Chronic kidney disease Flashcards
Stages of chronic kidney disease can be classified according to the international CKD classification system which groups according to the eGFR into 5 stages:
What is the eGFR of each stage
Stage 5 (advanced) <15 Stage 4 (severely impaired) 15-29 Stage 3 (moderately impaired) 30-59 Stage 2 (mild reduction in GFR) 60-89 Stage 1 (normal/high GFR) >90
Kidney excretory function is measured by estimating eGFR from serum creatinine levels
What is kidney filtration function be measured by (if normal filtration means no blood or protein should be found in urine) (2)
Urine dipstick
Protein creatinine ratio
Define chronic kidney disease
Proteinuria or haematuria, and/or a reduction in the EGFR <60, for >3 months
Relationship between plasma creatinine and GFR
Plasma creatinine unaffected until renal function <60%
Causes/risk factors of chronic kidney disease (4)
DM
Hypertension
Less common:
Glomerulonephritis
Genetic disorders, e.g. polycystic kidney disease
State the symptoms and signs of uraemia, i.e. high serum urea (major symptom of renal failure) (7)
Nausea. Vomiting. Fatigue. Anorexia. Weight loss. Muscle cramps - legs Pruritus - in very advanced kidney failure
Clinical approach to managing someone with CKD
Detect underlying cause
Slow the rate of renal decline
Assess complications related to reduced GFR (prevent or treat)
Prepare for renal replacement therapy, i.e. dialysis or transplant
Symptoms (5) /signs (3) of later stage chronic kidney disease
Symptoms
- fatigue
- anorexia
- nausea/vomiting
- pruritus
- dyspnoea
Signs
- oliguria (reduced urine output)
- peripheral oedema
- anaemia –> pallor
In early stages of CKD, often patients are…
asymptomatic
What ethnicity is at higher risk of CKD + what gender
Black/hispanic
Male
Questions to ask in history to detect underlying cause of CKD
Previous history of renal disease Family history of renal disease Existing diseases, any autoimmune diseases Long term medication Symptoms/signs of uraemia
Biochemical (3) and physiological (1) abnormalities of CKD
Biochemical
- Haematuria
- Proteinuria
- elevated serum creatinine
Physiological
-kidneys could be small/enlarged
Initial investigations of CKD (7)
+ later investigation (1)
Serum creatinine U+Es FBC - may have anaemia Urinalysis - dipstick, microscopy, culture Urine protein: creatinine ratio Estimation of GFR (eGFR) Renal ultrasound
Renal biopsy
In CKD, urine protein: creatinine ratio is…
protein > creatinine
What test can be used to quantify protein in urine
Protein creatinine ratio
Most important thing to do when CKD has been diagnosed is to slow the rate of renal decline if can do
What are the principles of the management of this (4)
BP control + proteinuria control
-with ACEI/ARB
Statin
Treat underlying cause, e.g. DM
Complications related to reduced GFR (5)
Anaemia - due to deficiency of erythropoietin production
Bone disease - due to elevated PTH as a result of phosphate retention and hypo Ca2+
CV disease
Metabolic acidosis
Hyperkalaemia - inability to excrete K+ from diet
Failure to maintain fluid balance in those with advanced stages 4 and 5 CKD is an indication to start
renal replacement therapy - dialysis or transplant
Pruritus only starts appearing in what stage of CKD
advanced stage 5
Treatment of metabolic acidosis (complication of CKD due to reduced eGFR)
oral sodium bicarbonate
Treatment of bone disease (complication of CKD due to reduced eGFR resulting in phosphate retention and elevated PTH) (2)
Restrict calcium and phosphate from diet
Phosphate binding drugs - bind to phosphate to normalise serum phosphate levels
Treatment of anaemia (long term complication of CKD)
Erythropoetin stimulating agent
Types of dialysis
Peritoneal
Haemo
