Chronic Kidney Disease Flashcards
What does renal injury cause?
Renal injury causes renal tissue to be replaced by extracellular matrix in response to tissue damage
What is chronic kidney failure?
Irreversible and sometimes progressive loss of renal function over a period of months to years.
Aetiology of chronic kidney disease?
Immunologic eg glomerulonephritis Infection eg polynephritis Hypertension Vascular eg cardiovascular disease Systemic disease eg diabetes, myeloma Neoplasm Hypercalcaemia
Who is chronic kidney disease more common in?
Elderly
Ethnic minorities
Socially disadvantaged
Risk factors for chronic kidney disease?
Acute insults from nephrotoxins
Decreased perfusion
Increased renal ammonia formation with interstitial injury
Hyperlipidaemia
Hyperphosphataemia with calcium phosphate deposition
What are the GFR a categories?
G1-G5
G1 - GFR >90 - normal/high
G2 - GFR 60-89 - mildly decreased
G5 - GFR < 15 - kidney failure
What are the ACR categories for classification of kidney disease?
ACR = albumin:creatinine ratio A1 = 30 severely increased
What do most patients die of before needing dialysis?
Cardiovascular disease
What is end stage renal failure? (ESRF)
When kidney disease reaches a stage when death is imminent without renal replacement therapy
What cardiovascular problems can chronic kidney disease (CKD) cause?
Atherosclerosis
Cardiomyopathy
Pericarditis
How can CKD a affect haematology?
Can cause anaemia due to decreased levels of or resistance to erythropoietin
How does renal bone disease happen?
Decreased GFR
- less phosphate excreted
- increased phosphate serum concentration
- forms complexes with calcium
- reduces calcium effective serum conc
- stimulates parathyroid to produce PTH
- overactivity of osteoclasts
- osteitis fibrosa cystica
How can damage to kidneys cause osteomalacia and hyperparathyroidism?
Less vitamin D undergoes second hydroxylation to its active form
Causes hyoerparathyroidim and osteomalacia
What CNS problems can CKD cause?
Neuropathy
Seizures
Coma
What general symptoms can CKD cause?
Tiredness Breathlessness Restless legs Sleep reversal Seizure Aches and pains Nausea and vomiting Itching Chest pain
Investigations for CKD to measure renal function?
GFR - renal function expressed as a percentage of the normal range
GFR can be measured by inulin clearance or 24hr creatinine clearance
What needs to be done if creatinine is used as a GFR a marker?
Needs to be modified by an equation to predict estimated GFR a
Equation takes into account age, gender and ethnicity
Phagocytosis investigations are used to assess the cause of CKD?
Auto-antibody screen Immunoglobulin CRP Complement ANCA SPEP/UPEP Imaging of kidneys -ultrasound for size and hydronephrosis -CT -MRI
Management of CKD?
Lifestyle - smoking, obesity, exercise Treat any diabetes Treat blood pressure ACE inhibitors/angiotensin receptor blockers Lipid lowerers (statins/diet) All to slow progression
Patient should be monitored by checking eGFR and indications for initiation of dialysis
What GFR a value indicates need for renal replacement therapy?
eGFR < 15ml/min
What does renal replacement therapy include?
Dialysis
Transplant
Indications for dialysis?
eGFR<15 ml/min Uraemia symptoms Acidosis Pericarditis Fluid overload Hyperkalaemia
How is peritoneal dialysis done?
Peritoneal dialysis fluid is put into the peritoneal cavity and the dialysis occurs across the peritoneal membrane. Fluid is then drained away and disposed of.
Advantages of peritoneal dialysis?
Low technology Home technique Easily learnt Allows mobility CVS stability May be better for elderly and diabetics
