

18
Q

CKD

What is the major cause of death in CKD pts?

A

cardiovascular

19
Q

CKD

How do we manage CKD? (prescribing)

A

treat CVR:
- control bp (ACEi / ARB)
- control blood glucose (diabetes education/medication)
- control cholestrol (statin)

20
Q

CKD

Why are ACEi and ARBs used in CKD?

A
  • to optimise bp
  • slow progression of CKD and delay need to renal replacement therapy
21
Q

CKD

There are many secondary complications of CKD. Name them and how we might manage them.

A

anaemia
- recombinant human erythropoiesis-stimulating agents

secondary hyperparathyroidism
- phosphate-binders
- vit d analogues

metabolic acidosis
- dialysis/haemodialyis
(stage 5)

renal transplant

Recombinant human erythropoiesis-stimulating agents (such as darbepoeitin-α)

phosphate binders (such as calcium carbonate)

vitamin D analogues (such as alfacalcidol)

22
Q

CKD

Where is the transplanted kidney placed?

A

iliac fossa

23
Q

Compare peritoneal dialysis and haemodialysis.

A

Hemodialysis is ongoing dialysis (3 to 5 times a week) that cleans your blood, usually in a dialysis center. The hemodialysis access is in your arm.

Peritoneal dialysis is ongoing dialysis (daily) that collects waste from the blood by washing the empty space in the abdomen (peritoneal cavity). It can be done from home.