Chronic Kidney Disease Flashcards
What is the definition of Chronic Kidney disease
Reduced GFR and/ or evidence of kidney damage
What is the definition of Chronic Kidney disease
Reduced GFR and/ or evidence of kidney damage
How is CKD diagnosed
At least 2 measurements of GFR or creatinine with a decent time period in between
Why do we not directly assess GFR very often
It is time consuming for both patient and staff
expensive - done in nuclear medicine
What can we use to estimate GFR instead of measuring it
Creatinine clearance
What is creatinine
A product of muscle breakdown - muscular people produce more creatinine
What other factors need to be considered for estimating GFR
Age - less creatinine as you age
sex - males are more muscular
race - blacks are more muscular than whites and asians
When is GFR overestimated
If muscle mass is low
Amputations
When is GFR underestimated
If muscle mass is high
When would we want to use nuclear medicine to measure GFR
If someone wanted to donate a kidney
Describe the relationship between creatinine and GFR
As GFR declines, you can lose about half without losing creatinine.
Regardless of age etc. the shape of the curve will remain the same
What is stage 1 CKD
GFR >90ml/min with evidence of kidney damage
What is stage 2 CKD
GFR 60-90ml./min with evidence of kidney damage
What are examples of evidence of kidney damage
Proteinuria
Haematuria
Abnormal imaging
What is stage 3 CKD
GFR 30-60
What is stage 4 CKD
GFR 15-30
What is stage 5 CKD
What would a patient with Stage 5 CKD require
Dialysis
When is CKD classed as severe
Stage 4
What does CKD increase the risk of
Cardiovascular risk
What is an indication that a patient with CKD will progress faster
Proteinuria
What are some of the causes of CKD
Diabetes Hypertension Vascular disease Chronic glomerulonephritis Reflux nephropathy Polycystic kidneys Unknown
What is the commonest single reason for needing dialysis
Diabetes (affecting small vessels of the kidneys)
How does Reflux nephropathy cause CKD
Reflux of urine - valves don’t work as well causing the urine to go back to kidneys - this causes scarring
What are the most common symptoms of CKD
non-speciifc tiredness poor appetite itch sleep disturbance Impaired concentration of urine
What are the 4 principles of managing CKD
slow the progression
reduce the CVD risk
Identify and treat complications of CD
prepare for renal replacement therapy
How can we slow the progression of CKD
reduce proteinuria
control BP - ACE inhibitors and ARBs
Stop smoking
Good glycemic control
What are the side effects of using ACEI or ARBs
They may cause hyperkalaemia
How can we reduce the CVD risk
BP and proteinuria
stop smoking
statins
How does anaemia arise
Erythropoietin is produced by the kidneys. It stimulates the bone marrow to make RBCs. The production of erythropoietin declines with CKD
How is anaemia usually corrected
IV iron
Erythropoeitin (Epo) - subcut injection once weekly
What is the main side effect with using Epo
The iron stores will be depleted
Why is bone disease a complication of CKD
Vitamin D is hydroxylated in the kidney - this leads to reduced Ca absorption and excreting less phosphate, leading to secondary hyperparathyroidism (increase PTH)
How is bone disease as a result of CKD managed
Alfacalcidol - hydroxylatsed vitamin D doesn’t need activation by the kidneys
What are the 4 treatment options for established “end stage” renal failure
Haemodialysis
Peritoneal dialysis
Transplantation
Conservative management
When would a patient not be put on Dialysis
When their quality of life probably would not be improved with dialysis due to other problems
When should a patient be referred for dialysis
When the GFR is about 20
What is required in order to start a patient on haemodialysis
Arteriovenous fistula (AVF) (needs 6 weeks to mature after formation)
What is required in order to start a patient on peritoneal dialysis
Operation to insert a catheter - patient then has to wait for 1-2 weeks in order to then start using the catheter so it is less likely to leak
When can a patient be listed for cadaveric transplantation
within 6 months of dialysis
A patient must be “fit enough” to go undergo a transplant. What does this mean
They must have a reasonable expectation with surviving 5 years
No recent malignancy
No heart disease or respiratory compromisation
How is a patient conservatively managed
Epo
Symptom control
How is CKD diagnosed
At least 2 measurements of GFR or creatinine with a decent time period in between
Why do we not directly assess GFR very often
It is time consuming for both patient and staff
expensive - done in nuclear medicine
What can we use to estimate GFR instead of measuring it
Creatinine clearance
What is creatinine
A product of muscle breakdown - muscular people produce more creatinine
What other factors need to be considered for estimating GFR
Age - less creatinine as you age
sex - males are more muscular
race - blacks are more muscular than whites and asians
When is GFR overestimated
If muscle mass is low
Amputations
When is GFR underestimated
If muscle mass is high
When would we want to use nuclear medicine to measure GFR
If someone wanted to donate a kidney
Describe the relationship between creatinine and GFR
As GFR declines, you can lose about half without losing creatinine.
Regardless of age etc. the shape of the curve will remain the same
What is stage 1 CKD
GFR >90ml/min with evidence of kidney damage
What is stage 2 CKD
GFR 60-90ml./min with evidence of kidney damage
What are examples of evidence of kidney damage
Proteinuria
Haematuria
Abnormal imaging
What is stage 3 CKD
GFR 30-60
What is stage 4 CKD
GFR 15-30
What is stage 5 CKD
What would a patient with Stage 5 CKD require
Dialysis
When is CKD classed as severe
Stage 4
What does CKD increase the risk of
Cardiovascular risk
What is an indication that a patient with CKD will progress faster
Proteinuria
What are some of the causes of CKD
Diabetes Hypertension Vascular disease Chronic glomerulonephritis Reflux nephropathy Polycystic kidneys Unknown
What is the commonest single reason for needing dialysis
Diabetes (affecting small vessels of the kidneys)
How does Reflux nephropathy cause CKD
Reflux of urine - valves don’t work as well causing the urine to go back to kidneys - this causes scarring
What are the most common symptoms of CKD
non-speciifc tiredness poor appetite itch sleep disturbance Impaired concentration of urine
What are the 4 principles of managing CKD
slow the progression
reduce the CVD risk
Identify and treat complications of CD
prepare for renal replacement therapy
How can we slow the progression of CKD
reduce proteinuria
control BP - ACE inhibitors and ARBs
Stop smoking
Good glycemic control
What are the side effects of using ACEI or ARBs
They may cause hyperkalaemia
How can we reduce the CVD risk
BP and proteinuria
stop smoking
statins
How does anaemia arise
Erythropoietin is produced by the kidneys. It stimulates the bone marrow to make RBCs. The production of erythropoietin declines with CKD
How is anaemia usually corrected
IV iron
Erythropoeitin (Epo) - subcut injection once weekly
What is the main side effect with using Epo
The iron stores will be depleted
Why is bone disease a complication of CKD
Vitamin D is hydroxylated in the kidney - this leads to reduced Ca absorption and excreting less phosphate, leading to secondary hyperparathyroidism (increase PTH)
How is bone disease as a result of CKD managed
Alfacalcidol - hydroxylatsed vitamin D doesn’t need activation by the kidneys
What are the 4 treatment options for established “end stage” renal failure
Haemodialysis
Peritoneal dialysis
Transplantation
Conservative management
When would a patient not be put on Dialysis
When their quality of life probably would not be improved with dialysis due to other problems
When should a patient be referred for dialysis
When the GFR is about 20
What is required in order to start a patient on haemodialysis
Arteriovenous fistula (AVF) (needs 6 weeks to mature after formation)
What is required in order to start a patient on peritoneal dialysis
Operation to insert a catheter - patient then has to wait for 1-2 weeks in order to then start using the catheter so it is less likely to leak
When can a patient be listed for cadaveric transplantation
within 6 months of dialysis
A patient must be “fit enough” to go undergo a transplant. What does this mean
They must have a reasonable expectation with surviving 5 years
No recent malignancy
No heart disease or respiratory compromisation
How is a patient conservatively managed
Epo
Symptom control
