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SM Renal > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is the definition of Chronic Kidney disease

A

Reduced GFR and/ or evidence of kidney damage

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2
Q

What is the definition of Chronic Kidney disease

A

Reduced GFR and/ or evidence of kidney damage

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3
Q

How is CKD diagnosed

A

At least 2 measurements of GFR or creatinine with a decent time period in between

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4
Q

Why do we not directly assess GFR very often

A

It is time consuming for both patient and staff

expensive - done in nuclear medicine

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5
Q

What can we use to estimate GFR instead of measuring it

A

Creatinine clearance

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6
Q

What is creatinine

A

A product of muscle breakdown - muscular people produce more creatinine

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7
Q

What other factors need to be considered for estimating GFR

A

Age - less creatinine as you age
sex - males are more muscular
race - blacks are more muscular than whites and asians

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8
Q

When is GFR overestimated

A

If muscle mass is low

Amputations

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9
Q

When is GFR underestimated

A

If muscle mass is high

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10
Q

When would we want to use nuclear medicine to measure GFR

A

If someone wanted to donate a kidney

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11
Q

Describe the relationship between creatinine and GFR

A

As GFR declines, you can lose about half without losing creatinine.
Regardless of age etc. the shape of the curve will remain the same

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12
Q

What is stage 1 CKD

A

GFR >90ml/min with evidence of kidney damage

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13
Q

What is stage 2 CKD

A

GFR 60-90ml./min with evidence of kidney damage

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14
Q

What are examples of evidence of kidney damage

A

Proteinuria
Haematuria
Abnormal imaging

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15
Q

What is stage 3 CKD

A

GFR 30-60

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16
Q

What is stage 4 CKD

A

GFR 15-30

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17
Q

What is stage 5 CKD

A
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18
Q

What would a patient with Stage 5 CKD require

A

Dialysis

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19
Q

When is CKD classed as severe

A

Stage 4

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20
Q

What does CKD increase the risk of

A

Cardiovascular risk

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21
Q

What is an indication that a patient with CKD will progress faster

A

Proteinuria

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22
Q

What are some of the causes of CKD

A 
Diabetes 
Hypertension 
Vascular disease
Chronic glomerulonephritis 
Reflux nephropathy 
Polycystic kidneys 
Unknown
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23
Q

What is the commonest single reason for needing dialysis

A

Diabetes (affecting small vessels of the kidneys)

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24
Q

How does Reflux nephropathy cause CKD

A

Reflux of urine - valves don’t work as well causing the urine to go back to kidneys - this causes scarring

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25
Q

What are the most common symptoms of CKD

A 
non-speciifc 
tiredness
poor appetite
itch 
sleep disturbance 
Impaired concentration of urine
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26
Q

What are the 4 principles of managing CKD

A

slow the progression
reduce the CVD risk
Identify and treat complications of CD
prepare for renal replacement therapy

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27
Q

How can we slow the progression of CKD

A

reduce proteinuria
control BP - ACE inhibitors and ARBs
Stop smoking
Good glycemic control

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28
Q

What are the side effects of using ACEI or ARBs

A

They may cause hyperkalaemia

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29
Q

How can we reduce the CVD risk

A

BP and proteinuria
stop smoking
statins

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30
Q

How does anaemia arise

A

Erythropoietin is produced by the kidneys. It stimulates the bone marrow to make RBCs. The production of erythropoietin declines with CKD

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31
Q

How is anaemia usually corrected

A

IV iron

Erythropoeitin (Epo) - subcut injection once weekly

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32
Q

What is the main side effect with using Epo

A

The iron stores will be depleted

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33
Q

Why is bone disease a complication of CKD

A

Vitamin D is hydroxylated in the kidney - this leads to reduced Ca absorption and excreting less phosphate, leading to secondary hyperparathyroidism (increase PTH)

34
Q

How is bone disease as a result of CKD managed

A

Alfacalcidol - hydroxylatsed vitamin D doesn’t need activation by the kidneys

35
Q

What are the 4 treatment options for established “end stage” renal failure

A

Haemodialysis
Peritoneal dialysis
Transplantation
Conservative management

36
Q

When would a patient not be put on Dialysis

A

When their quality of life probably would not be improved with dialysis due to other problems

37
Q

When should a patient be referred for dialysis

A

When the GFR is about 20

38
Q

What is required in order to start a patient on haemodialysis

A

Arteriovenous fistula (AVF) (needs 6 weeks to mature after formation)

39
Q

What is required in order to start a patient on peritoneal dialysis

A

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

40
Q

When can a patient be listed for cadaveric transplantation

A

within 6 months of dialysis

41
Q

A patient must be “fit enough” to go undergo a transplant. What does this mean

A

They must have a reasonable expectation with surviving 5 years
No recent malignancy
No heart disease or respiratory compromisation

42
Q

How is a patient conservatively managed

A

Epo

Symptom control

43
Q

How is CKD diagnosed

A

At least 2 measurements of GFR or creatinine with a decent time period in between

44
Q

Why do we not directly assess GFR very often

A

It is time consuming for both patient and staff

expensive - done in nuclear medicine

45
Q

What can we use to estimate GFR instead of measuring it

A

Creatinine clearance

46
Q

What is creatinine

A

A product of muscle breakdown - muscular people produce more creatinine

47
Q

What other factors need to be considered for estimating GFR

A

Age - less creatinine as you age
sex - males are more muscular
race - blacks are more muscular than whites and asians

48
Q

When is GFR overestimated

A

If muscle mass is low

Amputations

49
Q

When is GFR underestimated

A

If muscle mass is high

50
Q

When would we want to use nuclear medicine to measure GFR

A

If someone wanted to donate a kidney

51
Q

Describe the relationship between creatinine and GFR

A

As GFR declines, you can lose about half without losing creatinine.
Regardless of age etc. the shape of the curve will remain the same

52
Q

What is stage 1 CKD

A

GFR >90ml/min with evidence of kidney damage

53
Q

What is stage 2 CKD

A

GFR 60-90ml./min with evidence of kidney damage

54
Q

What are examples of evidence of kidney damage

A

Proteinuria
Haematuria
Abnormal imaging

55
Q

What is stage 3 CKD

A

GFR 30-60

56
Q

What is stage 4 CKD

A

GFR 15-30

57
Q

What is stage 5 CKD

A
58
Q

What would a patient with Stage 5 CKD require

A

Dialysis

59
Q

When is CKD classed as severe

A

Stage 4

60
Q

What does CKD increase the risk of

A

Cardiovascular risk

61
Q

What is an indication that a patient with CKD will progress faster

A

Proteinuria

62
Q

What are some of the causes of CKD

A 
Diabetes 
Hypertension 
Vascular disease
Chronic glomerulonephritis 
Reflux nephropathy 
Polycystic kidneys 
Unknown
63
Q

What is the commonest single reason for needing dialysis

A

Diabetes (affecting small vessels of the kidneys)

64
Q

How does Reflux nephropathy cause CKD

A

Reflux of urine - valves don’t work as well causing the urine to go back to kidneys - this causes scarring

65
Q

What are the most common symptoms of CKD

A 
non-speciifc 
tiredness
poor appetite
itch 
sleep disturbance 
Impaired concentration of urine
66
Q

What are the 4 principles of managing CKD

A

slow the progression
reduce the CVD risk
Identify and treat complications of CD
prepare for renal replacement therapy

67
Q

How can we slow the progression of CKD

A

reduce proteinuria
control BP - ACE inhibitors and ARBs
Stop smoking
Good glycemic control

68
Q

What are the side effects of using ACEI or ARBs

A

They may cause hyperkalaemia

69
Q

How can we reduce the CVD risk

A

BP and proteinuria
stop smoking
statins

70
Q

How does anaemia arise

A

Erythropoietin is produced by the kidneys. It stimulates the bone marrow to make RBCs. The production of erythropoietin declines with CKD

71
Q

How is anaemia usually corrected

A

IV iron

Erythropoeitin (Epo) - subcut injection once weekly

72
Q

What is the main side effect with using Epo

A

The iron stores will be depleted

73
Q

Why is bone disease a complication of CKD

A

Vitamin D is hydroxylated in the kidney - this leads to reduced Ca absorption and excreting less phosphate, leading to secondary hyperparathyroidism (increase PTH)

74
Q

How is bone disease as a result of CKD managed

A

Alfacalcidol - hydroxylatsed vitamin D doesn’t need activation by the kidneys

75
Q

What are the 4 treatment options for established “end stage” renal failure

A

Haemodialysis
Peritoneal dialysis
Transplantation
Conservative management

76
Q

When would a patient not be put on Dialysis

A

When their quality of life probably would not be improved with dialysis due to other problems

77
Q

When should a patient be referred for dialysis

A

When the GFR is about 20

78
Q

What is required in order to start a patient on haemodialysis

A

Arteriovenous fistula (AVF) (needs 6 weeks to mature after formation)

79
Q

What is required in order to start a patient on peritoneal dialysis

A

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

80
Q

When can a patient be listed for cadaveric transplantation

A

within 6 months of dialysis

81
Q

A patient must be “fit enough” to go undergo a transplant. What does this mean

A

They must have a reasonable expectation with surviving 5 years
No recent malignancy
No heart disease or respiratory compromisation

82
Q

How is a patient conservatively managed

A

Epo

Symptom control

SM Renal (23 decks)

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