Chronic Kidney Disease Flashcards
What is CKD?
Kidney damage for 3+ months based on abnormal structure or function
OR
eGFR < 60ml/min/1.73m with or without evidence of kidney damage
Which three conditions account for 70% of the causes of CKD?
Diabetes, hypertension, atherosclerosis.
Which patient groups should be tested annually for CKD?
Patients with: diabetes, HTN, AKI, CVD, obesity with metabolic syndrome, structural renal tract disease, renal calculi, BPH, SLE, family history of stage 5 CKD, nephrotoxic drug users
Give some examples of nephrotoxic drugs
Lithium, Iodine (iv contrast), Gentamicin, ACE-inhibitors, NSAIDS, Diuretics, Calcineurin inhibitors (ciclosporoin, tacrolimus, mesalazine).
What investigations should be ordered to test for CKD?
- Serum creatinine (to calculate eGFR)
- Albumin:Creatinine Ratio from early morning urine sample
- Urinalysis for haematuria
What is diagnostic of CKD?
Persistent (3+ months) eGFR < 60 and/or ACR > 3
How is CKD classified into stages according to eGFR?
Stage 1 = eGFR > 90 but kidney damage identified from other tests
Stage 2 = eGFR 60-89 +/- other evidence of kidney damage
Stage 3a = eGFR 45-59 +/- other evidence of kidney damage
Stage 3b = eGFR 30-44 +/- other evidence of kidney damage
Stage 4 = eGFR 15-29 +/- other evidence of kidney damage
Stage 5 = eGFR <15 +/- other evidence of kidney damage
How is CKD classified into stages according to ACR?
Stage 1 = ACR <3
Stage 2 = ACR 3-30
Stage 3 = ACR >30
eGFR and ACR stages are combined to give overall score e.g. G3aA2
What things should be covered when monitoring CKD?
Manage CV risk as appropriate with BP control, statins, antiplatelet therapy.
Lifestyle advice.
Medication review
At least annually, monitor eGFR, urinary ACR, FBC, serum calcium, phosphate, vit D, PTH
What is classed as accelerated CKD progression?
eGFR reduction by >25% or 15ml in 1 year
What eGFR level constitutes kidney failure?
<15ml/min/1.73m squared.
At this point, dialysis/kidney transplant/conservative management options must be considered.
