Chronic Kidney Disease Flashcards
What are the causes of CKD?
Diabetic nephropathy Glomerulonephritis Hypertension Systemic disease - SLE, Vasculitis, amyloid, myeloma Renal artery stenosis Polycystic kidney disease Chronic pyelonephritis Urinary tract obstruction Heart failure Drugs - NSAIDs Idiopathic
What is the definition of CKD?
Abnormality if kidney structure of function, present for >3 months, with implications for health
Mostly irreversible
Often progressive
NOT like AKI (sudden deterioration with absence of prior abnormality
Which patients should be screened for risk of developing CKD? And how?
Patients with the conditions previously listed Positive family history AKI Haematuria Cardiovascular disease
UandEs for eGFR
BP
Proteinuria/albuminuria (ACR)
How often should patients with CKD have their eGFR, ACR, and cardiovascular disease risk assessed?
Annually
If CKD is diagnosed, how is the rare of progression checked?
Assess rate of decline with three eGFRs over 90 days
What are the symptoms of CKD?
Often an incidental finding, symptoms occur with advanced disease
Renal - fluid retention, poly/nocturia CV - HTN, pulmonary oedema GI - anorexia, N+v, malnutrition Neuro - peripheral neuropathy Derm - pigmentation, pruritis Endocrine -oligomenorrhoea, subfertile MSK -bone pain, fractures, arthropathy
What GFR is CKD stage 1?
> 90 ml/min
Requires other evidence of CKD!
What GFR is CKD stage 2?
60-90 ml/min
Requires other evidence of CKD!
What is CKD stage 3a?
45-60 ml/min
What GFR is CKD stage 3b?
30-45 ml/min
What GFR is stage 4 CKD?
15-30 ml/min
What GFR is stage 5 CKD?
<15 ml/min
How is proteinuria assessed in CKD?
Spot urine sample (preferable morning)
For albumin creatine ratio
Microalbuminuria if:
> 2.5mg/mmol in men
3.5mg/mmol in women
What things may cause high urea?
Urea is a product of amino acid breakdown
Catabolic state High protein intake GI bleed Glucocorticoids Dehydration/cardiac failure
What relation does creatinine have wtb renal impairment?
Exponential
Therefore insensitive marker of renal impairment
Levels are related to muscle mass, so high if young, muscular, male, low if elderly, wasting, female
What investigations are done in suspected CKD?
Clinical history
FBC, UandEs, LFTs, phosphate, PTH
Urine dipstick and mc&s
Immunology screen - SLE, myeloma
Renal ultrasound - obstruction, cystic disease, scarring, renovascular
Renal biopsy or angiography in a few cases
24 hour urine for ACR
What are some complications of CKD?
Anaemia - reduced epo production
Hyperkalaemia
Bone mineral disorder - due to low serum calcium and phosphate retention, high PTH
Metabolic acidosis - low bicarbonate
What is the management of CKD?
Treat underlying cause Lifestyle BP control Cvs risk reduction Diet Treat anaemia with epo Treat bone disease with vit d analogues Bicarbonate for acidosis Consider ACEI/arbs Atorvastatin 20mg Folic acid and b vitamin supplements if at risk of delivery
When are ACEIs and ARBs used in CKD?
If Proteinuric disease:
Diabetes and ACR >30mg
HTN and ACR >30mg
ACR >70mg
What lifestyle changes can patients with CKD make to prevent progression?
Avoid dehydration - may cause acute deterioration Stop smoking Exercise Diet - restrict salt, reduce calories Maintain acceptable body weight Avoid nephrotoxins - NSAIDs, contrast
When should dialysis be discussed with patients with CKD?
Discuss options when GFR <10
What are the options for end stage renal failure?
Haemodialysis: via AV fistula, 4hours 3x a week
Peritoneal dialysis: automated nightly or 4x 2-3 litres a day
Transplantation: lifelong immunosuppressive, but best chance for survival
Conservative care: often elderly, multiple comorbidities , involves advanced planning of care
When should a patient with CKD be referred for specialist care?
EGFR <30 Progression Uncertain cause or suspected systemic disease Possible hereditary cause Significant proteinuria Complications of CKD
