Chronic Kidney Disease Flashcards
CKD
How do we define it?
an abnormality in kidney function and/or structural damage, present for at least three months, with associated health implications
CKD
What are 4 medical reasons/conditions that are risk factors?
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
CKD
What are some clinical features?
- 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
CKD
Why is anaemia a comon problem in pts with CKD?
reduced production of erythropoietin by the kidneys
CKD
Investigations:
What bloods do we take?
- creatinine
- eGFR
- electrolytes
CKD
How do we calculate eGFR?
Cockcroft-Gault or MDRD
CKD
What is the creatinine measurement like in CKD pts?
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.
CKD
What is the eGFR cut off value to diagnose CKD?
60ml/min/1.73m² for more than three months
CKD
How do we describe the acid-base status of the blood typically in end stage CKD?
metabolic acidosis
CKD
What do we typically find on urinalysis?
- haematuria (cola-coloured)
- proteinuria (frothy)
- albuminuria
CKD
Other than eGFR, what measurement do we need to classify CKD? Why?
urinary albumin
so that we can calculate the ACR
urinary albumin: creatinine ratio
CKD
How is the ACR in more severe disease?
raised
CKD
Patient A has an eGFR of 45 and an ACR of 25. What is the stage of his CKD?
G3aA2
CKD
Patient B has an eGFR of 60 and an ACR of 2. What is the stage of his CKD?
G2A1
CKD
Patient C has an eGFR of 90 and an ACR of 2. What is the stage of his CKD?
G1A1 (no CKD in the absence of markers of kidney damage)
CKD
Patient D has an eGFR of 10 and an ACR of 30. What is the stage of his CKD?
G5A3
Kidney failure
CKD
Patient E has an eGFR of 30 and an ACR of 20. What is the stage of his CKD?
G3bA2
CKD
What is the major cause of death in CKD pts?
cardiovascular
CKD
How do we manage CKD? (prescribing)
treat CVR:
- control bp (ACEi / ARB)
- control blood glucose (diabetes education/medication)
- control cholestrol (statin)
CKD
Why are ACEi and ARBs used in CKD?
- to optimise bp
- slow progression of CKD and delay need to renal replacement therapy
CKD
There are many secondary complications of CKD. Name them and how we might manage them.
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)
CKD
Where is the transplanted kidney placed?
iliac fossa
Compare peritoneal dialysis and haemodialysis.
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.
