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3.1 cards > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

Diagnostic criteria for CKD

A

Proteinuria/ haematuria and/or reduction in eGFR of < 60 ml/min/1.73m^2 for atleast 3 months

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2
Q

Two of the main causes of CKD

A
  1. Hypertension
  2. Type II DM
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3
Q

What is the triple whammy?

A
  1. NSAIDs
  2. Loop diuretics
  3. ACE-I
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4
Q

Nephorotoxin drugs

A
  1. NSAIDs or COX 2 inhibitor
  2. Triple whammy
  3. Lithium - bipolar disease
  4. Aminoglucosides - antibacterial gram -ive
  5. Radiographic contrast
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5
Q

Main investigations for CKD

A
  1. Dipstick/urinanalysis for presence of haematuria and proteinuria
  2. eGFR for staging and dx
  3. Serum Creatinine
  4. Microalbuminuria - risk factor for CKD
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6
Q

Role of Renal U/S in diagnosis of CKD

A

Kidney atrophy in CKD +

  • show obstruction with hydronephrosis (swelling of kidney due to urine build-up),
  • bladder retention
  • loss of corticomedullary differentiation
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7
Q

Serum biochemistry in CKD

A
  1. HyPERkalaemia
  2. HyPERphosphatemia
  3. HyPOcalcemia
  4. Acidosis
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8
Q

Complication in CKD

A
  1. Anaemia
  2. Renal Osteodystrophy
  3. CVD
  4. Protein malnutrition
  5. Metabolic acidosis
  6. Hyperkalamia
  7. Pulmonary oedema
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9
Q

Outline the stages of Kidney Failure

A

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

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10
Q

Staging of albuminuria

A

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
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11
Q

Guildelines for BP in CKD

A

<140/90

In DM or microalbuminuria/proteinurea below 130/80

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12
Q

Lifestyles modifications in CKD

A
  • 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
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13
Q

Management aims for DM in CKD

A

HbA1c <7%

Pre-prandial blood 4.0-6.0 mmol/L

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14
Q

Management aims for lipids during CKD

A

Total cholesterol <4.0 mmol/L

LDL <2.5 mmol/L

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15
Q

Indication for dialysis

A
  1. Severe metabolic acidosis
  2. Hyperkalemia refractory to medical emergency
  3. Pericarditis
  4. Encephalopathy
  5. Intractable volume overload
  6. Weight loss - persistent anorexia and worsening lathergy
  7. Peripheral neuropathy
  8. Intractable GI symptoms
  9. EGFR 5-9 ml/min/1.73m^2
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16
Q

DDx for CKD

A
  1. Diabetic nephropathy
  2. Hypertensive nephrosclerosis
  3. Ischaemic nephropathy
  4. Obstructive uropathy
  5. Nephrotic syndrome
  6. Glomerulonephritis
17
Q

Screening age for Aboriginals and Torres Strait Islanders for CKD

A

30+

18
Q

Screening for CKD

A
  • 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
19
Q

What is involved in a CKD screen

A

Blood test - creatinine, which dertermines the eGFR

Urine test either dipstick for protein, urinary protein/creatinine ratio

BP

20
Q

What is used to estimate GFR

A
  1. Serum creatinine level
  2. Age
  3. Sex
  4. Race
  5. Body size
21
Q

Urgent referals to renal unit

A
  • 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
22
Q

Management of Dialysis Patients

A
  • 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
23
Q
A

3.1 cards (13 decks)

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