Chronic Kidney Disease Flashcards
How is chronic kidney disease defined?
GFR <60ml/min/1.73m^2 for 3 months or more
eGFR is a useful measure of kidney function in pregnancy. T/F?
False
Describe stage one CKD
GFR >90 with evidence of kidney damage
Describe stage two CKD
GFR 60-89 with evidence of kidney. damage
Describe stage three CKD
GFR 30-59
Describe stage four CKD
GFR 15-29
Describe stage five CKD
GFR <15
How much protein in the urine per day can be considered normal?
<150mg/day
What phsyiological causes can result in 1+ proteinuria on dipstick?
Fever
Exercise
How is proteinuria quantified?
24 hour urine collection (not common practice, but gold standard)
Protein:creatinine ratio
Albumin:creatinine ratio
How is albuminuria defined?
Albumin:creatinine ratio >30
What is the nephrotic range of proteinuria on protein:creatinine ratio?
> 300
If there is heavy albuminuria, what test should be used to follow the patient’s progress?
Protein:creatinine ratio
Give examples of causes of CKD
Diabetic nephropathy
Renovascular disease/ischaemic nephropathy
Chronic glomerulonephritis
Reflux nephropathy/chronic pyelonephritis
ADPKD
Obstructive uroapthy
What are. the symptoms of advanced CKD?
Pruritus Nausea Anorexia Weight loss Fatigue Leg swelling Breathlessness Nocturia Joint/bone pain Confusion
What are the signs of advanced CKD?
Peripheral and pulmonary poedema Pericardial rub Rash/excoriation Hypertension Tachypnoea Cachexia Pallor/lemon yellow tinge
How can the progression of CKD be slowed?
Agressive bp control Good diabetic control Smoking cessation Diet Lowering cholesterol Treating acidosis
Which antihypertensives should be used in CKD?
ACE inhibitors or ARBs
There will be an initial reduction of eGFR of up to 25% with ACE inhibitor/ARB therapy in CKD. T/F?
True - this is acceptable as it reflects a decrease in glomerular pressure which will improve kidney disease
Anaemia in CKD is particularly common when eGFR falls to…?
<30
How should anaemia in CKD be treated?
Iron, B12 and folate replacement
Darbepoitin alfa 30 micrograms every 2 weeks
Targets Hb 100-120g/l
What is the target haemoglobin in CKD?
100-120 g/l
How can secondary hyperparathyroidism as a result of CKD be treated?
Replacement of activated vitamin D - 0.25 micrograms alfacalcidol
Magnesium sipplements
Phosphate bindings - calcium carbonate/acetate, sevelamer, lanthanum, aluminium
Cicimemetic e.g. cinacalet
Parthyroiectomy
What is the target phosphate in secondary hyperparathyroidism due to CKD?
0.9-1.5 mol/l
When is dialysis started in CKD?
eGFR 5-10 ml/min/1.73m^2
There is no benefit to outcomes to starting dialysis early in CKD. T/F?
True
