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Urinary clinical conditions > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

how do we measure GFR in clinical practise?

A

estimate eGFR from serum creatinine level

  • Crockcoft gault
  • MDRD 4 variable
  • CKD-EPI equation
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2
Q

at what eGFR means you require dialysis?

A

< 15 ml/min/1.73m2

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3
Q

what is the normal range of GFR?

A

60-110

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4
Q

what is the gold standard way to measure GRF? and when would this be used?

A

inulin

if you required an accurate GFR for example if someone was donating their kidney

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5
Q

how do we measure kidney filtering function?

A 
urinalysis (dipstick)
protein quantification (protein creatinine ratio PCR)
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6
Q

what molecules cross the glomerular basement membrane and are excreted in the urine?

A

water
electrolytes
urea
creatinine

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7
Q

what molecules cross the glomerular BM but are reabsorbed in the proximal tubule?

A

low molecular weight proteins i.e. a2 microglobulin

glucose

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8
Q

what molecules should never be filtered into the tubule?

A

WBC & RBC

larg proteins i.e. albumin

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9
Q

what is the definition of chronic kidney disease?

A

presence of kidney damage (haematuria and proteinuria) and/or GFR < 60 that is present for 3 months or more
(if its present for < 3 months = acute kidney injury)

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10
Q

what is the most common cause of chronic kidney disease?

A

diabetes

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11
Q

what are the causes of chronic kidney disease?

A 
diabetes
glomuerlonephritis
hypertension
systemic diseases i.e. lupus, SLE, amyloidosis
renovascular diseases (atheroma)
polycystic kidney disease
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12
Q

what are the symptoms of chronic kidney disease?

A 
fatigue / tiredness 
dyspnoea 
peripheral oedema
LUT symptoms i.e. polyuria, oliguria , nocturia, haematuria
pruritus 
cramps 
nausea/vomiting 
anorexia
uraemia odour 
taste disturbance
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13
Q

what are the signs of chronic kidney disease?

A 
pallor 
pale conjunctive (anaemia)
proteinuria (frothy urine)
hypertension 
clubbing , splinter haemorrhages, brown stains of the fingers
dehydration 
signs of kidneys on imaging
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14
Q

what drugs can cause kidney injury?

A 
NSAIDS
antibiotics
gentamicin
penicillamine
gold
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15
Q

what tests would you carry out to detect the underlying pathology of chronic kidney disease?

A 
FBC, U&amp;E's
urine dipstick
urine PCR or ACR
USS of kidneys 
kidney biopsy
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16
Q

what is the main thing to treat in chronic kidney disease and how do we treat it?

A

hypertension

- ACE inhibitors / ARB’s

17
Q

what are some of the complications related to reduced GFR?

A 
metabolic acidosis
anaemia
renal osteodystrophy 
CV risk
electrolyte disturbance - hyperkalaemia 
fluid overload
gout
hypetension
iatrogenic issues (ned to be aware that drug excretion is altered in CKD)
18
Q

what are the risk factors for chronic kidney disease?

A 
hypertension
diabetes
age > 50 
childhood kidney disease 
family history of chronic kidney disease
smoking
obesity 
male 
autoimmmune disorders
long term use of NSAIDS
19
Q

what is a sign of proteinuria?

A

foamy urine

20
Q

how can CKD cause metabolic acidosis?

A

due to declining GFR the kidney isn’t able to excrete acid and generate new bicarbonate

21
Q

how can CKD cause hyperkalaemia?

A

due to declining GFR the rate of which potassium is excreted is reduced

22
Q

What are the GFR levels of stages 1-5 of CKD?

A 
Stage 1: normal or high GFR ( >90)
Stage 2: normal or mild reduction in GFR (60-89)
Stage 3a: 45-59
Stage 3b: 30- 44
Stage 4: 15- 30
Stage 5: < 15
23
Q

what are the values of A1, A2 and A3 which classify extent of proteinuria?

A

A1: < 30mg
A2: 30- 300mg
A3: > 300mg

24
Q

On imaging, clubbed calyces and cortical scars suggest the damage has been caused by what?

A

Reflux with chronic infection

And/or ischaemia

25
Q

What can differentiate upper tract haematuria from lower tract haematuria?

A

Upper tract haematuria will show dysmorphic RBC and cellular casts on microscopy

26
Q

Does phosphate increase or decrease in CKD and why?

What is done to resolve this?

A

Phosphate levels increase because it isnt filtered by the kidney with a low GFR
This results in high serum phosphate levels
Phosphate binders are given to bind to the phosphate ingested (only source of phosphate is food) and excretes it in the urine

27
Q

Does serum calcium increase or decrease in CKD and why?

A

Serum calcium decreases because of decreased production of vitamin D (kidneys convert inactive 15 hydroxicalciferol into active vitamin D - 1,25 - dihydroxycalciferol)
- vitamin D/ calcitriol is required to raise Ca levels
CKD also causes an increase in serum phosphorus which increases Ca deposition in bone- therefore increased phosphorus = decreased calcium

28
Q

What is the best treatment for someone with anaemia due to CKD?

A

Erythropoeitin

29
Q

What is the best treatment for bone disease in CKD?

A

Phosphate binders and diet rich in Ca and vitamin D

Urinary clinical conditions (17 decks)

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