Chronic Kidney Disease Flashcards
What is CKD defined as?
An abnormality of kidney structure of function, present for >3 months with implications for health
Is CKD reversible?
Most often irreversible, and progressive
In which age range does incidence of CKD peak?
75 - 85+
What are the causes of CKD? (10)
- Diabetic neuropathy
- Glomerulonephritis
- Hypertension
- Systemic disease e.g. SLE, vasculitis, amyloid, myeloma
- Renal artery stenosis
- Hereditary e.g. polycystic kidney disease
- Chronic pyelonephritis
- Urinary tract obstruction e.g. prostatic disease
- Heart failure
- Drugs e.g. NSAIDs
Why is CKD defined as a syndrome?
It is not a unified disease, it is important to consider the underlying causes as this may impact on specific treatment, and it is classified according to severity of reduced eGFR
How may CKD present? (5)
- Incidental finding on blood or urine tests in investigation of other condition/routine test
- Hypertension
- Monitoring ‘at risk’ patients
- Symptoms of CKD - usually occur later with advanced impairment of kidney function
- ‘Crash landers’ with acute presentation of previously undiagnosed progressive CKD
What are the indications for monitoring patients who are at risk of developing CKD? (8)
- Diabetes
- Hypertension
- CVD
- Nephrotoxic drugs e.g. NSAIDs, lithium
- Structural renal disease
- Multi-system illness
- Family history
- Following episode of AKI
When assessing the kidney function, what levels of serum urea are associated with reduced renal excretion?
Serum urea is increased with reduced renal excretion
Why is proteinuria important in CKD?
Proteinuria is an important marker of risk of progression of CKD (both the presence and quantity of protein)
How is proteinuria traditionally measured? and what is more commonly done in practice?
24hr urine collection
More commonly it is quantified by spot urine sample (preferably morning) for protein/creatinine ratio (PCR) in urine or albumin/creatinine ratio (ACR)
How do you investigate CKD? (6)
- Clinical history
- Biochemistry/haematology
- Urine - dipstick, microscopy
- Immunology screen (e.g. SLE, vasculitis, myeloma)
- Renal ultrasound - ‘normal’, obstruction, cystic disease, scarring, renovascular, small kidneys
- +/- renal biopsy, angiography
What are the normal functions of the kidneys? (3)
- Excretory
- Homeostasis (fluid balance, blood pressure)
- Endocrine
What do the kidneys normally excrete?
- Inorganic substances e.g. potassium, phosphate
- Organic substances e.g. urea, creatining
- Larger molecules e.g. B2-microglobulin
- Clinically uraemic toxicity
What are the endocrine functions of the kidneys? (2)
- Erythropoietin
2. Bone metabolism vitamin D
What is a common complication of CKD with regards to the endocrine function being reduced?
Anaemia (due to reduced erythropoietin production)
In addition to anaemia, what are the other metabolic complications of CKD? (3)
- Bone-mineral disorder e.g. low serum Ca, high PO4, high PTH - lack of vitamin D 1-alpha hydroxylation by the kidneys (e.g. renal rickets in children / osteomalacia in adults)
Phosphate retention because of low GFR - can lead to vascular calcification - Metabolic acidosis
- Hyperkalaemia
What are the renal clinical features of CKD?
- Fluid retention
- Polyuria
- Nocturia
What are the cardiovascular clinical features of CKD? (6)
- Hypertension
- Pulmonary oedema
- LVH/dysfunction
- Vascular disease
- Dyslipidaemia
- Vascular calcification
What are the gastrointestinal clinical features of CKD? (4)
- Anorexia
- Nausea and vomiting
- Malnutrition
- Peptic ulceration
In addition to the renal, CV and GI clinical features, what other systems are affected by CKD? (4)
- Neurological - peripheral neuropathy, restless legs
- Dermatological - pigmentation, pruritis
- Endocrine - erectile dysfunction, reduced fertility
- MSK - bone pain, fractures
What are the aims of CKD management? (7)
- Early diagnosis
- Treatment of underlying cause where possible
- Slow or prevent progression
- Prevent or treat complications
- Timely education, planning and preparation for end-stage renal disease
- Reduce mortality
- Preserve quality of life
When are patients with CKD referred for specialist treatment? (7)
- eFR<30
- Progression of syndrome
- Uncertain cause/suspected systemic disease
- Possible hereditary disease
- Significant proteinuria
- Haematuria and proteinuria
- Complications of CKD
What are the management options for CKD? (8)
- Treatment of underlying cause
- Lifestyle changes
- Blood pressure control
- CVS risk reduction
- Diet
- Anaemia - erythropoietin
- Bone disease - vitamin D analogues, phosphate control
- Bicarbonate supplements for acidosis
What are the risk factors for the progression of CKD?
- Race, gender
- Smoking
- Hyperglycaemia, hyperlipidaemia
- Obesity
- CVS disease
- Nephrotoxic drugs
How does hypertension play a role in CKD?
Elevated BP is a major risk factor affecting rate of progression of renal failure
What is the target BP for anyone with CKD?
140/90
What is the target BP for anyone with CKD and diabetes?
<130/80
Which drugs for the treatment of hypertension are first-line in someone with CKD who have albuminuria/proteinuria?
ACE inhibitors/ARB (except if the patient has renal artery stenosis)
Why are ACE inhibitors/ARBs recommended in people with CKD to treat hypertension?
Studies have shown them to have a ‘renoprotective’ effect
