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Year 2 > Chronic kidney disease > Flashcards

Chronic kidney disease Flashcards

1
Q

What is chronic kidney disease?

A

Reduced GFR and/or evidence of kidney damage over a long period of time

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2
Q

How is GFR assessed?

A

24 hour urine collection (creatinine clearance)

eGFR (serum creatinine, age, sex & race)

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3
Q

Creatinine is a product of the breakdown of what?

A

Muscle

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4
Q

What are the drawbacks of eGFR?

A

Not sensitive over 60ml/min
Over estimates if muscle mass low
Under estimates if muscle mass high
Only valid is serum creatinine is stable (not acute illness)

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5
Q

When might we want to directly measure GFR with nuclear medicine?

A

Screening for kidney donation

Very high or low muscle mass

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6
Q

Describe the stages of CKD

A

Stage 1 - GFR >90 with evidence of kidney damage
Stage 2 - GFR 60-90 with evidence of kidney damage
Stage 3 - GFR 30-60 (A- 45-60 B- 30-44)
Stage 4 - GFR 15-30
Stage 5 - GFR

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7
Q

What do we mean by “evidence of kidney damage”?

A

Proteinuria
Haematuria
Abnormal imaging

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8
Q

How common in CKD?

A

Mild CKD is fairly common especially in the elderly

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9
Q

Why does CKD staging matter if most people don’t progress to severe disease?

A

Must identify those at risk of progression through the stages
Increased CVS risk is important in patient health

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10
Q

Who is likely to progress to severe CKD? Why?

A 
Those with proteinuria (more protein - faster progression)
Younger patients (longer to progress)
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11
Q

What are the common causes of CKD?

A 
Diabetes mellitus
Hypertension
Vascular disease (renal artery stenosis, large vessel disease, etc)
Chronic glomerulonephritis
Reflux nephropathy 
Polycystic kidneys
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12
Q

How does CKD present?

A

Asymptomatic until GFR

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13
Q

How is CKD managed?

A

Slow progression
Manage CVS risk
Treat complications
Prepare for replacement therapy

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14
Q

How can progression of renal disease be slowed?

A

Reducing proteinuria - control BP with ACE/ARB +/- spironolactone
Glucose control
Smoking cessation

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15
Q

How do ACE/ARBs characteristically affect the kidney when they are started? What is the risk of this? How is this monitored?

A

Initially reduce GFR –> risk of hyperkalaemia

Blood test a week or so post starting drugs

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16
Q

How might you reduce CVS risk in patients with CKD?

A

Smoking cessation
BP control
Statins (stage 4)

17
Q

What are the complications of CKD?

A

Anaemia

Bone disease

18
Q

Why is anaemia a complication of CKD?

A

Erythropoietin (stimulates RBC formation) production declines in CKD

19
Q

If a CKD patient has anaemia what must be measured?

A

Iron
Vitamin B12
Folate

Can all be other causes of anaemia

20
Q

How is anaemia of CKD treated?

A

IV iron

If iron doesn’t work weekly/fortnightly SC injection of erythropoietin

21
Q

What is the target haemoglobin in CKD anaemia?

A

105-125 g/dl

22
Q

If giving erythropoietin for CKD what else must be given?

A

Iron (as stores depleted)

23
Q

How is vitamin D metabolised in the kidney?

A

Hydroxylated

24
Q

What happens to vitamin D metabolism in CKD?

A

Reduced calcium absorption –> secondary hyperparathyroidism

Serum phosphate raised (advanced disease) –> increases PTH secretion

25
Q

Hyperplasia of all parathyroid glands occurs in CKD. T/F

A

True

26
Q

Explain tertiary hyperparathyroidism and its main complication

A

Autonomous production of PTH even when serum calcium normal –> hypercalcaemia

27
Q

What is the sequelae of CKD bone disease?

A

Severe bone disease (pain & imaging changes) uncommon

High phosphate and calcium –> calcification of vessels and heart valves

28
Q

How is bone disease in relation to CKD managed?

A 
Alfacalcidol (hydroxylated vit D)
Adjustment of phosphate intake in diet
Phosphate binders (bind to phosphate in gut to reduce absorption)
29
Q

Name three phosphate binders

A

Calcium carbonate
Calcium acetate
Sevelamer

30
Q

Name three types of renal replacement therapy

A

Haemodialysis
Peritoneal dialysis
Kidney transplant

31
Q

What is the best form of dialysis access? How long does it take to mature?

A

Arteriovenous fistula

6 weeks

32
Q

Why is an operation needed in peritoneal dialysis? How long does it take to mature?

A

Insertion of cannula

1-2 weeks

33
Q

How long must people be able to live to be considered for a transplant?

A

At least 5 years

34
Q

When is conservative management indicated over dialysis?

A

Older patients with multiple co-morbidities

Symptom control still given

Year 2 (72 decks)

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