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2 RENAL > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

what is chronic kidney disease

A

abnormal kidney function and/or structure

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2
Q

what does moderate-severe CKD increase the risk of

A

acute kidney injury
falls
frailty
mortality

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3
Q

what is needed to diagnose CKD

A

minimum of 2 samples with raised creatinine 90 days apart

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4
Q

what is the best measure of renal function

A

eGFR

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5
Q

what is eGFR based on

A

serum creatinine level
age
sex
race

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6
Q

how many stages of CKD are there

A

5

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7
Q

what is stage 1 CKD

A

eGFR >90

normal kidney functions

urine findings or structural abnormalities point to kidney disease

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8
Q

what is stage 2 CKD

A

eGFR 60-89

mildly reduced kidney function

urine findings or structural abnormalities or genetic traits point to kidney disease

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9
Q

what is stage 3a CKD

A

eGFR 45-59

moderately reduced kidney function

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10
Q

what is stage 3b CKD

A

eGFR 30-44

moderately reduced kidney function

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11
Q

what is stage 4 CKD

A

eGFR 15-29

severely reduced kidney function

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12
Q

what is stage 5 CKD

A

eGFR <15

established renal failure

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13
Q

what is the albumin creatinine ration (ACR)

A

a semi quantitive measure of glomerular damage

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14
Q

what is ACR category A1

A

<3

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15
Q

what is ACR category A2

A

3-30

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16
Q

what is ACR category A3

A

> 30

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17
Q

what follow up should a patient have after an acute kidney injury

A

monitoring for progression to CKD for 2-3 years after the acute kidney injury

18
Q

when is eGFRcystatinC used at initial diagnosis

A

to confirm/rule out CKD in people with a eGFR of 45-59 but no other marker of CKD

19
Q

what is accelerated progression of CKD

A

sustained decrease in GFR of 25% or more AND change in GFR category within 12 months

OR

sustained decrease in GFR or 15mil/min

20
Q

what risk factors are associated with CKD progression

A 
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
21
Q

what BP should you aim for in people with CKD

A

systolic bp <140 and diastolic <90

22
Q

what BP should you aim for in people with CKD and diabetic

A

systolic <130

diastolic <80

23
Q

what effect can RAAS inhibition (ACEi/ARB) have on CKD

A

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%

24
Q

what should you give CKD patients to reduce the risk of secondary CVD

A

Atorvastatin 20mg

25
Q

when should you increase dose of atorvastatin in CKD patients

A

if >40% drop in non-HDL cholesterol or eGFR is 30ml/min or more

26
Q

what are the 3 most common causes of CKD

A

diabetes
hypertension
glomerulonephritis

27
Q

what can cause primary glomerulonephritis

A 
membranous (autoimmune) 
IgA 
primary FSGS (focal segmental glomerulosclerosis)
28
Q

what can cause secondary glomerulonephritis

A 
diabetes 
lupus 
FSGS due to HIV 
Heroin 
Obesity
29
Q

what are some vascular causes of CKD

A
  • Renal artery stenosis
  • Ischaemic/hypertensive nephrosclerosis
  • microvascular disease (thrombosis which can be caused by haemolytic uremic syndrome or thrombocytopaenia purpura)
  • small vessel vasculitis
30
Q

what are the 3 types of small vessel vasculitis

A

granulomatosis with polyangitis

microscopic polyangitis

eosinophilic granulomatosis with polyangitis

31
Q

what are some causes of tubulointerstitial (problems are in the tubules n collecting ducts and stuff) CKD

A

acute interstitial nephritis
tubulointerstitial nephritis and uveitis
autosomal dominant polycystic kidney disease
reflux nephropathy

32
Q

what are some causes of post renal (obstructive) CKD

A

Calculi

  • renal
  • ureteric
  • bladder

Prostate

  • benign hyperplasia
  • cancer

Bladder

  • malignancy
  • bladder wall thickening

urethral stricture

33
Q

what are some clinical signs of CKD

A

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
34
Q

what are some uraemic symptoms of CKD

A 
Nausea and vomiting 
anorexia 
weight loss 
itch 
fatigue 
altered rase 
restless legs 
muscle twitching 
difficulties concentrating 
confusion
35
Q

what renal problems can CKD lead to

A

local pain/haemorrhage/infection

urinary - haematuria/proteinuria

impaired salt and water handling

hypertension

electrolyte abnormalities

acid-base disturbance

36
Q

what are some extra renal problems causes by CKD

A

cardiovascular disease
mineral and bone disease
anaemia
nutrition problems

37
Q

what are the treatment options for end stage renal disease

A

Haemodialysis
Peritoneal dialysis
Transplantation

or

conservative management

38
Q

how do you moderate the increased risk of CVD caused by CKD

A 
smoking cessation 
weight loss 
aerobic exercise 
limiting salt intake 
control prophylaxis 
lipid lowering therapies 
aspirin
39
Q

how does CKD lead to an increase risk of mineral and bone disease

A

through changes in

calcium 
phosphate 
PTH 
Vit D 
Fibroblast growth factor
40
Q

what consequences does CKD-mineral bone disease have

A 
hyperparathyroidism 
vascular calcification 
bone pain 
fractures 
CV events
lower quality of life 
high morbidity and mortality
41
Q

how do you manage mineral bone disease in CKD

A 
phosphate restriction 
salt reduction 
potassium restriction 
fluid restriction 
dietary restrictions

correct metabolic acidosis

give alfacalcidol (active form of vit d)

phosphate binders

calcimimetics

42
Q

what group of CKD patients are more likely to get anaemia

A

those in CKD 3a >

2 RENAL (20 decks)

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