Chronic Kidney Disease Flashcards
What is CKD
CKD is the irreversible and sometimes progressive loss of renal function over a period of months to years
Renal injury causes renal tissue to be replaced by ECM in response to tissue damage
Have scarring of kidneys at end of CKD
What happens to GFR in CKD and how does this affect urine and urine output
GFR decreases in CKD
Have decreased urine production as a result of decreased GFR
Lose the ability to concentrate urine
Name some causes of CKD
Diabetes
Hypertension
Immunologic - glomerulonephritis
Infection - pyelonephritis
Genetic - APCKD
Obstruction and reflux nephropathy
ATI
Vascular
Systemic diseases
Idiopathic
How is degree of renal impairment investigated
Check BP
Urine dipstick
Check creatinine and eGFR
Blood tests, e.g. U&Es, bone biochemistry, LFTs, FBC, CRP, iron levels, PTH
How is the cause of renal impairment investigated
Auto-antibody screen and complement levels - autoimmune disease
Anti-neutrophil cytoplasmic antibody - vasculitis
USS - kidney size (usually smaller in CKD but can be normal) and look for obstruction
Kidney biopsy
CT, MRI, MR angiogram
Myeloma - serum immunoglobulin screen, protein electrophoresis and serum light chain measurement
What are the risk factors for CKD
Modifiable risk factors: lifestyle, smoking, obesity, lack of exercise
Uncontrolled diabetes
Hypertension - give treatment
Proteinuria - give ACEi/ARBs
Lipids - treat with statins
Name some complications of CKD
Hyperkalaemia
Acidosis
Anaemia
Mineral bone disease
Altered drug metabolism
Accumulation of waste products
Why do patients with CKD develop hyperkalaemia
There is reduced excretion of K in CKD so K remains in the body and causes hyperkalaemia
Stop ACEi/ARBs (raise K) and do not give drugs that raise K
Alter diet to avoid foods with K
Why do patients with CKD develop acidosis and what are some symptoms
Acidosis occurs as there is decreased excretion of acid into the filtrate and increased loss of bicarbonate so have a loss of blood pH
Symptoms - headache, confusion, muscle weakness, seizures, diarrhoea, arrhythmia, shortness of breath, coughing, nausea, vomiting
Why do patients with CKD develop anaemia - what mechanisms cause anaemia
Acidosis decreases EPO production
Hepcidin level increases due to inflammation and causes decreased free iron levels in the body
Shorter RBC lifespan
CKD mineral and bone disorder
Medication
Deficiency of Vit B12, iron and folate
What is the treatment for anaemia in patients with CKD
Make sure iron levels are normal and if not then give iron to make levels normal
If Hb abnormal after iron levels corrected then give EPO stimulating agent to increase the level of Hb in the blood to a good levels (not perfect)
Why do patients with CKD develop mineral bone disease
Impaired renal function decreases levels of calcitriol so have impaired bone mineralised and decreased Ca absorption
Impaired renal function decreases levels of Klotho-FGF-23 so have decreased phosphate excretion and increased phosphate in the body which stimualtes PTH production which increase bone resorption
In CKD, patients can develop altered drug metabolism. In what way is drug metabolism altered
Drugs require alteration due to reduced metabolism and/or elimination
Drugs sensitivities can increase even if elimination unimpaired meansing side effects more likely
What are the symptoms of end stage renal disease
Tiredness, fatigue, physical and mental incapacitation
Difficulty sleeping and concentrating
Signs and symptoms of fluid overload
Nausea and vomiting
Reduced appetitie
Restless legs, cramps
Pruritus
Sexual dysfunction and reduced fertility
Increased infections due to reduce immunity
What are advantages and disadvantages of haemodialysis
Advantages - less responsibility and have days off
Disadvantages - travel time, waiting time, have designated slots, large restriction on fluid and food
