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General Medicine Pt1 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Define chronic kidney disease

A

Abnormalities in kidney function/structure present for >3/12, with implications for health.

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2
Q

Define stage 1 CKD

A
  • eGFR (ml/min/1.73m2)
    • 90+ (G1)
    • Requires markers of kidney damage
      • eg. ACR >3; sediment; U+Es; histology; imaging
  • Urinary ACR (mg/mmol)
    • A2: 3-30
    • A3 >30
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3
Q

Define stage 2 CKD

A
  • eGFR (ml/min/1.73m2)
    • 60-89 (G2)
    • Requires markers of kidney damage
      • eg. ACR >3; sediment; U+Es; histology; imaging
  • Urinary ACR (mg/mmol)
    • A2: 3-30
    • A3 >30
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4
Q

Define stage 3a CKD

A
  • eGFR (ml/min/1.73m2)
    • 45-59
  • Urinary ACR (mg/mmol)
    • A1: <3
    • A2: 3-30
    • A3: >30
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5
Q

Define stage 3b CKD

A
  • eGFR (ml/min/1.73m2)
    • 30-44
  • Urinary ACR (mg/mmol)
    • A1: <3
    • A2: 3-30
    • A3: >30
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6
Q

Define stage 4 CKD

A
  • eGFR (ml/min/1.73m2)
    • 15-29
  • Urinary ACR (mg/mmol)
    • A1: <3
    • A2: 3-30
    • A3: >30
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7
Q

Define stage 5 CKD

A
  • eGFR (ml/min/1.73m2)
    • <15
  • ACR (mg/mmol)
    • A1: <3
    • A2: 3-30
    • A3: >30
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8
Q

Define ‘accelerated progression’ of CKD

A

Either:

  • Both:
    • Persistent decrease in GFR of 25+%
    • Change in CKD category within 12 months
  • A persistent decrease in GFR of 15ml/min/1.73m2 per year
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9
Q

What variables are used to estimate GFR using the MDRD equation?

A
  • Serum creatinine
  • Age
  • Gender
  • Ethnicity: Caution in Asian or Chinese origin; if Black x1.159
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10
Q

What factors can affect the estimation of eGFR?

A
  • Pregnancy; oedema
  • Muscle mass: eg. amputees, body-builders
  • Eating red meat 1h prior to the sample being taken
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11
Q

List five risk factors for CKD progression

A
  • Cardiovascular disease
  • Proteinuria
  • AKI: monitor potential/worsening CKD for at 2-3+y after AKI
  • HTN
  • Diabetes
  • Smoking
  • African, Afro-Caribbean, or Asian
  • Chronic use of NSAIDs
  • Untreated urinary outflow tract obstruction
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12
Q

Categorise the aetiology of chronic kidney disease

A
  • 70% of CKD is due to
    • Diabetes mellitus: non-enzymatic glycation
    • HTN: glomerulosclerosis
    • Renovascular disease: Atherosclerosis
  • Congenital and inherited disease
  • Glomerular disease
  • Vascular disease
  • Tubulointerstitial disease
  • Urinary tract obstruction
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13
Q

Name one congenital/inherited cause of CKD

A
  • Polycystic kidney disease: adult and infantile forms
  • Medullary cystic disease
  • Tuberous sclerosis: benign tumour development
  • Oxalosis; cystinosis
  • Congenital obstructive uropathy
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14
Q

Name two glomerular causes of CKD

A
  • Primary glomerulonephritides:
    • FSGS; membranous nephropathy
  • Secondary glomerular disease:
    • Diabetic glomerulosclerosis
    • SLE
    • GPA
    • Amyloidosis
    • Sickle cell disease
    • Thrombotic thrombocytopenic purpura
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15
Q

Name two vascular causes of CKD

A
  • Renovascular disease: atherosclerosis
  • Small-vessel vasculitis: GPA; EGPA; Goodpasture’s
  • Medium-vessel vasculitis: Polyarteritis nodosa; Kawasaki’s
  • HTN nephrosclerosis: common in black Africans
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16
Q

Name two tubulointerstitial causes of CKD

A
  • Idiopathic
  • Nephrotoxic drugs
  • Reflux nephropathy
  • TB; schistosomiasis
  • Nephrocalcinosis: renal calcium deposition
  • Multiple myeloma
  • Diabetes
  • Sickle cell disease
  • Chinese herb nephropathy
17
Q

Name three urinary tract obstructive causes of CKD

A
  • Renal stones
  • Prostatic disease
  • Pelvic tumours
  • Retroperitoneal fibrosis
  • Schistosomiasis
18
Q

Explain the mechanisms by which angiotensin II causes progression of chronic kidney disease

A
  • Local ATII causes vasoconstriction of efferent arterioles
  • Increasing glomerular filtration fraction and pore size of basement membrane ➔ proteinuria
  • Increases collagen synthesis and excessive matrix formation ➔ scarring within the glomerular and interstitium

RAAS antagonists slow CKD progressionin both diabetic and non-diabetic renal disease

19
Q

Name five complications of CKD

A
  • HTN: inappropriate RAAS activation
  • Anaemia: low EPO
  • Hyperkalaemia
  • CKD mineral and bone disorder
  • Cardiovascular calcification; pericarditis
  • Uraemia
  • Impaired glucose tolerence
  • Gout; hypercholesterolaemia
  • hyperPRL; decreased testosterone; menstrual irregularities
20
Q

List three clinical features of uraemia

A
  • Anorexia; intractable NaV
  • Uraemic polyneuropathy; restless legs
  • Pruritus
  • Pericarditis
  • Encephalopathy
    • Intellectual clouding; drowsiness
    • Seizures
    • Coma
  • Haemorrhage: abnormal platelet adhesion
  • ‘Uraemic frost’: acummulation in skin
21
Q

What are CKD mineral and bone disorders

A

CKD results in:

  • Impaired 1-a-hydroxylation
    • Low vit D, low Ca2+​, 2o hyper-PTH
  • Impaired phosphate excretion: High PO4-
  • Osteomalacia
    • Due to high PO4- binding to Ca2+, activates PTH
22
Q

Give three indications for CKD testing

A

Offer CKD testing if any of following risk factors:

  • Diabetes
  • HTN
  • AKI
  • Cardiovascular: IHD; HF; PVD; stroke/TIA
  • Structural renal tract disease; recurrent renal calculi; BPH
  • Multisystem disease with possible renal involvement: eg. SLE
  • FHx of Stage 5 CKD
  • Opportunistic detection of haematuria
23
Q

Request four investigations for suspected CKD

A
  • Urinalysis: haematuria, proteinuria
  • Urine ACR
  • U+Es; Serum creatinine
  • CBG; HbA1c
  • Renal ultrasound scan if indicated
24
Q

Give three indications for renal USS in CKD

A
  • Accelerated progression of CKD
  • Visible or persistent invisible haematuria
  • Symptoms of urinary tract obstruction
  • FHx of polycystic kidney disease and are aged >20
  • CKD Stage 4 or 5
  • Considered to required renal biopsy
25
Q

Describe the lifestyle advice and dietary management of CKD

A
  • Encourage exercise, healthy weight
  • Smoking cessation
  • Diet
    • Careful potassium intake
    • Reduce phosphate if CKD-MBD
    • Calorie and salt intake
26
Q

Outline the medical management of CKD

A

Treat any underlying reversible causes; stop nephrotoxins

  • BP: <140/90 or 130/80 if diabetic or ACR >70
    • ACEi: CKD with either diabetes; HTN; ACR >70
  • Atorvastatin 20mg
  • Apixaban or Warfarin: secondary prevention of CVD
  • Consider and contact nephrology:
    • Bisphosphonates: osteoporosis
    • Vitamin D: CKD mineral and bone disease
    • EPO: CKD-associated anaemia
    • Sodium bicarbonate: metabolic acidosis
27
Q

What monitoring should be done prior to starting a RAAS antagonist for CKD?

A

Serum K+ and eGFR

Do not offer RAAS antagonists if K+ >5.0 mmol/L

Stop if K+ increases to 6.0

28
Q

What are acceptable changes in eGFR and creatinine after starting ACEi for CKD?

A

Either:

  • Decrease in eGFR of up to 25%
  • Rise in creatinine of up to 30% is acceptable
    • Greater than this may indicate renovascular disease

General Medicine Pt1 (25 decks)

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