Chronic Kidney Disease Flashcards
Diagnostic criteria for CKD
Proteinuria/ haematuria and/or reduction in eGFR of < 60 ml/min/1.73m^2 for atleast 3 months
Two of the main causes of CKD
- Hypertension
- Type II DM
What is the triple whammy?
- NSAIDs
- Loop diuretics
- ACE-I
Nephorotoxin drugs
- NSAIDs or COX 2 inhibitor
- Triple whammy
- Lithium - bipolar disease
- Aminoglucosides - antibacterial gram -ive
- Radiographic contrast
Main investigations for CKD
- Dipstick/urinanalysis for presence of haematuria and proteinuria
- eGFR for staging and dx
- Serum Creatinine
- Microalbuminuria - risk factor for CKD
Role of Renal U/S in diagnosis of CKD
Kidney atrophy in CKD +
- show obstruction with hydronephrosis (swelling of kidney due to urine build-up),
- bladder retention
- loss of corticomedullary differentiation
Serum biochemistry in CKD
- HyPERkalaemia
- HyPERphosphatemia
- HyPOcalcemia
- Acidosis
Complication in CKD
- Anaemia
- Renal Osteodystrophy
- CVD
- Protein malnutrition
- Metabolic acidosis
- Hyperkalamia
- Pulmonary oedema
Outline the stages of Kidney Failure
Stage 1- normal or increased GFR >90
Stage 2- mild decrease in GFR 60-89
Stage 3a- mod decrease in GFR 45-59
Stage 3b- mod decrease in GFR 30-44
Stage 4- severe decrease in GFR 15-20
Stage 5- kidney failure (end stage renal failure) GFR <15
Staging of albuminuria
Normal- M <2.5; F<3.5 mg/mmol
- Microalbuminuria - M 2.5-25 ; F 3.5-35 mg/mmol
- Macroalbuminuria - M >25; F>35 mg/mmol
Guildelines for BP in CKD
<140/90
In DM or microalbuminuria/proteinurea below 130/80
Lifestyles modifications in CKD
- Smoking cessation - nicotine replacement therapy
- Weight reduction
- Salt restriction
- Exercise
- Diet - low fat, low salt early, avoid high protein
- Fluid intake restriction
- Correct Anaemia if Hb <100g/L
- Assess for osteoporosis - osteoporosis, tertiary hyperparathyroidism and Vit D deficiency
Management aims for DM in CKD
HbA1c <7%
Pre-prandial blood 4.0-6.0 mmol/L
Management aims for lipids during CKD
Total cholesterol <4.0 mmol/L
LDL <2.5 mmol/L
Indication for dialysis
- Severe metabolic acidosis
- Hyperkalemia refractory to medical emergency
- Pericarditis
- Encephalopathy
- Intractable volume overload
- Weight loss - persistent anorexia and worsening lathergy
- Peripheral neuropathy
- Intractable GI symptoms
- EGFR 5-9 ml/min/1.73m^2
DDx for CKD
- Diabetic nephropathy
- Hypertensive nephrosclerosis
- Ischaemic nephropathy
- Obstructive uropathy
- Nephrotic syndrome
- Glomerulonephritis
Screening age for Aboriginals and Torres Strait Islanders for CKD
30+
Screening for CKD
- Everyone with risk factors (obesity, cigarette smoking, ATSI, fam hx, severe socioeconomical disadvantage)
- Everyone over 50-69, Aboriginals over 30
- Every 1-2 years
- 1 year with risk factors
- 2 years without
What is involved in a CKD screen
Blood test - creatinine, which dertermines the eGFR
Urine test either dipstick for protein, urinary protein/creatinine ratio
BP
What is used to estimate GFR
- Serum creatinine level
- Age
- Sex
- Race
- Body size
Urgent referals to renal unit
- Nephrotic sydrome - proteinurea >3g/day, hypoalbuminaeminia, peripheral odema and hypercholestrolaemia - need renal biopsy
- Severe hyperkalaemia >6.5mmol?/L
- Abrupt ride in serum creatinine, esp when coupled with HT, haematuria and systemic symptoms
- Oliguria urine output <400-500mL in adults
- Accelerated HT
Management of Dialysis Patients
- BP control
- Dietary recommendation - increase protein if on a low protein diet
- Immunisation - Hep B before dialysis begins
- Screening - cervical cancer, breast cancer and colorectal cancer
- polypharmacy - modify dose and timing
Specifically consider
- Fluid overload - esp in lungs
- Abdo pain - esp in intraperitoneal antibiotics
- Bone related issues
- Rheumatological complains - ayloidosis –> carpal tunnel, bone cyst, destructive spondylarthropathy or chronic shoulder pain
- Arterivenous fistulas -
- transfusion of blood and blood products - may develop HLA antibiotics
