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
What are some contraindiactions of haemodialysis
Failed vascular access
Heart failure
Coagulopathy
What are some complications of haemodialysis
Lines - infection, thrombosis, venous stenosis
AVF - thrombosis, bleeding, access failure, steal syndrome
CVS instability
Feeling chronically unwell
Accumulate morbidity
What are the advantages and disadvantages of peritoneal dialysis
Advantages - self-sufficient, generally less fluid and food restrictions, fairly easy to travel with, renal failure may be better preserved initially
Disadvantages - frequent daily exchanges/overnight, have responsibility, have peritonitis every 20mths, only lasts 5yrs
Name some contraindiactions of peritoneal dialysis
Failure of peritoneal membrane
Adhesions, previous abdo surgery, hernia, stoma
Patient/carer unable to connect/disconnect PD
Obese or large muscle mass
Name some complications of peritoneal dialysis
Peritonitis, exit or tunnel site infection
Ultrafiltration failure
Leaks
Development of a hernia
What is APCKD and describe it briefly
Autosomal polycystic kidney disease
It is due to a mutation in either PKD 1 or 2 gene with PKD1 more common and causing an earlier disease
In PCKD, cysts grow with age and generally present in adulthood - can have cysts in the liver
Is diagnosed with USS
Prognosis depends on rate of increase in kidney size and age
What are some complications of polycystic kidney disease
Complications of cysts - infection, pain, bleeding into cyst, increased risk of kidney stones
Hypertension
Increased risk of intra-cranial aneurysms
Increased risk of heart valve abnormalities
What is the management for PCKD
Treat hypertension - block RAAS
Tolvoptan - blocks ADH and helps reduce growth rate of kidneys
Diet - drink fluids, low salt, normal protein
What risks are assocaited with kidney transplant and what side effects can the medication cause
Peri-operative risk
Malignancy and infection risk due to dampened down immune system
Risk of diabetes and hypertension from medication
Medication risks - GI ulceration, nausea, diarrhoea, low WCC, low platelet, high cholesterol
