Chronic kidney disease Flashcards
OHCM, PTS, GP
What is CKD?
Long-standing and often deteriorating reduction in renal function due to irreversible loss of nephrons, occuring over years.
How does hypertension lead to CKD?
- Hypertension causes thickening of renal artery walls so narrow lumen
- Low blood flow to the glomerulus, causing ischaemic injury.
- This triggers an immune response which leads to glomerular sclerosis and decreased renal function.
Give 3 risk factors for CKD.
Acute kidney injury and any causes of AKI (pre-, intra- and post-renal.)
Diabetes (25%) - diabetic nephropathy
Hypertension (20%)
Glomerulonephritis (15%)
Interstitial diseases (10%)
Congenital eg polycystic kidney disease (5%)
Give 3 symptoms of CKD
- Anorexia
- Nausea/ vomiting/ diarrhoea
- Restless legs
- Fatigue and weakness (due to anaemia)
- Pruritus due to high urea
- Bone pain
8 Nocturia, polyuria due to decreased reabsorption.
(OHCM)
Give 3 signs of CKD.
- polyuria
- ankle swelling/ oedema.
- Increased BP.
- Gradual onset of symptoms
- Later stages: oligouria, CNS involvement.
(PTS)
What investigations should you do in ?CKD?
Renal USS - small kidneys with increased echogenicity.
Bloods:
Hb - shows normocytic normochromic anaemia.
Glucose - diabetes mellitus
Calcium - decreased
Phosphate - increased
Urine disptick, microbiological cultures, ACR.
Examination - pallow, yellowish tinge, purpura.
Define and describe the management of stage 5 CKD.
End-stage renal failure: death is imminent without renal replacement therapy (transplant). GFR <15 if not already on dialysis.
Prepare for dialysis if appropriate.
What is uraemia?
High urea in blood. Leads to amennorrhea, impotence.
Define and describe the management of stage 1 CKD
Kidney damage present which has been detected by urine test or imaging studies. GFR >90.
Investigate more thoroughly - check for proteinuria and haematuria. (PTS)
Define and describe the management of stage 2 CKD
Kidney damage with GFR 60-89.
Renoprotection by controlling blood pressure and having a low-protein diet.
Define and describe the management of stage 3 CKD
GFR 30-59. Renoprotection by controlling BP and having a low-protein diet.
Define and describe the management of stage 4 CKD
GFR 15-29. Prepare for dialysis if appropriate.
Give 3 differences between AKI and CKD.
CKD shows small kidneys while AKI shows normal kidneys
AKI symptoms are more like shock symptoms while CKD is more like serious disease
AKI shows low BP while CDK shows high BP.
AKI shows rapid onset of symptoms while CKD shows slow progression.
What are the types of dialysis and which is used more commonly?
Haemodialysis (more common)
Peritoneal dialysis
How does haemodialysis work?
In haemodialysis, blood is filtered in a dialysis machine which acts as an artificial kidney, then returned to the body.
Blood is passed over a semi-permeable membrane against dialysis fluid flowing in the opposite direction. Diffusion of solutes occurs down the concentration gradient. A hydrostatic gradient is used to clear excess fluid as required (ultrafiltration).
Why should an AV fistula be created prior to dialysis?
An atrioventricular fistula is a surgical anastamosis between an artery and vein, which increases strength and blood flow. This should be created prior to need for dialysis to avoid the infection risk associated with central venous dialysis catheters.
How does peritoneal dialysis work?
Blood is filtered within the peritoneal cavity, using the peritoneum as a semi-permeable membrane. A catheter is inserted into the peritoneal cavity and solutes diffuse across. Ultrafiltration is achieved by adding osmotic agents.
Give 2 advantages of haemodialysis
4 dialysis-free days a week.
Home dialysis possible for some patients.
Give 2 disadvantages of HD
Risk of infection due to access
Hypotension because blood is taken out during HD.
Time-consuming
Have to restrict diet and fluid intake
Give 2 advantages of PD
Done at home
More freedom to travel
Fewer restrictions of diet and fluid intake
Give 2 disadvantages of PD
Catheter site infection
PD peritonitis
Loss of membrane function over time
Needs to be carried out every day
Give 4 drugs that can cause CKD.
DAMN: Diuretics ACE inhibitors Metformin NSAIDs
