Chronic kidney disease Flashcards
What is chronic kidney disease?
Reduced kidney function. Long-standing - reversal unlikely.
What are the potential causes of CKD?
Diabetes mellitus, glomerular disease, genetics, renal vascular disease, AKI, interstitial disease, idiopathic
What is the most common cause of CKD leading to ESKD?
Diabetes mellitus
What percentage of diabetic patients develop nephropathy and what other features may be present?
20-30%
Retinopathy, neuropathy and proteinuria
What meadiates glomerular disease?
Autoimmunity
How can glomerular disease present?
Nephrotic syndrome, asymptomatic proteinuria/haematuria, nephritic syndrome or rapidly progressing nephritis
What is the difference between nephrotic and nephritic syndrome?
Nephrotic - large proteinuria, hypoabuminaemia, oedema and hyperlipidaemia.
Nephritic - Haematuria, proteinuria (small), HTN and low urine volume
What would you think of throat infection, swollen ankles and HTN?
Nephritic syndrome
What would you think of joint pains, rash, fevers and red eyes?
Rapidly progressive glomerular nephropathy.
What are the features of autosomal dominant polycystic kidney disease?
•Autosomal dominant
•Prevalence 1:400 to 1:1000
•Presents in adult life
•Development of multiple cysts
–Kidneys
–Liver
–Pancreas
•Hypertension
•Cardiac abnormalities
•Berry aneurysms
What are the genetic defects in ADPKD?
–85% PKD1 gene Xsome 16
•Codes for Polycystin 1
•Membrane glycoprotein
•Cell to cell interactions
–15% PKD2 gene Xsome 4
•Polycystin 2
•Calcium ion channel
What are the stages of CKD?
- Normal or increased GFR (>90) with other evidence of kidney damage.
- Slight decrease in GFR (60-89) with other evidence of kidney damage.
- Moderate decrease in GFR (3A:45-59, 3B:30-44) with or without other evidence of kidney damage.
- Severe decrease in GFR (15-29) with or without other evidence of kidney damage.
- GFR<15. Established renal failure.
What are the signs and symptoms of CKD?
Anaemia - pallor/lethargy/breathlessness
Platelet abnormality - epistaxsis/bruising
Skin - pigmentation, pruritis
GI - anorexia, nausea, vomiting, diarrhoea
Endocrine - amenorrhoea, erectile dysfunction, infertility
CNS - confusion, coma, seizure
CVS - pericarditis, HTN, PVD, heart failure
Renal - polyuria, nocturia, oedama
Renal osteodystrophy
How would you distiguish AKI from CKD?
Copare baseline creatinine
Low calcium
High phosphate
CKD has small shrunken kidneys on US
What would you consider in the managment of AKI?
- BP control
- Cholesterol
- Fluid balance
- Anaemia
- Bone metabolism
- Acidaemia
- Drug prescribing
- Dietary advice
