Chronic kidney disease Flashcards
What is the broad definition of chronic kidney disease?
Reduced GFR and/or evidence of kidney disease
When is eGFR a) over-estimated and b) under-estimated?
a) if muscle mass is low b) if muscle mass is hight
How is chronic kidney disease classified?
5 stages based on eGFR and evidence of kidney disease
What does stage 1 CKD constitute?
> 90mls/min with evidence of renal damage e.g. imaging, biopsy, proteinuria, haematuria
What stage of CKD is defined as established renal failure?
Stage 5 (<15mls/min)
When do direct renal symptoms usually occur?
Stage 4 (<30mls/min)
Which groups of CKD patients are most likely to progress to advanced CKD?
Younger patients; those with proteinuria
What are the two most common causes of CKD?
Diabetes and hypertension
[Others- glomerulonephritis; polycystic disease; SLE; vasculitis]
Give examples of how progression can be slowed in CKD.
Control blood pressure- ACE inhibitors/ARBs
Good glycaemic control in diabetics
Statins
Smoking cessation
Why does CKD sometimes result in anaemia?
Declining EPO production
How is anaemia in CKD patients treated?
Check for and correct deficiences (B12, iron)
Injections of human recombinant EPO may be indicated
[Target Hb is 10.5-12.5g/dl]
How does CKD lead to secondary hyperparathyroidism?
Reduced Vit D hydroxylation; reduced calcium absorption leading to hyperparathyroidism
What may be the result of secondary hyperparathyroidism?
Tertiary hyperparathyroidism (autonomous gland)- may cause hypercalcaemia
How can CKD cause calcification of vessels and heart valves?
High calcium from bone resorption and high phosphate
How is bone disease in CKD managed?
Restrict phosphate (diet and phosphate binders) Vit D analogues e.g. alfacalcidol (doesn't need hydroxylated)
