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Year 2 Urinary (JK) > Chronic kidney disease > Flashcards

Chronic kidney disease Flashcards

1
Q

What is meant by chronic kidney disease?

A

irreversible and significant loss of renal function

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2
Q

How do we measure the filtration (excrete out) function of the kidney?

A

eGFR from creatinine blood test

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3
Q

How do we measure the filtration (keep in) function of the kidney?

A

blood/protein in urine

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4
Q

How do we assess the anatomy of the kidney?

A

histology/radiography

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5
Q

Define the stages of CKD in terms of eGFR

A 
Stage 1 >90
Stage 2 60-89
stage 3a 45-59
stage 3b 30-44
stage 4 15-29
Stage 5 <15
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6
Q

How is eGFR measured?

A

serum creatinine

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7
Q

3 problems with serum creatinine for eGFR

A

need to lose about 60% GFR for a rise in Screatinine
muscle mass
other sources eg steak dinner

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8
Q

What substances cross GBM bit reabsorbed in PCT?

A

glucose

low molecular weight proteins

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9
Q

What substances do not cross GBM?

A

cells eg RBC, WBC

high molecular weight proteins eg albumin

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10
Q

Should there be blood or protein in the urine?

A

no

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11
Q

How do we quantify protein in the urine?

A

protein creatinine ratio - PCR

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12
Q

Define CKD

A

Presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR <60mls/min/1.73msquared for more than 3 months

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13
Q

List the complications of CKD

A 
Acidosis 
Anaemia 
Bone disease 
CVS 
Death and dialysis 
Electrolyte 
fluid overload 
gout 
hypertension 
iatrogenic issues
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14
Q

What are CKD complications more likely with?

A

worsening eGFR

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15
Q

List some causes of CKD

A

diabetes, glomerulonephritis, PKD, myeloma
renovascular disease eg atherosclerosis, renal artery stenosis
hypertension
persistent decreased renal perfusion eg heart failure and cirrhosis
chronic exposure to nephrotoxins eg NSAIDS

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16
Q

List some symptoms and signs of CKD

A 
cognitive impairment 
hypertension 
pallor - anaemia 
peripheral oedema 
pulmonary oedema
anorexia, vomiting
polyuria, haematuria, proteinuria, oliguria, nocturia, frothy urine 
itch, cramps
unilateral small kidneys, cystic kidneys etc
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17
Q

What would give evidence of previous renal disease?

A

raised creatinine/urea
LUTS
proteinuria/haematuria
hypertension

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18
Q

What would you ask in a history for CKD?

A

FH - PKD
systemic eg malignancy, hypertension, DM
Drugs eg NSAIDS, aminoglycosides, ACEI
pre/post renal factors eg V&D, heart failure, diuretics
uraemic symptoms eg pruritus, weight loss, fatigue, nausea

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19
Q

Examination in CKD

A 
vital signs eg bp, fever 
volume status - overload eg raised JVP, oedema 
deplete eg skin turgor
skin eg rash 
cardiac murmurs 
bruits, palpable organs
pulses
bones and joints
obstruction eg bladder
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20
Q

Blood chemistry CKD

A

U+E and FBC

bicarbonate, calcium, phosphate, LFT, CK, Ig

21
Q

Urine tests for CKD

A

urine dip, urine PCR or ACR, 24 hour collection

22
Q

How would we do renal histology?

A

with a biopsy

23
Q

What imaging would be done for CKD?

A

USS, CT, MRI, plain radiography, nuclear medicine

24
Q

Positives and negatives of USS in CKD

A

positive - no radiation, not invasive

negative - no functional data, not tell about chronicity of disease, operator dependent

25
Q

How can we manage CKD to slow that rate of decline

A 
Bp control 
lipid control 
control acidosis 
protein restriction 
control proteinuria - ACEI/ARB
26
Q

Identify how we would assess the complications of CKD

A 
Acidosis - bicarbonate and H+
anaemia - FBC, film, haematinincs 
bone disease - ca, phosphate, albumin, PTH
CVS - chest pain, bp, cholesterol 
death and dialysis - urea, creatinine, GFR
electrolytes - and K+
fluid overload - bp, oedema, JVP, CXR
gout 
hypertension - bp +/- 24 hour tape 
iatrogenic issues - medications
27
Q

What GFR will acidosis be seen?

A

not until <20mls/min

28
Q

When is acidosis most marked?

A

in tubular interstitial disease

29
Q

How is metabolic acidosis treated?

A

oral sodium bicarbonate

30
Q

Problems with metabolic acidosis

A

worsens renal bone disease

hyperkalaemia risk

31
Q

Why does anaemia occur in CKD?

A

Reduced erythropoietin production
reduced RBC survival
increased blood loss

32
Q

When would we usually treat anaemia in CKD?

A

<10mls/min GFR or symptomatic

33
Q

How is anaemia treated?

A

iron replacement

ESA therapy

34
Q

What does a reduced GFR lead to in terms of bone disease?

A

hyperphosphataemia

35
Q

Why does CKD affect vitamin D and calcium reabsorption?

A

less renal tissue - less activated vit D

therefore less calcium reabsorption

36
Q

Consequence of high phosphate and low calcium in CKD

A

high PTH

secondary hyperparathyroidism - can become tertiary

37
Q

What is high phosphate associated with?

A

vascular and cardiac calcification

38
Q

How do we treat renal bone disease?

A

control phosphate - diet, phosphate binders

normalise calcium and PTH - active vitamin D analogues, parathyroidectomy, calcimetics

39
Q

What increases CV risk in CKD?

A 
hypertension 
diabetes 
lifestyle 
smoking 
hyperlipidaemia 
renal bone disease
40
Q

Why is hyperkalaemia found in CKD?

A

usually exchanged for sodium to be excreted in DCT
reduced sodium delivery as GFR falls
also ACEI, ARB, diet etc

41
Q

Acute treatments of hyperkalaemia

A

stabilise - calcium gluconate
shift - insulin dextrose, salbutamol
remove - dialysis, calcium resonium

42
Q

Chronic treatments of hyperkalaemia

A

diet

drug modifications

43
Q

Why does CKD lead to fluid overload?

A

unable to excrete excess sodium load leading to sodium and water retention

44
Q

Treatment of fluid overload

A

sodium restriction
loop diuretics
fluid restriction

45
Q

Blood pressure aims for CKD patients with and without proteinuria

A

with : <125/75

without: 130/80

46
Q

What causes uraemic pericarditis?

A

build up of own urea toxin

47
Q

What drugs can cause AKI on top of CKD?

A

contrast, antibiotics

48
Q

5 preparations steps for ESRD+RRT

A 
education and info 
MDT 
select modality 
planning access 
deciding when to start

Year 2 Urinary (JK) (26 decks)

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