Chronic Kidney Disease Flashcards
What is the definition of CKD?
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
How do we estimate GFR?
Measure creatinine
Serum creatinine
What causes variation in creatinine?
Muscle mass Age Ethnicity Gender Weight
What are accurate ways of measuring GFR?
Inulin
And isotop GFR
Why do we not use inulin or isotope GFR in clinical practice?
Takes too long to clear
What is GFR is CKD stage 1?
> 90
What is GFR in CKD stage 2?
60-89
What is GFR in CKD stage 3a?
45-59
What is GFR in CKD stage 3b?
30-44
What is GFR in CKD stage 4?
15-29
What is GFR in stage 5 CKD?
<15
What should urine dipsticks be used to test for?
Blood and protein
Should there be blood and protein in the urine?
No
What do the 3 classes of A1 A2 and A3 measure?
Albuminuria
At what stage is CKD typically diagnosed at?
Stage 3
As GFR decreases what is the risk of complication?
More likely to have complications
What are some causes of CKD?
DM Glomerulonephritis Hypertension Renovascular disease PKD Chronic exposure to nephrotoxins Chronic obstructive nephropathy
What are some signs and symptoms of CKD?
Pallor Hypertension SOB Proteinuria Haematuria Peripheral oedema Itch and cramps
What blood tests should be done for CKD?
U&E Creatinine Bicarbonate Total protein Toral albumin Calcium LFT Immunoglobulins Platelets Hb Coagulation screen
What urine tests should be done for CKD?
Blood
Protein
Protein creatinine ratio
Albumin creatinine ration
What histology investigations should be done for CKD?
Renal biopsy
What radiological investigations should be done for CKD?
USS
plain radiograph
CT
MRI
What managing factors should be controlled in CKD?
BP control
Control proteinuria
Be aware of drugs and toxins
Reverse other contributing factors
When is metabolic acidosis seen regarding GFR?
When GFR <20 mls/min
When does anaemia usually manifest in CKD?
When GFR <20mls/min
What is the treatment for anaemia?
Iron replacement
What is the effect of CKD on bones?
¥ As GFR gets worse
¥ Get high phosphate in the blood
¥ Loss of renal tissue leads to lack of activated vitamin D
¥ Indirect reduction in calcium absorption
¥ Low calcium and raised phosphate
¥ Secondary hyperparathyroidism (elevated PTH)
- In response to hypocalcaemia
¥ Lose Ca2+ from the bones
What can be done to manage hyperkalaemia?
Reduce potassium in diet
Change medications that may ‘hold onto’ K+
What is a main cause of CKD?
Hypertension
How does hypertension cause CKD?
Narrows vessels
What is the 2nd commonest cause of CKD?
Diabetes
What is azotemia?
High levels of nitrogen containing compounds in the blood
How does CKD lead to anaemia?
Erythropotein levels fall
Reduction of RBC
Leading to anaemia
