Chronic Kidney Disease Flashcards
Someone has chronic kidney disease. What do you do next?
Look at urine
By how much does eGFR fall in healthy adults?
Up to 10 mL/min per decade beyond age 40
What is chronic kidney disease?
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
What is evidence of kidney damage?
Microalbuminuria Proteinuria Glomerular haematuria Pathological abnormalities Anatomical abnormalities
What gives a false positive albuminuria or proteinuria?
Exercise UTI Sepsis CCF Heavy protein intake Menses
When do signs and symptoms of chronic kidney disease appear?
Severe CKD - eGFR <15 mL/min
What are methods to detect albuminuria or proteinuria?
Urinalysis Quantitation - Urine albumin:creatinine ratio - Urine protein:creatinine ratio - 24 hr urine collection
What does staging in chronic kidney disease identify?
Risk of progression of kidney disease
Risk of CV complications
Who is at risk of chronic kidney disease?
Age >55 HTN Diabetes Smoker Obese 1st degree family relative with CKD Established CVD Chronic infection Aboriginal and Torres Strait Islander descent
What investigations should be conducted in people who are at risk of chronic kidney disease?
Serum creatinine
Urine albumin creatinine ratio
BP
What proportion of people will decline with chronic kidney disease?
1/3 maintain stable kidney function/mild decline
1/3 moderate progression
1/3 severe progression
What are the imaging modalities used in chronic kidney disease?
Renal US CT +/- contrast Nuclear isotope scans - DMSA - MAG-3 scan - DTPA
What is the inheritance pattern of adult polycystic kidney disease?
Autosomal dominant
What are the principles of management for chronic kidney disease?
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
What can cause haematuria?
Glomerular pathology Malignancy Ureteric stones Periods UTI
What lifestyle modifications can be implemented in chronic kidney disease?
Weight reduction Healthy diet Dietary salt restriction Physical activity Moderate alcohol consumption Cease smoking
What are the two most important modifiable risk factors in reducing the progression of chronic kidney disease?
HTN
Proteinuria
What is the target blood pressure in chronic kidney disease?
Less than 130/80 mmHg
Less than 125/75 mmHg in proteinuria/diabetes
What is the leading cause of death in chronic kidney disease patients?
CVD
What are the metabolic complications of chronic kidney disease?
Anaemia Metabolic acidosis Hypocalcaemia Dyslipidaemia Nutrition
Correcting anaemia in dialysis patients can improve what?
Energy levels
Sleep
Cognitive function
Quality of life
What is the treatment for metabolic acidosis in chronic kidney disease?
Na bicarbonate
Aim for serum bicarbonate >20 mmol/L
How is chronic kidney disease-mineral and bone disorder (CKD-MBD) treated?
Phosphate binders
Control of hyperparathyroidism
What are the general symptoms and signs of someone with late stage chronic kidney disease?
Lethargy and malaise
Fluid overload
Nocturia
What are the cardiovascular symptoms and signs of someone with late stage chronic kidney disease?
High BP
Heart failure
Pericarditis
IHD
What are the gastrointestinal symptoms and signs of someone with late stage chronic kidney disease?
Anorexia
Nausea and vomiting
Dysgeusia/metallic taste in mouth
What are the skin symptoms and signs of someone with late stage chronic kidney disease?
Pruritis
What are the neurological symptoms and signs of someone with late stage chronic kidney disease?
Peripheral neuropathy
Seizures
Restless legs
What are the ophthalmological symptoms and signs of someone with late stage chronic kidney disease?
Changes of HTN may be present
What are the targets for glucose control in chronic kidney disease?
Pre-prandial BSL = 4.4-6.7 mmol/L
HbA1c <7.0%
How are glucose levels managed in chronic kidney disease?
Lifestyle modification
Oral hypoglycaemic agents
Insulin
How does chronic kidney disease stage 4 to 5 management differ from management of chronic kidney disease stage 3?
Basic underlying principles same
Plus plan for treatment options when solute clearance and fluid balance declines to level at which life endangered
What is renal replacement therapy?
Dialysis
Renal transplant
When do most patients start dialysis?
GFR <10 mL/min or when symptoms dictate
What is the penetrance of adult polycystic kidney disease?
Not every nephron gets a cyst
What is the commonest cause of glomerulonephritis?
IgA nephropathy
What does only protein in the urine mean, compared with protein and blood in the urine?
Only protein - damage to kidneys
Protein + blood = inflammation
What medications can be used to lower blood pressure in the setting of proteinuria?
ACE inhibitors
ARBs
Direct renin inhibitors
Spironolactone
What is the classical picture of diabetic nephropathy?
Microalbuminuria > macroalbuminura
Decrease in eGFR
Do you do a renal biopsy to diagnose diabetic nephropathy?
If classic presentation, don’t biopsy
If non-classical presentation, biopsy
Why do you get anaemia in chronic kidney disease?
Low EPO
Why do you get metabolic acidosis in chronic kidney disease?
Decreased H ion excretion > HCO3 decrease > metabolic acidosis
