Chronic kidney disease Flashcards
What is the GFR in stage 1 CKD?
> 90 ml/min
What is the GFR in stage 2 CKD?
60-89 ml/min
What is the GFR in stage 3 CKD?
30-59 ml/min
What is the GFR in stage 4 CKD?
16-29 ml/min
What are the causes of CKD?
HTN DM Glomerulonephritis Polycystic kidney disease Drugs eg analgesic nephropathy SLE Amyloidosis Myeloma
What is the GFR in stage 5 CKD?
What investigations can be done in a patient with suspected CKD?
Bloods -↓Hb, U+E, CRP, glucose, ↓Ca/↑PO4, ↑ALP, ↑PTH
Can do ANA and complement if suspecting immune causes
Urine - dip, microscopy, sensitivity and culture, protein creatinine ratio
Imaging - CXR, AXR, renal US, bone x ray for renal osteodystrophy
Renal biopsy if unclear on cause and size normal
What is the general management of CKD?
Treat reversible causes Stop nephrotoxic drugs Lifestyle adjustments eg healthy weight, exercise, smoking cessation, limit Na, PO4 and fluid intake Frusemide for oedema Clonazepam for restless legs Erythropoietin to raise Hb in anaemia
What are the features of Renal Osteodystrophy?
Osteoporosis: ↓ bone density
Osteomalacia: ↓ mineralisation of osteoid (matrix)
2ndary/3rd Hyperparathyroidism causing osteitis fibrosa cystica
- Subperiosteal bone resorption
- Acral osteolysis: short stubby fingers
- Pepperpot skull
What is the mechanism of Renal Osteodystrophy?
↓ 1α-hydroxylase → ↓ vit D activation → ↓ Ca → ↑ PTH
Phosphate retention → ↓ Ca and ↑ PTH (directly)
↑ PTH → activation of osteoclasts ± osteoblasts
What is the inactivate version of vitamin D?
Calciferol
What is the active version of vitamin D?
Calcitroil
How do you manage the CV risk in CKD patients?
Statins
Low dose aspirin
Manage diabetes well
How can you manage bone disease in CKD?
Phosphate binders
Vitamin D analogues
Calcium supplements
