Chronic Kidney Disease Flashcards
Chronic kidney disease
Permanent (> 3 months), progressive, and irreversible loss of nephrons causing reduced kidney function.
Causes of chronic kidney disease
- diabetes
- hypertension
- AKI
- glomerulonephritis
- polycystic kidneys
- medications (e.g. NSAIDs, lithium)
Clinical features of chronic kidney disease
Usually asymptomatic until later stage.
Symptoms/signs are manifestations of CKD complications.
Include:
- anaemia (fatigue, pallor, SOB)
- fluid overload (oedema, SOB)
- renal bone disease (bone pain, fractures)
- metabolic acidosis (tachypnoea, confusion, malaise)
- uraemia (N&V, anorexia, hiccups, itch)
- other (hypertension, oliguria)
Investigating chronic kidney disease
- eGFR (reduced)
- proteinuria (albumin:creatinine raised)
- renal ultrasound
Classifying chronic kidney disease
G score by eGFR:
- G1 = > 90
- G2 = 60-89
- G3a = 45-59, G3b = 30-44
- G4 = 15-29
- G5 = < 15
A score by ACR:
- A1 = < 3
- A2 = 3-30
- A3 = > 30
Diagnosis criteria for chronic kidney disease
Consistent results for a minimum 3 months of either:
1. eGFR sustained < 60
2. ACR sustained > 3
Complications of chronic kidney disease
- anaemia
- renal bone disease
- metabolic acidosis
- uraemic syndrome
- CVD complications
- peripheral neuropathy
Aims of chronic kidney disease management
- optimise diabetic control
- optimise hypertension control
- reduce nephrotoxic drugs
Standard medications given for chronic kidney disease
- ACE-i (or ARB)
- SGLT2-i
- Atorvostatin
Managing renal bone disease
- vitamin D supplements
- low phosphate diet
- phosphate binding drugs (e.g. sevelamer)
Managing anaemia in chronic kidney disease
- iron
- erythropoetin
Managing metabolic acidosis in chronic kidney disease
oral sodium bicarbonate
