Chronic Kidney Disease Flashcards
Define chronic kidney disease
The presence of kidney damage or decreased kidney function for three months or longer.
Define accelerated CKD
A sustained decrease in GFR of at least 25% and a change in GFR category within 12 months, or when GFR decreases by 15ml/min per year.
Define kidney failure
GFR < 15ml/min, or when dialysis or transplant is required.
Describe Stage 1 CKD
Kidney damage
Normal or high GFR
GFR>90
Describe Stage 2 CKD
Kidney damage
Mild reduction in GFR
GFR = 60 - 89
Describe Stage 3 CKD
Kidney function is moderately impaired
3a: GFR = 45 - 59
3b: GFR = 30 - 44
Describe Stage 4 CKD
Kidney function is severely impaired
GFR = 15 - 29
Describe Stage 5 CKD
Advanced disease or patient is on dialysis
GFR <15
What does it mean if the suffix “p” is added onto the CKD classification?
The patient has proteinuria as well as decreased GFR.
Give five pieces of evidence that indicate CKD, other than GFR.
- Persistent microalbuminuria.
- Persistent proteinuria.
- Persistent haematuria (after exclusion of other causes – e.g. urological disease).
- Structural abnormalities of the kidneys, demonstrated on ultrasound scanning or other radiological tests
- Biopsy-proven chronic glomerulonephritis.
List possible causes or risk factors for CKD
Diabetes Glomerulonephritis Hypertension Renovascular disease Polycystic kidney disease Infective, obstructive and reflux nephropathies Hypercalcaemia Multisystem diseases such as SLE Neoplasms Myeloma
Describe the specific symptoms that can present in sever CKD
Anorexia, nausea and vomiting Fatigue, lethargy, weakness Weight loss Dyspnoea, pulmonary oedema, peripheral oedema Nocturia, polyuria, headache Pruritus Impotence (men), amenorrhoea (women)
Describe the clinical signs that can present in a patient with advanced CKD
Skin pigmentation or pallor
Excoriation (skin picking) due to pruritus
Hypertension but with postural hypotension
Peripheral oedema
Left ventricular hypertrophy
Pleural effusions
Peripheral vascular disease, peripheral neuropathy
Give five classes of drugs that are particularly significant in kidney disease
NSAIDs penicillins/aminoglycosides chemotherapeutic drugs narcotics ACE inhibitors/ARBs
How is eGFR calculated?
eGR is calculated by measuring serum creatinine and using a set formula.
What is the gold standard for measuring kidney function?
Glomerular filtration rate (GFR) using inulin.
In CKD, would serum levels of sodium, potassium, bicarbonate and phosphate be expected to be high, low or normal?
Sodium - usually normal but may be low
Potassium - high
Bicarbonate - low (four from 24 = chronic)
Phosphate - usually high
When might hypoalbuminaemia occur in patients with chronic kidney disease?
Hypoalbuminaemia may occure in patients who are nephrotic and/or malnourished. Low levels of albumin at the start of dialysis are associated with a poor prognosis
How is serum level of parathyroid hormone affected by chronic kidney disease?
Serum PTH rises progressively with declining kidney function.
What is the significance of a high serum alkaline phosphatase in CKD patients?
A high alkaline phosphatase is indicative of the development of bone disease.
What is the cause of anaemia in CKD?
low levels of haemoglobin (normal Hb is 11.5-16g/dL in females and 13.5-18g/dL in males)
Describe the three components of the nephrotic syndrome triad
Proteinuria (>3.5g/24hrs)
Hypoalbuminaemia - due to renal protein loss
Oedema - due to low intravascular oncotic pressure associated with hypoalbuminaemia, and to some extend the fluid retention caused by decreased tubular function in the kidney.
(may also have hypercholersterolaemia)
Describe the components of nephritic syndrome
Hyperension
Haematuria (usually microscopic but can be macroscopic)
Acute renal failure
(may also have oedema)
Name three equations used to calculate eGFR from serum creatinine
Cockcroft Gault equation
MDRD 4 variable equation
CKD-EPI equation
List the types of imaging which may be used in the investigation of kidney disease
ECG and echocardiography Abdominal X-ray Renal ultrasound Renal CT MRI
What should always be done before taking a renal biopsy?
Check clotting ability
List 10 potential complications of chronic kidney disease
Acidosis Anaemia Bone disease Cardiovascular risk Dialysis and Death Electrolytes Fluid overload Gout Hypertension Iatrogenic issues
Generally speaking, when does fluid overload become problematic?
When GFR<20mls/min
How is hyperkalaemia managed?
Acute:
- administer calcium gluconate to stabilise patient
- administer salbutamol or insulin-dextrose to shift potassium into cells
- use dialysis and/or calcium resonium to remove excess potassium
Chronic hyperkalaemia can be managed with diet and drug modifications.
What is the normal range for potassium? At what level is there a serious risk of cardiac arrest?
Normal range 3.5 - 4.5 mmol/L
K+ > 7 mmol/L may induce cardiac arrest
Describe the management of fluid overload in CKD
Na+ restriction
Fluid restriction
Loop diuretics
Describe the presentation of Polycystic Kidney Disease
Acute loin pain May have haematuria Vague abdominal/loin discomfort due to increasing size of kidneys Hypertension Features of uraemia
What are the potential extrarenal manifestations of PKD?
Cysts can occur in the liver (most common), pancreas, spleen and/or lungs
Berry aneurysms
Mitral valve prolapse
Increased frequency of colonic diverticula
What is the prognosis of Polycystic Kidney Disease?
45% will be in end stage renal disease by the age of 60
