Chronic Kidney Disease Flashcards
What is CKD?
Gradual and irreversible deterioration of renal function
Progressive loss of nephron function
What are the indicators of CKD?
Proteinuria
Haematuria
eGFR < 60ml/min for > 3 months
Structural abnormalities
Primary causes of CKD
Hypertension
Diabetes
Objectives for management of CKD
Prevent disease progression
Identify and treat underlying causes
Treat complications of renal failure
How does hypertension cause CKD?
High BP damages blood vessels in the body and kidney
Reduces blood supply to the kidney
What complication of CKD is also a cause of it?
Hypertension
Fluid builds up and raises BP
Kidneys cannot remove waste and excess fluid
What is the target BP for patients with diabetes?
130/80 mmHg
What is the target BP for patients without diabetes?
140/90 mmHg
How is blood pressure regulated?
By the kidneys
Which drugs are used for renoprotection in CKD?
ACE inhibitors first line
ARBs
Lower glomerular pressure and proteinuria
What monitoring is required for ACEi and ARBs?
Before initiation monitor U + Es (potassium), creatinine and eGFR
Then monitor again after 1-2 weeks of initiation or dose change
What is the cause of diabetic nephropathy?
Haemodynamic and metabolic changes
What is the recommended HbA1c target?
53 mmol/mol or 7%
Which drugs should be given for Type 2 in CKD?
SGLT2i - dapagliflozin
Renoprotective and ACE can be used
What are symptoms and management for uraemia?
Reduce protein intake
Gastro symptoms - antiemetic or laxative
Pruritis - chlorphenamine, promethazine (sedating antihistamine)
Muscle cramps - oral quinine (gluconate/ hydrochloride)
Management for fluid retention?
Restrict fluids to 1L per day
Reduce dietary sodium and medicines like gaviscon
Furosemide (high dose in advanced CKD eGFR <30ml/min)
Dialysis
Management of metabolic acidosis
Oral sodium bicarbonate 1-6g
Severe/ persistent acidosis - dialysis
How does CKD cause anaemia?
Kidneys can’t make enough erythropoietin (EPO) so less red bloods cells produced and haemoglobin
What is the management for anaemia in CKD?
Blood transfusions
Erythropoeiesis-stimulating agents (ESAs)
Why should you use Novel ESAs to treat anaemia?
Reduced frequency of administration (SC or IV):
Aranesp - once weekly or every 2 weeks
Mircera - once monthly
When should you give ESAs for anaemia?
Hb 100 - 120 or symptoms affect quality of life
What is the risk of ESAs and how is it caused?
Hypertension
Increase in RBC production, increases blood volume and viscosity
What does CKD stage 3-5 affect to cause mineral and bone disorders ?
Calcium
Phosphate
Vitamin D
PTH levels
What is the monitoring for ESA therapy?
Iron levels
Blood pressure
Hb level
What are the complications of hyperphosphataemia?
Renal bone disease
Fractures
Bone and joint abnormalities
Management for hyperphosphataemia
Reduce dairy and oily fish
Phosphate-binders if diet fails
First line phosphate binders
Calcium carbonate
Calcium acetate
Can correct hypocalcaemia
Management of Vitamin D deficiency
Calcitriol
Alfacalcidol (contraindicated in liver disease)
What other complications are managed with Vitamin D therapy?
Hypocalcaemia
Hyperparathyroidism
What is the cause of hypocalcaemia
High phosphate and low Vitamin D3
Phosphate binds to calcium making it less soluble
Treatment for hypocalcaemia
Vitamin D
Phosphate binder- higher calcium
Calcium supplements
Complications of hyperparathyroidism
Fractures
Soft tissue calcification
CVD (calcium in heart and blood vessels)
Treatment for early hyperparathyroidism with normal/low calcium levels
Vitamin D
Treatment for secondary hyperparathyroidism
Removal of parathyroid
Cinacalcet (for dialysis patients)
