Chronic Kidney Disease Flashcards
what is chronic kidney disease
abnormal kidney function and/or structure
what does moderate-severe CKD increase the risk of
acute kidney injury
falls
frailty
mortality
what is needed to diagnose CKD
minimum of 2 samples with raised creatinine 90 days apart
what is the best measure of renal function
eGFR
what is eGFR based on
serum creatinine level
age
sex
race
how many stages of CKD are there
5
what is stage 1 CKD
eGFR >90
normal kidney functions
urine findings or structural abnormalities point to kidney disease
what is stage 2 CKD
eGFR 60-89
mildly reduced kidney function
urine findings or structural abnormalities or genetic traits point to kidney disease
what is stage 3a CKD
eGFR 45-59
moderately reduced kidney function
what is stage 3b CKD
eGFR 30-44
moderately reduced kidney function
what is stage 4 CKD
eGFR 15-29
severely reduced kidney function
what is stage 5 CKD
eGFR <15
established renal failure
what is the albumin creatinine ration (ACR)
a semi quantitive measure of glomerular damage
what is ACR category A1
<3
what is ACR category A2
3-30
what is ACR category A3
> 30
what follow up should a patient have after an acute kidney injury
monitoring for progression to CKD for 2-3 years after the acute kidney injury
when is eGFRcystatinC used at initial diagnosis
to confirm/rule out CKD in people with a eGFR of 45-59 but no other marker of CKD
what is accelerated progression of CKD
sustained decrease in GFR of 25% or more AND change in GFR category within 12 months
OR
sustained decrease in GFR or 15mil/min
what risk factors are associated with CKD progression
cardiovascular disease proteinuria acute kidney injury hypertension diabetes smoking African, African Caribbean or asian family origin chronic use of NSAIDs untreated urinary outflow tract obstruction
what BP should you aim for in people with CKD
systolic bp <140 and diastolic <90
what BP should you aim for in people with CKD and diabetic
systolic <130
diastolic <80
what effect can RAAS inhibition (ACEi/ARB) have on CKD
can reduced GFR and increase serum creatinine at the start
do not stop meds if the GFR decrease is <25% and the serum creatinine increase is <30%
what should you give CKD patients to reduce the risk of secondary CVD
Atorvastatin 20mg
when should you increase dose of atorvastatin in CKD patients
if >40% drop in non-HDL cholesterol or eGFR is 30ml/min or more
what are the 3 most common causes of CKD
diabetes
hypertension
glomerulonephritis
what can cause primary glomerulonephritis
membranous (autoimmune) IgA primary FSGS (focal segmental glomerulosclerosis)
what can cause secondary glomerulonephritis
diabetes lupus FSGS due to HIV Heroin Obesity
what are some vascular causes of CKD
- Renal artery stenosis
- Ischaemic/hypertensive nephrosclerosis
- microvascular disease (thrombosis which can be caused by haemolytic uremic syndrome or thrombocytopaenia purpura)
- small vessel vasculitis
what are the 3 types of small vessel vasculitis
granulomatosis with polyangitis
microscopic polyangitis
eosinophilic granulomatosis with polyangitis
what are some causes of tubulointerstitial (problems are in the tubules n collecting ducts and stuff) CKD
acute interstitial nephritis
tubulointerstitial nephritis and uveitis
autosomal dominant polycystic kidney disease
reflux nephropathy
what are some causes of post renal (obstructive) CKD
Calculi
- renal
- ureteric
- bladder
Prostate
- benign hyperplasia
- cancer
Bladder
- malignancy
- bladder wall thickening
urethral stricture
what are some clinical signs of CKD
Anaemia (due to lack or erythropoietin production)
weight loss
in advanced uraemia:
lemon yellow uraemic frost (urea deposited on skin) twitching encephalopathic flap confusion pericardial rub or effusion kussmaul breathing
what are some uraemic symptoms of CKD
Nausea and vomiting anorexia weight loss itch fatigue altered rase restless legs muscle twitching difficulties concentrating confusion
what renal problems can CKD lead to
local pain/haemorrhage/infection
urinary - haematuria/proteinuria
impaired salt and water handling
hypertension
electrolyte abnormalities
acid-base disturbance
what are some extra renal problems causes by CKD
cardiovascular disease
mineral and bone disease
anaemia
nutrition problems
what are the treatment options for end stage renal disease
Haemodialysis
Peritoneal dialysis
Transplantation
or
conservative management
how do you moderate the increased risk of CVD caused by CKD
smoking cessation weight loss aerobic exercise limiting salt intake control prophylaxis lipid lowering therapies aspirin
how does CKD lead to an increase risk of mineral and bone disease
through changes in
calcium phosphate PTH Vit D Fibroblast growth factor
what consequences does CKD-mineral bone disease have
hyperparathyroidism vascular calcification bone pain fractures CV events lower quality of life high morbidity and mortality
how do you manage mineral bone disease in CKD
phosphate restriction salt reduction potassium restriction fluid restriction dietary restrictions
correct metabolic acidosis
give alfacalcidol (active form of vit d)
phosphate binders
calcimimetics
what group of CKD patients are more likely to get anaemia
those in CKD 3a >
