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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
What are the most common symptoms of CKD
``` non-speciifc tiredness poor appetite itch sleep disturbance Impaired concentration of urine ```
26
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
27
How can we slow the progression of CKD
reduce proteinuria control BP - ACE inhibitors and ARBs Stop smoking Good glycemic control
28
What are the side effects of using ACEI or ARBs
They may cause hyperkalaemia
29
How can we reduce the CVD risk
BP and proteinuria stop smoking statins
30
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
31
How is anaemia usually corrected
IV iron | Erythropoeitin (Epo) - subcut injection once weekly
32
What is the main side effect with using Epo
The iron stores will be depleted
33
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)
34
How is bone disease as a result of CKD managed
Alfacalcidol - hydroxylatsed vitamin D doesn't need activation by the kidneys
35
What are the 4 treatment options for established "end stage" renal failure
Haemodialysis Peritoneal dialysis Transplantation Conservative management
36
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
37
When should a patient be referred for dialysis
When the GFR is about 20
38
What is required in order to start a patient on haemodialysis
Arteriovenous fistula (AVF) (needs 6 weeks to mature after formation)
39
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
40
When can a patient be listed for cadaveric transplantation
within 6 months of dialysis
41
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
42
How is a patient conservatively managed
Epo | Symptom control
43
How is CKD diagnosed
At least 2 measurements of GFR or creatinine with a decent time period in between
44
Why do we not directly assess GFR very often
It is time consuming for both patient and staff | expensive - done in nuclear medicine
45
What can we use to estimate GFR instead of measuring it
Creatinine clearance
46
What is creatinine
A product of muscle breakdown - muscular people produce more creatinine
47
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
48
When is GFR overestimated
If muscle mass is low | Amputations
49
When is GFR underestimated
If muscle mass is high
50
When would we want to use nuclear medicine to measure GFR
If someone wanted to donate a kidney
51
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
52
What is stage 1 CKD
GFR >90ml/min with evidence of kidney damage
53
What is stage 2 CKD
GFR 60-90ml./min with evidence of kidney damage
54
What are examples of evidence of kidney damage
Proteinuria Haematuria Abnormal imaging
55
What is stage 3 CKD
GFR 30-60
56
What is stage 4 CKD
GFR 15-30
57
What is stage 5 CKD
58
What would a patient with Stage 5 CKD require
Dialysis
59
When is CKD classed as severe
Stage 4
60
What does CKD increase the risk of
Cardiovascular risk
61
What is an indication that a patient with CKD will progress faster
Proteinuria
62
What are some of the causes of CKD
``` Diabetes Hypertension Vascular disease Chronic glomerulonephritis Reflux nephropathy Polycystic kidneys Unknown ```
63
What is the commonest single reason for needing dialysis
Diabetes (affecting small vessels of the kidneys)
64
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
65
What are the most common symptoms of CKD
``` non-speciifc tiredness poor appetite itch sleep disturbance Impaired concentration of urine ```
66
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
67
How can we slow the progression of CKD
reduce proteinuria control BP - ACE inhibitors and ARBs Stop smoking Good glycemic control
68
What are the side effects of using ACEI or ARBs
They may cause hyperkalaemia
69
How can we reduce the CVD risk
BP and proteinuria stop smoking statins
70
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
71
How is anaemia usually corrected
IV iron | Erythropoeitin (Epo) - subcut injection once weekly
72
What is the main side effect with using Epo
The iron stores will be depleted
73
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)
74
How is bone disease as a result of CKD managed
Alfacalcidol - hydroxylatsed vitamin D doesn't need activation by the kidneys
75
What are the 4 treatment options for established "end stage" renal failure
Haemodialysis Peritoneal dialysis Transplantation Conservative management
76
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
77
When should a patient be referred for dialysis
When the GFR is about 20
78
What is required in order to start a patient on haemodialysis
Arteriovenous fistula (AVF) (needs 6 weeks to mature after formation)
79
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
80
When can a patient be listed for cadaveric transplantation
within 6 months of dialysis
81
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
82
How is a patient conservatively managed
Epo | Symptom control

SM Renal (23 decks)

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