Chronic Kidney Disease Flashcards
What is this?
Impaired renal function for > 3 months, or, GFR <60ml/min/1.73m2 for >3 months with or without evidence of kidney damage.
when do symptoms typically occur?
At stage 4 (GFR = <30)
End stage renal failure means?
GFR = <15ml/min/1.73m2 or need for renal replacement therapy (RRT - Dialysis or transplant)
How do we classify CKD?
eGFR
ACR
What does ACR do?
Albumin - Creatinine Ratio provides depiction of how much albumin being released into urine (should just be in plasma) Indicated towards end stage renal failure or when eGFR is particularly low, since creatinine only rises significantly <60ml/min
eGFR stage 1 =
> 90ml/min
stage 2 =
60-89ml/min
stage 3 =
30-59ml/min
stage 4 =
15-29ml/min
stage 5 =
<15 established renal failure
Majority of cases are caused by….
Diabetes
Hypertension
Glomerulonephritis
Other causes of CKD =
Malignancy
Anatomical Abnormality of renal tract
Hereditary Disease (e.g. polycystic kidney disease)
Patients with CKD often present as …
asymptomatic (until GFR = <30ml/min)
Symptoms are …
Non Specific:
- tired
- poor appetite
- itch
- sleep disturbance (nocturia)
Signs are …
Pallor
HT
FLuid overload
Peripheral Neuropathy
4 aspects of management are
Slow Progression
Reduce CVS risk
Identify and treat Complications
Prepare for Renal Replacement Therapy
Slow progression by…
giving ACEi or ARB to lower BP and proteinuria
Maintaining good glycaemic control
Adjusting Diet
Reduce CVS risk by…
Giving statins to lower lipids
Stop smoking
Examples of complications:
Anaemia
Bone Disease
Hyperkalaemia
Management of anaemia?
Erythropeotien produced by kidneys is declined in CKD so…
- Assess iron status, vit B12 + folate levels and replace if necessary
- Still Anaemic then give RECOMBINANT HUMAN ERYTHROPOIETIN (injected)
Management of bone disease?
Vit D hydroxylation is impaired in CKD > reduces Ca absorption (hypocalcaemia + hyperphosphataemia) > secondary hyperparathyroidism
So parathyroid hormone takes Ca from bones > boney pathology
Give ALFACALCIDOL (hydroxylated Vit D)
Phosphate Binders + Phosphate reduced diet
Management of Hyperkalaemia?
avoid NSAIDS + K sparing diuretics + Gentamicin + Contrast. Give Calcium gluconate to stabilise myocardium + insulin/dextrose to drive K intracellularly
4 Renal Replacement Therapy options?
Haemodialysis
Peritoneal Dialysis
Transplantation
Conservative Management
When is dialysis indicated?
when GFR = 20ml/min
best from of access in haemodialysis
Arteriovenous fistula
