Chronic Kidney Disease Flashcards
Definition of chronic kidney disease
The presence of kidney damage (abnormal blood, urine or x-ray findings) OR GFR <60 ml/min/1.73m2
FOR ≥3 MONTHS
What is used to assess for kidney disease
Anatomy
Filtering function
Excretory function
How is Excretory function assessed
GFR
Formula used to estimate GFR from serum, creatinine
Cockcroft Gault
What 4 substances are filtered out at the glomerulus
Water
Urea
Creatinine
Electrolytes
What does not get filtered at the glomerulus
WBC
RFC
Large proteins like albumin
How is kidney filtering assesed
Urinalysis (dipsticks)
Should be no blood or protein
How is the anatomy of ghetto kidney assesed
Histology
Radiology
Complications of CKD
AABCDDEF
Acidosis Anaemia Bone disease Cardiovascular (Hypertension/arrhythmias) Death & Dialysis Electrolytes Fluid overload
7 causes of CKD
Heart Failure (persistently low kidney perfusion) Hypertention Diabetes Sarcoidoses Polycystic kidney disease Nephrotoxic drugs Glomerulonephritis
Tests for underlying aetiology of CKD
Blood tests- U&E’s, FBC
Histology - Biopsy
Urine test - Urinalysis (Dipstick)
Radiology- Ultrasound, CT, Plain Film
4 steps in the clinical approach to CKD
- Detection of the underlying aetiology (then treatment of it)
- Slowing the rate of renal decline
- Assessment of complications related to reduced GFR (prevention and treatment of those)
- Preparation for Renal Replacement Therapy
How to slow the rate of renal decline
BP management
Control Proteinuria
Control Acidosis
Dietary Protein Restriction
CKD’s effect on activated vitamin D
Reduced levels as it’s activated in the kidney by 1 aplha-hydroxylase, which is low in CKD 》low activated vitamin D
How does CKD lead to low calcium
Low vitamin D 》low Ca2+ intestinal reabsorption and reduced tubular reabsorption
Why can CKD cause secondary hyperparathyroidism
Low vitamin D 》Ca2+ 》Increased PTH release
Why can CKD cause bone disease
Low vitamin D 》Ca2+ 》Increased PTH release 》Increased activity of Osteoclasts》Increased calcium (released from bone weakening it)
Management of CKD bone disease
Consume more Ca2+
Calcitriol (Active Vitamin D Analogue)
Management of Acidosis and Anaemia caused by CKD
Acidosis - Bicarbonate
Anaemia - Erythropoietin (EPO) and Iron
Management of CV risk and Death and Dialysis caused by CKD
CV risk - Aspirin, BP weight and cholesterol control, exercise
Death and Dialysis - Counsel and Prepare
Management of Electrolytes and Fluid Overload
Electrolytes - Diet, consider drugs
Fluid Overload - Salt and Fluid restriction and diuretics
What would suggest a poor prognosis
Low GFR and more proteinuria
3 Common CKD complications
Anaemia
Acidosis
Bone disease
