Chronic kidney disease Flashcards
What is chronic kidney disease (CKD)?
CKD describes a chronic reduction in kidney function sustained over three months. It tends to be permanent and progressive.
What are common causes of CKD?
- diabetes nephropathy
- hypertension
- medications (e.g., NSAIDs or lithium),
- glomerulonephritis
- chronic pyelonephritis
- adult polycystic kidney disease.
What are the signs and symptoms of CKD?
Most patients are asymptomatic. Symptoms may include:
* fatigue
* foamy urine
* nausea and vomiting
* loss of appetite
* pruritus
* oedema
* hypertension
* polyuria
How is the estimated glomerular filtration rate (eGFR) calculated?
eGFR is based on serum creatinine, age and gender, estimating the rate at which fluid is filtered from the blood into Bowman’s capsule.
What factor may affect eGFR results
- pregnancy
- muscle mass (e.g. amputees, body-builders)
- eating red meat 12 hours prior to the sample being taken
What is proteinuria and how is it quantified?
Proteinuria is the presence of protein in the urine, quantified with a urine albumin:creatinine ratio (ACR).
What investigations are necessary for CKD?
- renal ultrasound
- blood pressure
- HbA1c
- lipid profile for hypercholesterolaemia.
Appearance of chronic kidney disease on ultrasound
most patients with CKD have bilateral small kidneys.
What are the criteria for diagnosing CKD?
Diagnosis can be made with consistent results over three months of eGFR below 60 mL/min/1.73 m2 or ACR above 3 mg/mmol.
When can stage 1 + 2 CKD be diagnosed
if there’s supporting evidence to accompany eGFR, i,e abnormal U&Es and proteinuria
What is the G score and A score in CKD classification?
The G score is based on eGFR, while the A score is based on the albumin:creatinine ratio.
What are the stages of CKD based on eGFR?
G1: Over 90
G2: 60-89
G3a: 45-59
G3b: 30-44
G4: 15-29
G5: Under 15
What are the stages of CKD based on albumin:creatinine ratio
A1 (< 3mg/mmol): Normal to mildly increased
A2 (3-30) Moderately increased
A3 (> 30) Severely increased
What is accelerated progression in CKD?
Accelerated progression is a sustained decline in eGFR of either 25% or 15 mL/min/1.73 m2 within one year.
When should a patient be referred to a renal specialist?
- eGFR is less than 30 mL/min/1.73 m2
- urine ACR of 70 mg/mmol or more
- urinary ACR of 30 mg/mmol or more, together with persistent haematuria
- accelerated progression
- uncontrolled HTN
What are the targets for blood pressure in CKD patients?
The target is less than 130/80 in patients under 80 with CKD and an ACR above 70 mg/mmol.
What medications help slow CKD progression?
ACE inhibitors (or angiotensin II receptor blockers) and SGLT-2 inhibitors (specifically dapagliflozin) are used.
What is the management for end-stage renal disease?
Management involves special dietary advice, dialysis, and renal transplant.
When managing CKD, who should receive ACE inhibitors?
- patients with diabetes plus ACR above 3 mg/mmol,
- patients with coexistent HTN and CKD, if the ACR is > 30 mg/mmol
- any patient with ACR above 70 mg/mmol.
When managing CKD, what needs to be monitored when using ACE inhibitors?
Serum potassium needs close monitoring, as both CKD and ACE inhibitors can cause hyperkalaemia.
When managing CKD, who should receive dapagliflozin
- patients with diabetes plus ACR above 30 mg/mmol
- non-diabetics with ACR of 22.6 mg/mmol or above.
What are common complications of CKD?
Anaemia
Renal bone disease
Cardiovascular disease
Peripheral neuropathy
End-stage kidney disease
Dialysis-related complications
What lifestyle changes can reduce complications in CKD?
Exercise, maintain a healthy weight, and avoid smoking.
atorvastatin 20mg
How is anaemia managed in CKD?
Management includes oral sodium bicarbonate for metabolic acidosis, iron, and erythropoietin.
