Chronic Kidney Disease Flashcards
define chronic kidney disease
abnormalities of the kidneys function or structure for more than 3 months that affects ones health
what other condition can ckd exist with
cardiovascular disease
diabetes
what does acr stand for
albumine urine creatinine ratio
how do we define the staging of CKD
we compare the egfr and measure it against albumine urine creatinine ratio
How many stages of CKD are there
6
1,2
3a
3b
4,5
what does stage 1 mean
mild kidney damage but can work as normal
what does stage 2 mean
mild kidney damage but still work well
what does stage 3a mean
mild to moderate damage and the kidneys stop working as they should
what does stage 3b mean
moderate to severe damage and the kidneys stopped working as they should
what does stage 4 mean
severe kidney damage and kidneys aren’t close to working at all
what does stage 5 mean
most severe kidney damage and the kidneys are very close to stopping working or have stopped working entirely
Define the risks of CKD
Think Conditions, Non modifiable then what else
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
how is CKD diagnosed
Persistent microalbuminuria, proteinuria, haematuria can be signs that CKD is present
Ultra sound
Biopsy
What are the functions of the kidney
Homeostasis
Regulate hormone function
Regulate metabolic function
What are the complications of CKD
Acidosis
Anaemia
Dyslipidaemia
Fluid overload
Hyperkalaemia
Hypertension
Mineral and bone disorder
Uraemia
Describe how Acidosis can be caused by CKD
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
Describe how we should manage acidosis in CKD patients
Patients with CKD are given longterm sodium bicarbonate tablets
if a drastic treatment is needed its given iv
What is renal anaemia and how can it be caused
quality of quantity of red blood cells are below normal
this is therefor caused by either a lack of circulating iron or erythropoietin
What are the benefits of correcting renal anaemia
Increase in
- qol
- excercise capacity
- endocrine func
- immune func
- muscle metabolism
- sleep patterns
- cog function
- nutrition
decrease in
- depression
- hospitilisation
- transfusions
- bleeding tendency
how can lack of circulating iron be caused
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
How do we treat lack of iron
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
What is dyslipidaemia
abnormal lipid metabolism
in what patient groups is dyslipidaemia most common
cardiovascular + CKD
How do we treat dyslipidaemia
Atorvastatin 20mg
How does fluid overload develop in ckd patients
kidneys decreased ability to maintain the sodium fluid balance
how do we treat fluid overload
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
How does hyperkalaemia develop
CKD patients less able to excrete potassium
how do we manage hyperkalaemia
potassium restriction
Calcium resonium
IV calcium gluconate
Actrapid insulin
Dialysis
How do we manage hypertension in CKD
Ace inhibitor since it is renoprotective in CKD
can use an arb
if both unsuitable then doxazosin?
what is doxazosin
alpha blocker
how do mineral and bone density disorders develop in ckd patients
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
how do we treat mbd
Alfacalcidol (activated vit d)
phosphate binders
cinacalcet or parathyroidectomy
