Chronic kidney disease Flashcards
what are different functions of the kidneys?
what three aspects are assessed to assess kidney disease?
Filtration (excretory) function - remove
Filtration (barrier) function - retain
Anatomy - abnormality
how is excretory renal function measured?
Inulin clearance
Isotope GFR
24 hour urine collection plus blood test
GFR estimating equations
describe the relationship between creatinine and GFR?
what is the problem against a clear relationship between creatinine and GFR?
Problem
Creatinine is generated from breakdown of muscle
Not everyone has the same muscle mass
Depends on:
Age
Ethnicity
Gender
Weight
Other issues eg liver disease
what are formulae to estimate GFR from serum creatinine?
Cockcroft Gault
= ([140-age] x weight x 1.23) / SCr x (0.85 if female)
MDRD 4 variable equation
= 175 x [SCr/88.4] -1.154 x [age] -0.203 x (0.742 if female) x (1.212 if black)
CKD-EPI equation
how is CKD classified?
how should permeability of the GBM be?
Crosses GBM
Water
Electrolytes
Urea
Creatinine
Crosses GBM but reabsorbed in proximal tubule
Glucose
Low molecular weight proteins (α2 microglobulin)
Does not cross GBM
Cells (RBC, WBC)
High molecular weight proteins (albumin, globulins)
how is urine analysed to assess kidney filtering function?
Should be no blood or protein measurable in urine if filtering properly
Urinalysis (“dipstick”)
Blood
Protein
Protein quantification
Protein creatinine ratio (PCR)
what is the definition of CDK?
Chronic kidney disease (CKD) is defined by either the presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR<60 ml/min/1.73m2 that is present for ≥3 months
what is the prevalence of CDK?
what is renal replacement therapy?
Renal replacement therapy comprises either transplantation or dialysis
what are aetiological factors for CDK?
what should the clinical approach be towards CDK?
Detection of the underlying aetiology
Treatment for specific disease
Slowing the rate of renal decline
Generic therapies
Assessment of complications related to reduced GFR
Prevention and Treatment
Preparation for Renal Replacement Therapy
describe symptoms and signs of CKD
how is underlying aetiology of CKD detected?
what is done to detect underlying aetiology following history and thorough examination?
what investigations are done in chemistry to detect aetiology of CKD?
Urea, creatinine, electrolytes (Na, K, Cl)
Bicarbonate
Total protein, albumin
Calcium, phosphate
Liver function tests
Creatine kinase
Immunoglobulins, serum protein electrophoresis
what investigations are done in haematology to detect aetiology of CKD?
Full blood count
Hb
MCV
MCH
WBC
Platelets
% hypochromic RBCs
what investigations are done in coagulation screen to detect aetiology of CKD?
PT
APPT
+/- Fibrinogen
what urine investigations are done for CKD?
Urinalysis (“dipstick”)
Blood
Protein
Protein quantification
Protein creatinine ratio (PCR)
Albumin creatinine ratio
what imaging is done to detect aetiology of CKD?
US
Non-invasive
No ionising radiation
May provide information about chronicity of renal disease
how can you pathological confirm aetiology?
kidney biopsy
how can the rate of renal decline be slowed?
BP control *most important
Control proteinuria (particularly ACE inhibitors / ARBs)
Treat underlying cause
Others
what complications are associated with reduced GFR?
Acidosis
Anaemia
Bone disease
CV risk
Death & Dialysis
Electrolytes
Fluid overload
Gout
Hypertension
Iatrogenic issues
how are complications rekated to GFR managed?
Acidosis - bicarb
Anaemia – EPO and iron
Bone disease – diet and phosphate binders
CV risk – BP, aspirin, cholesterol, exercise, weight
Death & Dialysis – counsel and prepare
Electrolytes – diet and consider drugs
Fluid overload – salt and fluid restriction, diuretics
Gout – optimise +/- meds
Hypertension – weight, diet, fluid balance, drugs
Iatrogenic issues – BE AWARE
what preparation for end stage renal disease and renal replacement therapy should be done?
Education & information
Selection of modality
HD / PD ?transplant ??conservative care
Planning access
Deciding when to start RRT
Multidisciplinary team
