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MD2 Medicine > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Someone has chronic kidney disease. What do you do next?

A

Look at urine

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2
Q

By how much does eGFR fall in healthy adults?

A

Up to 10 mL/min per decade beyond age 40

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3
Q

What is chronic kidney disease?

A

GFR <60 mL/min for >3 months with/without evidence of kidney damage
OR
Evidence of kidney damage with/without decreased GFR for >3 months

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4
Q

What is evidence of kidney damage?

A 
Microalbuminuria
Proteinuria
Glomerular haematuria
Pathological abnormalities
Anatomical abnormalities
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5
Q

What gives a false positive albuminuria or proteinuria?

A 
Exercise
UTI
Sepsis
CCF
Heavy protein intake
Menses
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6
Q

When do signs and symptoms of chronic kidney disease appear?

A

Severe CKD - eGFR <15 mL/min

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7
Q

What are methods to detect albuminuria or proteinuria?

A 
Urinalysis
Quantitation
- Urine albumin:creatinine ratio
- Urine protein:creatinine ratio
- 24 hr urine collection
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8
Q

What does staging in chronic kidney disease identify?

A

Risk of progression of kidney disease

Risk of CV complications

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9
Q

Who is at risk of chronic kidney disease?

A 
Age >55
HTN
Diabetes
Smoker
Obese
1st degree family relative with CKD
Established CVD
Chronic infection
Aboriginal and Torres Strait Islander descent
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10
Q

What investigations should be conducted in people who are at risk of chronic kidney disease?

A

Serum creatinine
Urine albumin creatinine ratio
BP

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11
Q

What proportion of people will decline with chronic kidney disease?

A

1/3 maintain stable kidney function/mild decline
1/3 moderate progression
1/3 severe progression

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12
Q

What are the imaging modalities used in chronic kidney disease?

A 
Renal US
CT +/- contrast
Nuclear isotope scans
- DMSA
- MAG-3 scan
- DTPA
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13
Q

What is the inheritance pattern of adult polycystic kidney disease?

A

Autosomal dominant

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14
Q

What are the principles of management for chronic kidney disease?

A

ID and treat underlying cause of kidney disease
Reduce further progression of kidney disease
Reduce CV risk
Early detection and management of metabolic complications
Medication adjustment/avoidance of renally excreted and nephrotoxic medications

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15
Q

What can cause haematuria?

A 
Glomerular pathology
Malignancy
Ureteric stones
Periods
UTI
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16
Q

What lifestyle modifications can be implemented in chronic kidney disease?

A 
Weight reduction
Healthy diet
Dietary salt restriction
Physical activity
Moderate alcohol consumption
Cease smoking
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17
Q

What are the two most important modifiable risk factors in reducing the progression of chronic kidney disease?

A

HTN

Proteinuria

18
Q

What is the target blood pressure in chronic kidney disease?

A

Less than 130/80 mmHg

Less than 125/75 mmHg in proteinuria/diabetes

19
Q

What is the leading cause of death in chronic kidney disease patients?

A

CVD

20
Q

What are the metabolic complications of chronic kidney disease?

A 
Anaemia
Metabolic acidosis
Hypocalcaemia
Dyslipidaemia
Nutrition
21
Q

Correcting anaemia in dialysis patients can improve what?

A

Energy levels
Sleep
Cognitive function
Quality of life

22
Q

What is the treatment for metabolic acidosis in chronic kidney disease?

A

Na bicarbonate

Aim for serum bicarbonate >20 mmol/L

23
Q

How is chronic kidney disease-mineral and bone disorder (CKD-MBD) treated?

A

Phosphate binders

Control of hyperparathyroidism

24
Q

What are the general symptoms and signs of someone with late stage chronic kidney disease?

A

Lethargy and malaise
Fluid overload
Nocturia

25
Q

What are the cardiovascular symptoms and signs of someone with late stage chronic kidney disease?

A

High BP
Heart failure
Pericarditis
IHD

26
Q

What are the gastrointestinal symptoms and signs of someone with late stage chronic kidney disease?

A

Anorexia
Nausea and vomiting
Dysgeusia/metallic taste in mouth

27
Q

What are the skin symptoms and signs of someone with late stage chronic kidney disease?

A

Pruritis

28
Q

What are the neurological symptoms and signs of someone with late stage chronic kidney disease?

A

Peripheral neuropathy
Seizures
Restless legs

29
Q

What are the ophthalmological symptoms and signs of someone with late stage chronic kidney disease?

A

Changes of HTN may be present

30
Q

What are the targets for glucose control in chronic kidney disease?

A

Pre-prandial BSL = 4.4-6.7 mmol/L

HbA1c <7.0%

31
Q

How are glucose levels managed in chronic kidney disease?

A

Lifestyle modification
Oral hypoglycaemic agents
Insulin

32
Q

How does chronic kidney disease stage 4 to 5 management differ from management of chronic kidney disease stage 3?

A

Basic underlying principles same

Plus plan for treatment options when solute clearance and fluid balance declines to level at which life endangered

33
Q

What is renal replacement therapy?

A

Dialysis

Renal transplant

34
Q

When do most patients start dialysis?

A

GFR <10 mL/min or when symptoms dictate

35
Q

What is the penetrance of adult polycystic kidney disease?

A

Not every nephron gets a cyst

36
Q

What is the commonest cause of glomerulonephritis?

A

IgA nephropathy

37
Q

What does only protein in the urine mean, compared with protein and blood in the urine?

A

Only protein - damage to kidneys

Protein + blood = inflammation

38
Q

What medications can be used to lower blood pressure in the setting of proteinuria?

A

ACE inhibitors
ARBs
Direct renin inhibitors
Spironolactone

39
Q

What is the classical picture of diabetic nephropathy?

A

Microalbuminuria > macroalbuminura

Decrease in eGFR

40
Q

Do you do a renal biopsy to diagnose diabetic nephropathy?

A

If classic presentation, don’t biopsy

If non-classical presentation, biopsy

41
Q

Why do you get anaemia in chronic kidney disease?

A

Low EPO

42
Q

Why do you get metabolic acidosis in chronic kidney disease?

A

Decreased H ion excretion > HCO3 decrease > metabolic acidosis

MD2 Medicine (18 decks)

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