Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nephrology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is it?

A

impaired renal function for >3m based on abnormal structure or function
OR
GFR <60 for >3m w or w/o evidence of renal damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What stage to sx usually start to appear?

A

4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What signifies ESRF

A

GFR <15 or need for RRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the causes of CKD?

A
  1. DM T1>T2
  2. GN - commonly IgA
  3. Unknown - many present w small shrunken kidneys
  4. HTN or renovascular disease
  5. Pyelonephritis + reflux nephropathy
    Others - obstructive (AKIs), chronic interstitial nephritis, prev AKI, ADPKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who should automatically be screened for CKD?

A
  • DM, HTN, CHD
  • Structural renal disease, stones BPH
  • Recurrent UTIs, childhood hx of vesicoureteric reflux
  • Multisystem disorders which may include the kidney e.g. SLE
  • FHx of ESRF or known hereditary disease
  • Opportunistic detection of haematuria or proteinuria
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What may be found OE in a patients first presentation

A
  1. pallor
  2. uraemia skin (yellow tinge)
  3. Purpura, excoriations
  4. Raised BP
  5. Cardiomegaly
  6. Signs of fluid overload
  7. Poss cause e.g. ballotable kidneys in PKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What may be seen in untreated CKD?

A

in extremis - severe uraemia, hyperkalaemia - arrhythmia, encephalopathy, seizures or coma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give the classification of CKD including the diff stages and GFRs

A 
Stage 1: >90
2: 60-89
3A: 45-59
3B: 30-44
4: 15-29
5: <15 - established RF
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What signs would u look for in peripheries of a pt w known CKD/ESRF?

A

HTN
AV fistula (thrill, bruit, recently needled)
Signs of prev. transplant - bruising from steroids, skin malignancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What signs would u look for in the face of a pt w known CKD/ESRF?

A

pallor (anaemia)
Yellow tinge (uraemia)
Gym hypertrophy (cyclosporin)
Cushingoid appearance from steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What signs would u look for in the neck of a pt w known CKD/ESRF?

A
  • Line insertion (removed = scar over internal jugular + larger scar in breast pocket area)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What abdominal signs would u look for in a pt w known CKD/ESRF?

A
  • PD catheter, scar = midline scar below umbilicus + small round scar to side of midline)
  • signs of prev transplant - hockey stick scar, palpable mass
  • PKD (ballotable kidneys)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What OTHER signs would u look for in a pt w known CKD/ESRF?

A

Signs of diabetic neuropathy, retinopathy, CVD or PVD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What investigations would u do for a pt w CKD

A
  1. BLOOD - Hb (normochromic, normocytic), ESR, U+E, glucose, reduced Ca, raised phosphate + alk phos (renal osteodystrophy), raised PTH if CKD 3 or more
  2. URINE - dipstick, MC+S, albumin:creatinine
  3. IMAGING - USS (usually small but big in infiltrative disorders (amyloid, myeloid), PKD + DM
  4. HISTOLOGY - do if rapidly progressive or unclear cause + normal sized kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are reversible causes of CKD?

A 
oBSTRUCTION
Nephrotoxic drugs 
High Ca2+
CV risk (smoking)
Uncontrolled DM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How do you limit progression/ complications of CKD

A
  1. Control BP w ACEi/ARBs
  2. Check for renal bone disease
  3. CV modification - statins and aspirin
  4. Diet - healthy mod protein, K+ restriction if raised, avoid high phosphate foods
17
Q

What foods are high in phosphate

A

milk cheese eggs

18
Q

How do you manage renal bone disease

A

Measure calcium, phosphate, ALP, PTH, and 25-OH vit D if eGFR <30.
Treat if phosphate >1.5mmol/L (>1.7mmol/L if RRT) with dietary restriction ± phosphate binders.
Give vitamin D supplements (colecalciferol, ergocalciferol) if deficient.

19
Q 
SYMPTOM CONTROL:
How do you treat:
i. Anaemia
ii. Acidosis
iii. Oedema
iv. Restless legs/cramps
A

i. Replace iron/B12/folate if needed. EPO if still anaemic. Keep Hb 100-120g/L
ii. Sodium bicarbonate supplements if low
iii. Furosemide, restrict fluid and Na intake
iv. Check ferritin, clonazepam or gabapentin may help and quinine sulphate for cramps

20
Q

What is the target BP in CKD What if they have DM or ACR >70

A

<130/80

<125/75

21
Q

How long before anticipated RRT should a patient be listed for renal transplantation?

A

at least 6m

22
Q

how is CKD classified using albumin conc and albumin creatinine ratio?

A

A1 - <30 mg/24h conc - <3 ratio
A2 - 30-300 - 3-30
A3 - >300 - >30

23
Q

What ACR indicates microalbuminuria?

A

> 2.5 (men)

>3.5 (women)

24
Q

What ACR indicates proteinuria

A

> 30

25
Q

What ACR indicates nephrotic syndrome

A

> 220

Nephrology (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions