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Urinary System > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What are some of the main functions of the kidneys?

A

Bod fluid homeostasis
Regulation of vascular tone
Excretory function
Electrolyte homeostasis
Acid base homeostasis
Endocrine function

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2
Q

How do we assess for kidney disease?

A

Filtration function (excretory) - remove
Filtration function (barrier) - retain
Anatomy - abnormality

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3
Q

What is the GFR?

A

Pressure difference leads to glomerular filtration
Normal is 120ml/min

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4
Q

How do you measure excretory renal function?

A

Insulin clearance
Isotope GFR
24 hr urine collection plus blood test
GFR estimating equations
Creatinine measurement

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5
Q

What is the problem when measuring creatinine and GFR?

A

Creatinine is generated in breakdown of muscle and not everyone has the same muscle mass

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6
Q

What does serum creatinine and GFR depend on?

A

Age, ethnicity, gender, weight and other issues (ex. liver disease)

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7
Q

What are some names of the formulae used to estimate GFR from serum creatinine?

A

Cockcroft Gault
MDRD 4 variable equation
CKD-EPI equation - most accurate

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8
Q

Describe the international CKD classification system

A

Stage 1 - >90 GFR kidney damage
2 - 60-89 GFR kidney damage
3a - 45-59 GFR
3b - 30-44 GFR
4 - 15-29 GFR
5 - <15 advanced or on dialysis

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9
Q

What crosses and does not cross the GBM?

A

Can cross - water, electrolytes, urea and creatinine
Crosses but reabsorbed in proximal tubule - glucose and low molecular weight proteins
Not cross - cells and high molecular weight proteins (albumin and globulins)

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10
Q

How is kidney filtering function assessed?

A

Urinalysis - urine dipstick looking for blood and proteins
Protein quantification - protein creatinine ration PCR

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11
Q

What is the current CKD definition?

A

Either a presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR <60ml/min/1.73m2 that is present for more than 3 months

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12
Q

What helps classify CKD?

A

GFR values and albuminuria

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13
Q

What is the prevalence of CKD?

A

Increases with age
8-12% of the UK

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14
Q

Why is CKD important?

A

Renal replacement therapy
Dialysis is £35000/patient/year
£6500 for drug cost a patient
£20000 per patient transplant

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15
Q

Describe the aetiology of CKD

A

Diabetes, glomerulonephritis, hypertension, renovascular disease and polycystic kidney disease

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16
Q

What is the clinical approach for CKD?

A

Detection of underlying aetiology
Slowing the rate of renal decline
Assessment of complications related to reduced GFR
Preparation for renal replacement therapy

17
Q

What are some symptoms and signs of CKD?

A

Hypertension, SOB, itch and cramps, haematuria, proteinuria, peripheral oedema, change in urine output, GI symptoms and cognitive changes

18
Q

What can be included in the history and examination of CKD?

A

Previous renal disease, FH, systemic diseases, drug exposure, pre-post renal factors and uraemic symptoms
Vital signs, volume status, systemic illness and obstruction

19
Q

How is underlying aetiology of CKD detected?

A

Blood tests - U+Es and FBC
Urine tests - urine dip and PCR
Histology - renal biopsy
Radiology

20
Q

What chemistry investigations detect aetiology?

A

Urea, creatinine, electrolytes, bicarbonate, total protein, calcium, phosphate, LFTs, creatine kinase, and immunoglobulins

21
Q

What haematology investigations detect aetiology?

A

FBC - Hb, MCV, WBC, MCH, platelets and RBCs
Coagulation screen

22
Q

What might be the only symptom in CKD?

A

Often asymptomatic
Only sign may be abnormal BP or urinalysis

23
Q

What imaging is used for CKD?

A

US - shows shrunken kidneys and if no differentiation between cortex and medulla

24
Q

How is pathology investigated for CKD?

A

Kidney biopsy

25
Q

What are potential interventions which can slow the rate of renal decline?

A

BP control - most important
Control proteinuria - ACE inhibitors/ ARB
Treat underlying cause

26
Q

What are some complications related to reduced GFR?

A

Acidosis, anaemia, bone disease, CV risk, death + dialysis, electrolytes, fluid overload, gout,, itching, hypertension, and iatrogenic issues

27
Q

When are complications are more likely?

A

With worsening eGFR

28
Q

What is some of the managements to the complications of anaemia?

A

Acidosis - bicrab
Bone disease - diet and phosphate binders
CV risk - BP, aspirin, cholesterol and exercise
Electrolytes - diet and possible drugs
Fluid overload - diuretics
Gout - optimise and meds

29
Q

What slows the rate of decline?

A

Early identification and management

30
Q

What is the preparation for end stage renal disease and RRT?

A

Education and info
Selection of modality
Planning access
RRT?
MDTs

Urinary System (26 decks)

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