Chronic Kidney Disease Flashcards
Define CHronic Kidney Disease
Reduced GFR or evidence of Kidney damage
How is GFR assessed?
Can be measured – nuclear medicine; time-consuming and expensive
Estimation by creatinine clearance; over-estimates GFR as creatinine is secreted by tubules;
Also – 24 hour urine collection often inaccurate
what are the stages of CKD
- Stage 1 – GFR >90ml/min, with evidence of kidney damage*
- Stage 2 – GFR 60-90ml/min, with evidence of kidney damage or abnormal imaging
- *Such as proteinuria, haematuria (in absence of lower urinary tract damage)
- Stages 3-5 defined on GFR alone
- Stage 3 – GFR 30-60ml/min
(3A – 45-60ml/min; 3B – 30-44ml/min)
- Stage 4 – GFR 15-30ml/min
- Stage 5 – GFR <15ml/min, or on renal replacement therapy
name causes of CKD
- Diabetes
- Hypertension
- Vascular disease
- Chronic glomerulonephritis
- Reflux nephropathy
- Polycystic kidneys
symtpoms of CKD
- Symptoms due to reduced GFR don’t occur until late – GFR<20ml/min
- Non-specific – tiredness, poor appetite, itch, sleep disturbance
- Impaired urinary concentrating ability – symptoms may occur earlier - nocturia
how is progression slowed in CKD?
•BP and proteinurian (with ACEI and ARBs, spironolactone)
- Stop smoking
- Statins
Complications of CKD
what causes them?
What signs are there?
How are they treated?
Anaemia- Due to lack of EPO (first check iron, folate and B12 levels)
EPO can be injected
Bone Disease
Vit D is not hydroxylated in the kidney and less Clacium is reabsorbed. To make up for this excess PTH is produced and Calcium is sucked out of bone. High calcium and phosphate leads to calcified vessels and heart valves.
- Alfacalcidol – hydroxylated vitamin D – doesn’t need activation by kidneys
- Phosphate – advice from dietician on intake
at what GFR is dialysis offered?
20ml/min
when can patients be listed for renal transplant?
•Patients can be listed for cadaveric transplantation when within 6 months of dialysis
