Chronic kidney disease Flashcards
List the functions of the kidneys
- Control of BP
- Excretion of nitrogenous waste
- Drug metabolism and disposal
- Maintenance of acid and electrolyte balance
- Activation of vitamin D
- Production of erythropoetin
What was the traditional definition of chronic kidney disease?
Irreversible and significant loss of renal function, and thus problems with the various roles of the kidneys
How do we assess kidney function?
Filtration (excrete out) function – use estimates of GFR (eGFR) from creatinine blood test
Filtration (keep in) function – check for presence of blood or protein in urine
Anatomy – histology, radiography
What problems arise when using creatinine to assess GFR?
o Muscle mass • Age • Ethnicity • Gender • Weight o Other sources
What ethnic group have higher creatinine levels?
African Americans will have a higher serum creatinine level at any level of creatinine clearance because they have a higher muscle mass.
What formulae are used to estimate GFR from serum creatinine?
- Cockcroft Gault
- MDRD 4 variable equation
- CKD-EPI equation
What crosses the glomerular basement membrane but is not necessarily reabsorbed?
– Water
– Electrolytes
– Urea
– Creatinine
What is the current definition of chronic kidney disease?
Chronic kidney disease (CKD) is defined by either the presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR<60 ml/min/1.73m2 that is present for ≥3 months
What complications are associated with chronic kidney disease?
- Acidosis
- Anaemia
- Bone disease
- Cardiovascular
- Death & Dialysis
- Electrolytes
- Fluid overload
- Gout
- Hypertension
- Iatrogenic issues
List some causes of CKD
o Diabetes
o Polycystic kidney disease
o Glomerulonephritis and all causes of this
o Hypertension
o Renovascular disease - renal artery stenosis from atherosclerosis or fibromuscular dysplasia leads to ischaemic nephropathy
o Persistently decreased renal perfusion - on-going heart failure or cirrhosis
o Myeloma
o IgA nephropathy
o Nephrocalcinosis
o Sarcoidosis
o Chronic exposure to nephrotoxins (NSAIDs, lithium, lead, certain herbs)
o Reflux nephropathy and scarring
o Chronic obstructive nephropathy (prostatic disease, metastatic cancer, retroperitoneal fibrosis, PUJ obstruction)
What is the general clinical approach to CKD?
Detection of the underlying aetiology
– Treatment for specific disease
Slowing the rate of renal decline
– Generic therapies
Assessment of complications related to reduced GFR
– Prevention and Treatment
Preparation for Renal Replacement Therapy
List some symptoms and signs of CKD
Pallor - anaemia Hypertension Shortness of breath - oedema, anaemia, CV risk Kidney - shape on imaging, palpable? Itch and cramps Cognitive changes GI symptoms e.g. vomiting, anorexia, uraemic odour Change in urine output Haematuria Proteinuria Peripheral oedema
What would be asked during history to see if there is any previous history of renal disease?
o Raised urea/creatinine o Proteinuria/haematuria o Hypertension o Lower urinary tract symptoms o Family history (PKD/Alports)
What systemic diseases are linked to CKD?
o Diabetes mellitus o Collagen vascular diseases o SLE, scleroderma, vasculitis o Malignancy o Myeloma, breast, lung, lymphoma o Hypertension o Sickle cell disease o Amyloidosis
What drugs are linked to CKD development?
o NSAIDs o Penicillins/aminoglycosides o Chemotherapeutic drugs o Narcotic abuse o ACE inhibitor / ARBs
Also antibiotics, morphine, digoxin, metformin and contrast agents