Chronic kidney disease Flashcards
What is chronic kidney disease?
Defined by either a pathological abnormality of the kidney, such as haematuria and/or proteinuria or a reduction in the GFR to < 60 ml/minute/1.73 m2 for >3 months duration
Causes of chronic kidney disease
-The most common cause in the adult population is diabetes (a third develop kidney problems)
-Hypertension is the second most common cause
-Less frequent causes include:
Cystic disorders of the kidney
Obstructive uropathy
Glomerular nephrotic and nephritic syndrome (focal segmental glomerulosclerosis, membranous nephropathy, lupus nephritis, amyloidosis, rapidly progressive glomerulonephritis)
Staging of CKD
Albuminuria categories
Normal: <30 mg albumin/24 hours or albumin to creatinine ratio [ACR] of <3.4 mg/mmol (<30 mg/g)
Moderately increased (microalbuminuria): 30-300 mg albumin/24 hours or ACR of 3.4-34.0 mg/mmol (30-300 mg/g)
Severely increased (macroalbuminuria): >300 mg albumin/24 hours or ACR >34 mg/mmol (>300 mg/g).
Glomerular filtration rate (GFR) categories
G1: GFR 90 (ml/min/1.73 m²) = normal or high
G2: GFR 60–89 (ml/min/1.73 m²)
G3a: GFR 45–59 (ml/min/1.73 m²)
G3b: GFR 30–44 (ml/min/1.73 m²)
G4: GFR 15–29 (ml/min/1.73 m²)
G5: GFR <15 (ml/min/1.73 m²) = kidney failure
Signs and symptoms of CKD
Fatigue (anaemia due to lack of EPO) Oedema (salt and water retention) Nausea w/wo vomiting (toxic waste buildup of urea) Pruritus (toxic waste buildup of urea) Anorexia (toxic waste buildup of urea) Infection-related glomerular disease Arthralgia Enlarged prostate gland (obstructive uropathy)
Risk factors of CKD
DM HTN Age > 50 years Childhood kidney disease Smoking Obesity Black ethnicity FHx of CKD Autoimmune disorders Male sex Long term use of NSAIDs
Investigations for CKD
Serum creatinine (raised) Urinalysis (haematuria and/or proteinuria) Urine microalbumin (30-300 mg/day) Renal ultrasound Estimation of GFR (<60 ml) Renal biopsy AXR (kidney stones) Abdominal CT (kidney stones, renal masses or cysts)
Differentials of CKD
Diabetic kidney disease Hypertensive nephrosclerosis Ischaemic nephropathy Obstructive uropathy Nephrotic syndrome Glomerulonephritis
Who should be tested for CKD?
Diabetes Hypertension AKI CVD (ischaemic heart disease, CHF, DVD, cerebral vascular disease) SLE FHx of end-stage kidney disease
Who should you offer a renal ultrasound to?
Accelerated progression of CKD Visible or persistent invisible haematuria Symptoms of urinary tract obstruction FHx of PKD and aged over 20 GFR less than 30
Management of CKD
Information and education about CKD Lifestyle and diet advice (especially potassium, phosphate and salt intake) Treat: Blood pressure- keep systolic below 140mmHg and diastolic below 90 mmHg Anaemia Secondary hyperparathyroidism High-phosphate levels Metabolic acidosis
How do you treat blood pressure in CKD?
(offer ACE-i or ARB)- if ACEi/ARB is CI then offer non-dihydropyridine calcium-channel blocker like diltiazem or verapamil
How do you treat anaemia in CKD?
Darbepoetin alfa- EPO stimulating agent
How do you treat secondary hyperparathyroidism in CKD?
Ergocalciferol or Calcimmetic (cinacillet, calcitriol) w/wo vitamin D analogue
How do you protect the bones in CKD?
Alphacalcidiol, Phosphate binders (sevelamer)
How do you treat metabolic acidosis in CKD?
Oral sodium bicarbonate
