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Urinary System > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

How do you measure excretory real function?

A
  • Inulin clearance
  • Isotope GFR
  • 24hr urine collection + blood test
  • GFR estimating equations
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2
Q

What is the relationship between creatinine and GFR?

A

Will not be raised above normal range until 60% of total kidney function is lost (increases with decrease GFR)

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3
Q

What is the problem with estimating GFR using serum creatinine?

A

Creatinine is generated from breakdown of muscle and not everyone has the same muscle mass.

Depends on:
• Age
• Ethnicity 
• Gender
• Weight 
• Other issues i.e. liver disease
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4
Q

What are the formulae that are used to estimate GFR from serum creatinine?

A

Cockcroft Gault
=([140-age] x weight x 1.23) / SCr x (0.85 if female)

MDRD 4 variable equation

CKD-EPI equation

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5
Q

What criteria is used to assess kidney excretory function??

A

International CKD Classification System

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6
Q

What are the different stages to the international’s CKD classification system to assess excretory kidney function?

A

Stage 1
Kidney Damage / Normal or high GFR
GFR >90

Stage 2
Kidney Damage / Mild reduction in GFR
GFR 60-89

Stage 3a / 3b
Moderately Impaired
3a GFR 45-59
3b GFR 30-44

Stage 4
Severely Impaired
GFR 15-29

Stage 5
Advanced or on Dialysis
GFR < 15

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7
Q

What three functions of the kidney is assessed to determined kidney disease?

A

Filtration (excretory) function - remove

Filtration (barrier) function - retain

Anatomy - abnormality

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8
Q

How is filtration (excrete) function assessed?

A

Uses estimated of GFR (eGFR) from creatinine blood test

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9
Q

What crosses and does not cross the glomerular basement membrane?

A 
Crosses GBM (glomerular basement membrane)
• Water
• Electrolytes
• Urea
• Creatinine

Crosses GBM but reabsorbed in proximal tubule
• Glucose
• Low molecular weight proteins (α2 microglobulin)

Does not cross GBM
• Cells (RBC, WBC)
• High molecular weight proteins (albumin, globulins)

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10
Q

How is kidney filtering function assessed?

A

Should be no blood or protein measurable I urine if filtering properly
• Urinalysis (“dipstick”) - blood, protein
• Protein quantification - protein creatinine ratio (PCR)

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11
Q

What is the definition of CKD?

A

Chronic kidney disease (CKD) is defined by either the presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR<60 ml/min/1.73m2 that is present for ≥ 3 months

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12
Q

What is the progression of untreated CKD?

A
  1. Normal - screen for CKD risk factors
  2. Increased risk - CKD risk reduction
  3. Damage - diagnosis + treatment, treat cormorbidties
  4. Decreased GFR - estimate progression, treat complication, prepare for replacement
  5. Kidney failure - replacement by dialysis & transplant
  6. CKD death
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13
Q

What is the aetiology of CKD?

A
  • Diabetes
  • Glomerulonephritis
  • Hypertension
  • Renovascular disease
  • Polycystic kidney disease
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14
Q

Describe the clinical approach to CKD

A
  • Detect underlying aetiology -> treatment for specific disease
  • Slow rate of renal decline (with generic therapies)
  • Assess complications of reduced GFR
  • Prep for Renal Replacement Therapy
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15
Q

What are the symptoms and signs of CKD?

A
  • Dyspnoea (fluid overload, anaemia cardiomyopathy)
  • Pruritus
  • Haematuria
  • Proteinuria
  • Change to urin output (polyuria, oliguria, nocturia)
  • GI: anorexia, vomiting, taste disturbance)
  • Cognitive impairment
  • Hypertension
  • Peripheral oedema (Na retention)
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16
Q

How is underlying aetiology of CKD detected?

A
  • Bloods: U+Es, FBC
  • Urine tests: urine dip, PCR or ACR, 24hr collection
  • Histology: renal biopsy
  • Radiology
17
Q

What chemistry tests are used to detect aetiology of CKD?

A
  • Urea, creatinine, electrolytes (Na, K, Cl)
  • Bicarbonate
  • Total protein, albumin
  • Calcium, phosphate
  • Liver function tests
  • Creatine kinase
  • Immunoglobulins, serum protein electrophoresis
18
Q

What haematology tests are used to detect aetiology of CKD?

A
  • Full blood count
  • Hb
  • Mean corpuscular volume (MCV) - average volume of red cells
  • Mean corpuscular haemoglobin (MCH) - average mass of haemoglobin per RBC
  • WBC
  • Platelets
  • % hypochromic RBCs

Coagulation screen:
• Prothrombin Time
• Activated partial thromboplastin time (APPT)
• +/- Fibrinogen

19
Q

What urine tests are used to detect aetiology of CKD?

A

Urinalysis (“dipstick”)
• Blood
• Protein

Protein quantification
• Protein creatinine ratio (PCR)
• Albumin creatinine ratio
• 24 hour urine collection

20
Q

What imaging tests are used to detect aetiology of CKD?

A

USS: may provide information about chronicity of renal disease and show obstruction

21
Q

What pathology tests are used to detect aetiology of CKD?

A

Kidney biopsy

22
Q

What is the management of CKD to slow the rate of renal decline using potential interventions?

A
  • BP control *most important
  • Control proteinuria (particularly ACE inhibitors / ARBs)
  • Treat underlying cause
23
Q

What are the complications that can occur with reduced GFR?

A
  • Acidosis
  • Anaemia
  • Bone disease
  • CV risk
  • Death & Dialysis
  • Electrolyte disturbance
  • Fluid overload
  • Gout
  • Hypertension
  • Iatrogenic issues
24
Q

What is the management of the complication that occur due to reduced GFR?

A
  • Acidosis -> bicarbonate
  • Anaemia -> EPO and iron
  • Bone disease –> diet and phosphate binders
  • CV risk –> BP, aspirin, cholesterol, exercise, weight
  • Death & Dialysis –> counsel and prepare
  • Electrolytes –> diet and consider drugs
  • Fluid overload –> salt and fluid restriction, diuretics
  • Gout –> optimise +/- meds
  • Hypertension –> weight, diet, fluid balance, drugs
  • Iatrogenic issues – BE AWARE
25
Q

What is involved in the prep for end-stage renal disease and renal replacement therapy?

A
  • Education & information
  • Selection of modality - HD / PD, transplant, conservative care
  • Planning access
  • Deciding when to start Recommended Replacement Time

• Multidisciplinary team

Urinary System (31 decks)

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