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CCC > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

0
Q

What are the causes of CKD?

A 
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
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1
Q

What is the definition of CKD?

A

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

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2
Q

Which patients should be screened for risk of developing CKD? And how?

A 
Patients with the conditions previously listed
Positive family history
AKI
Haematuria
Cardiovascular disease

UandEs for eGFR
BP
Proteinuria/albuminuria (ACR)

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3
Q

How often should patients with CKD have their eGFR, ACR, and cardiovascular disease risk assessed?

A

Annually

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4
Q

If CKD is diagnosed, how is the rare of progression checked?

A

Assess rate of decline with three eGFRs over 90 days

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5
Q

What are the symptoms of CKD?

A

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
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6
Q

What GFR is CKD stage 1?

A

> 90 ml/min

Requires other evidence of CKD!

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7
Q

What GFR is CKD stage 2?

A

60-90 ml/min

Requires other evidence of CKD!

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8
Q

What is CKD stage 3a?

A

45-60 ml/min

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9
Q

What GFR is CKD stage 3b?

A

30-45 ml/min

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10
Q

What GFR is stage 4 CKD?

A

15-30 ml/min

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11
Q

What GFR is stage 5 CKD?

A

<15 ml/min

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12
Q

How is proteinuria assessed in CKD?

A

Spot urine sample (preferable morning)

For albumin creatine ratio

Microalbuminuria if:

> 2.5mg/mmol in men
3.5mg/mmol in women

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13
Q

What things may cause high urea?

A

Urea is a product of amino acid breakdown

Catabolic state
High protein intake
GI bleed
Glucocorticoids
Dehydration/cardiac failure
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14
Q

What relation does creatinine have wtb renal impairment?

A

Exponential

Therefore insensitive marker of renal impairment

Levels are related to muscle mass, so high if young, muscular, male, low if elderly, wasting, female

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15
Q

What investigations are done in suspected CKD?

A

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

16
Q

What are some complications of CKD?

A

Anaemia - reduced epo production
Hyperkalaemia
Bone mineral disorder - due to low serum calcium and phosphate retention, high PTH
Metabolic acidosis - low bicarbonate

17
Q

What is the management of CKD?

A 
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
18
Q

When are ACEIs and ARBs used in CKD?

A

If Proteinuric disease:
Diabetes and ACR >30mg
HTN and ACR >30mg
ACR >70mg

19
Q

What lifestyle changes can patients with CKD make to prevent progression?

A 
Avoid dehydration - may cause acute deterioration
Stop smoking
Exercise
Diet - restrict salt, reduce calories
Maintain acceptable body weight
Avoid nephrotoxins - NSAIDs, contrast
20
Q

When should dialysis be discussed with patients with CKD?

A

Discuss options when GFR <10

21
Q

What are the options for end stage renal failure?

A

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

22
Q

When should a patient with CKD be referred for specialist care?

A 
EGFR <30
Progression
Uncertain cause or suspected systemic disease
Possible hereditary cause
Significant proteinuria
Complications of CKD

CCC (12 decks)

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