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Renal > Chronic kidney disease > Flashcards

Chronic kidney disease Flashcards

1
Q

What is the definition of chronic kidney disease

A

Reduction in kidney function or structural damage or both, present for more than 3 months with associated health implications

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2
Q

What are some causes of CKD?

A

Diabetes
Hypertension
PKD
Glomerular disease
AKI
Nephrotoxic drugs
Obstructive uropathy
Multisystem disease
Hereditary kidney disease
CVD
Obesity with metabolic syndrome

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3
Q

What are some examples of potentially nephrotoxic drugs?

A

Aminoglycosides
ACEi and ARBs
Bisphosphonates
Calcineurin inhibitors
Diuretics
Lithium
Mesalazine
NSAIDs

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4
Q

What are some causes of obstructive neuropathy that can cause CKD?

A

Calculi
Prostate (BPH, malignancy, etc)
Bladder (Malignancy, chronic cystitis)
Malignancy
Strictures/stenosis
Extrinsic compression

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5
Q

What are the markers of kidney damage - “THE ASS-H”

A

T - Transplant - Previous transplant Hx
H - Histological abnormality on biopsy
E - Electrolyte abnormalities
A - ACR > 3mg/mmol
S - Sediment absnrmalities in urine (Blood, casts)
S - Structural abnormalities on imaging
H - Hereditary condition on genetic testing

Also an eGFR <60 ml/min/1.73m^2

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6
Q

How many stages of CKD are there?

A

5 (6 including 3a and 3b)

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7
Q

G1 CKD GFR

A

eGFR > 90

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8
Q

G2 CKD GFR

A

eGFR 60-89

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9
Q

G3a CKD GFR

A

eGFR 45-59

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10
Q

C3b CKD GFR

A

eGFR 30-44

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11
Q

G4 CKD GFR

A

eGFR 15-29

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12
Q

G5 CKD GFR

A

eGFR < 15

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13
Q

How many ACR classifications of CKD are there?

A

3

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14
Q

A1 CKD ACR

A

ACR < 3

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15
Q

A2 CKD ACR

A

ACR 3-30

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16
Q

A3 CKD ACR

A

ACR > 30

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17
Q

CKD 5D

A

eGFR < 15 and commenced on dialysis

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18
Q

ERF

A

Established renal failure (eGFR < 15)

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19
Q

KRT/RRT

A

Kidney/Renal replacement therapy

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20
Q

ESKD

A

End-stage kidney disease - eGFR < 15 and on/approaching RRT or conservative management

21
Q

What is meant by accelerated progression of CKD?

A
  • a persistent decrease in eGFR by 25% or more AND a change in CKD category within 12 months
  • OR can also be defined as a persistent decrease in eGFR of 15 mL/min/1.73 m2 within 12 months
22
Q

How does CKD usually present?

A

Usually asymptomatic

23
Q

What are some possible symptoms of CKD?

A

Pruritus
Loss of appetite
Nausea
Oedema
Muscle cramps
Hypertension

24
Q

What are some investigations required in CKD?

A

U+Es
eGFR
Urinalysis (Proteinuria, haematuria)

25
Q

When may renal USS be used in CKD?

A

Accelerated CKD
Haematuria
Family history of PKD
Evidence of obstruction

26
Q

How is CKD managed?

A

Manage the underlying condition
- Diabetes - HbA1c to target
- Hypertension - ACEi/ARB
- Autoimmune - Immunosuppression
- Obstruction - Relieve obstruction
- Nephrotoxins - Stop drugs

27
Q

What is the BP target in CKD?

A

140/90

28
Q

What is the BP target in CKD + Diabetes or ACR>70mg/mol

A

130/80

29
Q

What is the link between CKD and CVD

A

≥ G3 CKD increases CVD risk by 40% compared to G1 or 2

25mg/mmol increase in urinary ACR leads to 10% increase in stroke risk

30
Q

What are some CVD risk modification strategies in CKD?

A

Smoking cessation
Weight loss
Aerobic exercise
Limited salt intake
Lipid-lowering therapy
Aspirin (Possibly)

31
Q

Describe the link between AKI and CKD

A

AKI may initiate or accelerate CKD progression

32
Q

Describe the link between dyslipidaemia and CKD

A

Secondary causes of dyslipidaemia may include renal causes such as nephrotic syndrome

33
Q

Describe the use of lipid lowering therapy in CKD

A
  • Offer atorvastatin for the primary or secondary prevention of CDK to people with CKD
  • Increase the dose if a greater than 40% reduction in non-HDL cholesterol is not achieved and eGFR is 30 ml/min/1.73 m2 or more
34
Q

What Hb level is classified as renal anaemia?

A

Hb < 110g/L

35
Q

How will renal anaemia present?

A

Tiredness
Shortness of breath
Lethargy
Palpitations

36
Q

What is the cause of renal anaemia?

A

Thought to be caused by reduce EPO production by the kidneys, reduced RBC survival and iron deficiency

37
Q

What is the target Hb in renal anaemia treatment?

A

100-120g/L

38
Q

Which CKD stages are more prone to renal anaemia

A

> G3

39
Q

What investigations are required in renal anaemia?

A

Blood tests to rule out B12, folate and other causes of anaemia
Check ferritin stores

40
Q

Renal anaemia management

A

Iron therapy:
1st line - Oral iron
2nd line - IV iron (Ferinject, vendor)
If this doesn’t work:
- ESA (Athlete doping drug)

41
Q

What is renal mineral and bone disorder (MBD)

A

A complication of CKD in which there is an abnormality in bone turnover and mineralisation

42
Q

How does CKD MBD present?

A

Bone pain
Increased bone fragility
Extra-skeletal calcification of skin or blood vessels

43
Q

What causes CKD MBD?

A

Impaired regulation of intestinal absorption, renal tubular excretion and vitamin D activation in the kidneys

This disturbs vitamin D, calcium, PTH and phosphate metabolism

This causes abnormalities in bone turnover and mineralisation with vitamin D deficiency, raised serum phosphate, low serum calcium and 2º or 3º hyperparathyroidism

44
Q

What endocrine conditions can arise from CKD MBD?

A

2º or 3º hyperparathyroidism
Vitamin D deficiency

45
Q

What are some dietary changes required in CKD MBD?

A

Phosphate restriction
Consider salt, potassium and fluid restriction

46
Q

What are some drugs required in CKD MBD?

A

Oral sodium bicarbonate - Manage metabolic acidosis
Alfacalcidol (Active vit D)
Phosphate binders (Lanthanum/sevelamer)

47
Q

What are some other complications of CKD?

A

Peripheral neuropathy and myopathy
Malnutrition
Malignancy
End-stage renal disease
All cause mortality

48
Q
A

Renal (41 decks)

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