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The End Game > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

define chronic kidney disease

A

abnormalities of the kidneys function or structure for more than 3 months that affects ones health

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2
Q

what other condition can ckd exist with

A

cardiovascular disease
diabetes

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3
Q

what does acr stand for

A

albumine urine creatinine ratio

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4
Q

how do we define the staging of CKD

A

we compare the egfr and measure it against albumine urine creatinine ratio

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5
Q

How many stages of CKD are there

A

6

1,2
3a
3b
4,5

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6
Q

what does stage 1 mean

A

mild kidney damage but can work as normal

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7
Q

what does stage 2 mean

A

mild kidney damage but still work well

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8
Q

what does stage 3a mean

A

mild to moderate damage and the kidneys stop working as they should

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9
Q

what does stage 3b mean

A

moderate to severe damage and the kidneys stopped working as they should

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10
Q

what does stage 4 mean

A

severe kidney damage and kidneys aren’t close to working at all

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11
Q

what does stage 5 mean

A

most severe kidney damage and the kidneys are very close to stopping working or have stopped working entirely

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12
Q

Define the risks of CKD

Think Conditions, Non modifiable then what else

A

Conditions (5)
Diabetes
Hypertension
Cardiovascular Disease
HIV
Hepatitus c

Kidney (2)
AKI
Kidney disorders

Non modifiable (2)
Age
History of CKD

misc (2)
Malignancy
Medications

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13
Q

how is CKD diagnosed

A

Persistent microalbuminuria, proteinuria, haematuria can be signs that CKD is present

Ultra sound

Biopsy

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14
Q

What are the functions of the kidney

A

Homeostasis
Regulate hormone function
Regulate metabolic function

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15
Q

What are the complications of CKD

A

Acidosis
Anaemia
Dyslipidaemia
Fluid overload
Hyperkalaemia
Hypertension
Mineral and bone disorder
Uraemia

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16
Q

Describe how Acidosis can be caused by CKD

A

Kidney maintain the pH of the blood through excretion of HCO3- and H+

as CKD progresses kidneys cant reabsorb the HCO3- and cant excrete the H+ as well

This leads to acidic blood

17
Q

Describe how we should manage acidosis in CKD patients

A

Patients with CKD are given longterm sodium bicarbonate tablets

if a drastic treatment is needed its given iv

18
Q

What is renal anaemia and how can it be caused

A

quality of quantity of red blood cells are below normal

this is therefor caused by either a lack of circulating iron or erythropoietin

19
Q

What are the benefits of correcting renal anaemia

A

Increase in
- qol
- excercise capacity
- endocrine func
- immune func
- muscle metabolism
- sleep patterns
- cog function
- nutrition

decrease in
- depression
- hospitilisation
- transfusions
- bleeding tendency

20
Q

how can lack of circulating iron be caused

A

Haemodialysis and blood samples contribute to a loss of blood and therefor loss of iron

Dietary inadequacy

poor iron absorption due to uraemia

reduced or impaired erythropoiesis due to lack of epo or iron

21
Q

How do we treat lack of iron

A

in a pre dialysis patient
start oral iron for 3 months max

if no improvement give iv iron

watch for gi irritation and black stools

In dialysis we give iv iron after dialysis

22
Q

What is dyslipidaemia

A

abnormal lipid metabolism

23
Q

in what patient groups is dyslipidaemia most common

A

cardiovascular + CKD

24
Q

How do we treat dyslipidaemia

A

Atorvastatin 20mg

25
Q

How does fluid overload develop in ckd patients

A

kidneys decreased ability to maintain the sodium fluid balance

26
Q

how do we treat fluid overload

A

first reduce dietary sodium
second reduce fluid intake

Then offload the fluid with diuretic therapy

Often loop diuretics are preferred over thiazide like diuretics as they are less effective in patients with CrCL <20ml/min

Then if no improvement dialysis is needed

27
Q

How does hyperkalaemia develop

A

CKD patients less able to excrete potassium

28
Q

how do we manage hyperkalaemia

A

potassium restriction

Calcium resonium
IV calcium gluconate
Actrapid insulin

Dialysis

29
Q

How do we manage hypertension in CKD

A

Ace inhibitor since it is renoprotective in CKD

can use an arb

if both unsuitable then doxazosin?

30
Q

what is doxazosin

A

alpha blocker

31
Q

how do mineral and bone density disorders develop in ckd patients

A

the kidney is involved in regulating phosphorous and calcium in the blood two of which are involved in mbd disorders

They also convert vitamin d into calcitriol

in ckd
- production of calcitriol stops

  • this causes a reduction of calcium in the blood
  • phosphorus/phosphate levels in the blood rise
32
Q

how do we treat mbd

A

Alfacalcidol (activated vit d)

phosphate binders

cinacalcet or parathyroidectomy

33
Q
A

The End Game (7 decks)

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