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Renal and Urology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

definition

A

reduction in glomerular filtration rate over a minimum period of 3 months

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2
Q

to diagnose chronic kidney disease what do you need

A

2 samples at least 90 days apart

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3
Q

what is reported for diagnosing chronic kidney disease

A

eGFR and creatinine levels because eGFR provides a more accurate estimation of renal function than creatinine alone

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4
Q

stages of chronic kidney disease

A
  • G1
  • G2
  • G3a
  • G3b
  • G4
  • G5
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5
Q

G1 : eGFR

A

greater than 90ml/min/1.73m2

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6
Q

G1 description

A

normal kidney function but urine findings or structural abnormalities or genetic trait point to kidney disease

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7
Q

G2: eGFR

A

60-89

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8
Q

G2 description

A

Middle reduced kidney function and urine findings or structural abnormalities or genetic trait point to kidney disease

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9
Q

G3a: eGFR

A

45-59

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10
Q

G3b; eGFR

A

30-44

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11
Q

Description of G3a and G3b

A

moderately reduced kidney function

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12
Q

G4; eGFR

A

15-29

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13
Q

G5; eGFR

A

less than 15

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14
Q

ALBUMIN CREATININE RATIO CATEGORIES

A

A1
A2
A3

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15
Q

A1

A

albumin creatinine ratio less than 3 mg/mmol

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16
Q

A2

A

albumin creatinine ration 3-30 mg/mmol

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17
Q

A3

A

albumin creatinine ratio greater than 30mg/mmol

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18
Q

normal glomerular filtration rate is between

A

100-125ml/min/1.73m2 however, this value is slightly less in females than males and declines with are

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19
Q

who is at increased risk of developing chronic kidney disease

A

those who have had acute kidney injury

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20
Q

people with acute kidney injuries should be monitored for what

A

the development of chronic kidney disease for at least 2-3 years after the acute kidney injury even if creatinine has returned to baseline

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21
Q

accelerated progression of chronic kidney disease

A
  • a sustained decreased in glomerular filtration rate of 25% or more and a change in GFR category within 12months
    OR
  • a sustained decreased in GFR or 15ml/min/1.73m2 per year
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22
Q

risk factors associated with chronic kidney disease progression

A
  • cardiovascular disease
  • proteinuria
  • AKI
  • hypertension
  • diabetes
  • smoking
  • african or afro-carribean
  • chronic use of NSAIDS
  • untreated urinary outflow obstruction
23
Q

blood pressure control in chronic kidney disease

A
  • aim to keep systolic blood pressure below 140 and diastolic below 90mmHg
24
Q

in people with chronic kidney disease and diabetes or people with chronic kidney disease with an albumin creatinine ratio of 70mg/mmol or more blood pressure control

A

aim to keep systolic less than 130 and diastolic less than 80

25
Q

what should be used to control blood pressure

A

an ACE inhibitor or an angiotensin receptor blocked

26
Q

do not modify the dose of the ACE inhibitor if

A
  • the GFR decrease from pre-treatment baseline is less than 25% or
  • the serum creatinine increase from baseline is less than 30%

if it exceeds these values then dosage should be reduced

27
Q

cardiovascular disease and lipid lowering therapy in CKD

A

offer atorvastatin 20mg fro the primary or secondary preventing of CVD in people with CVDi

28
Q

increasing the dose of atorvastatin

A

increase the dose if a greater than 40% reduction in non-HDL cholesterol is not achieved and eGFR is more than 30ml/min/1.73m2. If eGFR is less than 30ml/min/1.73m2 then consult a renal specialist

29
Q

causes of chronic kidney disease

A
  • hypertension
  • diabetes mellitus
  • glomerulonephritis
  • polycystic kidney disease
  • post-renal obstructive causes
30
Q

hypertension is the

A

most common causes of chronic kidney disease

31
Q

hypetension cuasing CKD pathophysiology

A
  • atherosclerosis of arteries supplying the kidney cause narrowing of the lumen meaning less blood and oxygen gets to the kidney causing ischaemic injury of the glomerulus
  • Macrophages and foam cells enter the glomerulus and secrete growth factors like TGF-B1 causing the mesangial cells to regress to there imitate state called mesangiocytes which secrete extra-cellular matrix causing glomerulosclerosis (hardening and scarggin) which reduces the kidneys ability to filter blood
32
Q

2nd most common cause of chronic kidney disease

A

diabetes mellitus; hyperglycameia causes non-enzymatic glycation of the basement membrane which aprticualryl occurs at the efferent arteriole causing hyaline arteriosclerosis causing an obstruction of blood exiting the glomerulus which increases the pressure within the glomerulus causing hyper-filtration
- in response to this the mesangial cells lay down more structural matrix which causes expansion of the six of the glomerulus diminishing the ability of the kidney to filter blood

33
Q

what does CKD present with in terms of calcium and phosphate levels

A

hypocalcaemia and hyperphospahtaemia

34
Q

why does hypocalcaemia and phyerpphospahtaemia occur

A

there is reduced production of 1,25- dihydroxyvitamin D3 (calcitriol) because the kidney is responsibel for 1- hydroxylation of 25-hydrxyvitamin D3

  • Calcitriol is responsible for increased GI absorption of calcium and re-absorption of calcium from the bone hence causing hypocalcaemia
  • the hypocalcaemia causes secondary hyperparathyroidism but despite the increased PTH calcium levels cannot increase in response because of deficiency in calcitriol however, the re-absorption of phosphate in the kidneys can occur hence the huyperphopshataemia
35
Q

treatment of hypocalcaemia and hyperphospahtaemia

A
  • phosphate binders= sevalamer
  • Cinaccalcet blocks production of PTH
  • alfacidol which is an active vitamin D
36
Q

what blood problem does chronic kidney disease cause

A

anaemia

37
Q

why does chronic kidney disease cause anaemia

A

because the kidney are responsible for the production of erythropeatein which tells the bone marrow to make red blood cells, deficiency in red blood cells causes a normocytic anaemia

38
Q

why is it a normocyitc anaemia

A

because there is no lack of iron or disease of red blood cells

39
Q

symptoms of anaemia

A

fatigue and pallor

40
Q

what else can chronic kidney disease cause

A

electrolyte abnormalities

41
Q

the kidneys most critical excretion products are

A

sodium, potassium, hydrogen and magnesium, loss of renal function can cause elevated levels of all

42
Q

loss of excretion of potassium can cause

A

hyperkalaemia which shoes tall tented T waves in ECG

43
Q

what is classified as hyperkalaemia on ECG

A

anything greater than 5mm in the limb leads

44
Q

inability to excrete hydrogen ions causes

A

a metabolic acidosis

45
Q

treatment of anaemia in chronic kidney disease

A

check ferrite and iron stores aiming for:
ferritin greater than 100
TSATS GREATER THAN 20%
if low= oral iron therapy (veneer)
- erythropoiesis stimulating agent if haemoglobin is less than 100-110g/dl despite no iron or haematocrit deficiencies

46
Q

inability to excreted nitrogenous waste products causes

A

uraemia/ azotemia

47
Q

azotemia

A

is the build up of nitrogenous waste products in the blood, uraemia is the clinical symptoms caused by azotemia

48
Q

symptoms of uraemia

A

pericarditis, encephalitis, bleeding, increased infection

49
Q

why does uraemia cause increased infection

A

because white blood cells cannot degranulate

50
Q

why does uraemia cause pericarditis

A

excuse the waste products physically irritate the pericardium

51
Q

why does uraemia cause increased risk of bleeding

A

because platelets cannot adhere to one another

52
Q

reduced glomerular filtration rate in chronic kidney disease causes

A

fluid overload and fluid shifts into the third space causing oedema

53
Q

management of end stage renal disease

A

haemodialysis, peritoneal dialysis or renal transplant

54
Q

long term management for all its chronic kidney dsieas

A
  • avoid NSAIDS and don’t use gentamicin
  • fluid restriction
  • low potassium, phosphate and sodium diet

Renal and Urology (51 decks)

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