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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
How can we manage CKD to slow that rate of decline
``` Bp control lipid control control acidosis protein restriction control proteinuria - ACEI/ARB ```
26
Identify how we would assess the complications of CKD
``` 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
What GFR will acidosis be seen?
not until <20mls/min
28
When is acidosis most marked?
in tubular interstitial disease
29
How is metabolic acidosis treated?
oral sodium bicarbonate
30
Problems with metabolic acidosis
worsens renal bone disease | hyperkalaemia risk
31
Why does anaemia occur in CKD?
Reduced erythropoietin production reduced RBC survival increased blood loss
32
When would we usually treat anaemia in CKD?
<10mls/min GFR or symptomatic
33
How is anaemia treated?
iron replacement | ESA therapy
34
What does a reduced GFR lead to in terms of bone disease?
hyperphosphataemia
35
Why does CKD affect vitamin D and calcium reabsorption?
less renal tissue - less activated vit D | therefore less calcium reabsorption
36
Consequence of high phosphate and low calcium in CKD
high PTH | secondary hyperparathyroidism - can become tertiary
37
What is high phosphate associated with?
vascular and cardiac calcification
38
How do we treat renal bone disease?
control phosphate - diet, phosphate binders | normalise calcium and PTH - active vitamin D analogues, parathyroidectomy, calcimetics
39
What increases CV risk in CKD?
``` hypertension diabetes lifestyle smoking hyperlipidaemia renal bone disease ```
40
Why is hyperkalaemia found in CKD?
usually exchanged for sodium to be excreted in DCT reduced sodium delivery as GFR falls also ACEI, ARB, diet etc
41
Acute treatments of hyperkalaemia
stabilise - calcium gluconate shift - insulin dextrose, salbutamol remove - dialysis, calcium resonium
42
Chronic treatments of hyperkalaemia
diet | drug modifications
43
Why does CKD lead to fluid overload?
unable to excrete excess sodium load leading to sodium and water retention
44
Treatment of fluid overload
sodium restriction loop diuretics fluid restriction
45
Blood pressure aims for CKD patients with and without proteinuria
with : <125/75 | without: 130/80
46
What causes uraemic pericarditis?
build up of own urea toxin
47
What drugs can cause AKI on top of CKD?
contrast, antibiotics
48
5 preparations steps for ESRD+RRT
``` education and info MDT select modality planning access deciding when to start ```

Year 2 Urinary (JK) (26 decks)

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