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year 2 renal > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

what are the functions of the kidney?

A
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2
Q

Measurement of kidney function and definition of chronic kidney disease

A
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3
Q

How do we assess for kidney disease?

A
  • Filtration (excretory) function - remove
  • Filtration (barrier) function - retain
  • Anatomy - abnormality
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4
Q

what is glomerular filtration rate?

A

estimates how much blood passes through the glomeruli each minute

One method of determining GFR from creatinine is to collect urine (usually for 24 h) to determine the amount of creatinine that was removed from the blood over a given time interval

Pressure difference leads to glomerular filtration

Normal GFR = 120/min

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5
Q

How do you measure excretory Renal Function?

A
  • Inulin clearance
  • Isotope GFR
  • 24 hour urine collection plus blood test
  • GFR estimating equations

Creatinine will not be raised above the normal range until 60% of total kidney function is lost

Serum creatinine is the basic thing used to measure kidney function

Need to lose around 50% or more of GFR before you see a rise in your creatinine

There are pitfalls to using it

African Americans will have a higher serum creatinine level at any level of creatinine clearance because they have a higher muscle mass

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6
Q

What is the problem of the relationship between serum creatinine and GFR?

A

Creatinine is generated from breakdown of muscle

Not everyone has the same muscle mass

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7
Q

What does the relationship between serum creatinine and GFR depend on?

A

Age

Ethnicity

Gender

Weight

Other issues eg liver disease

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8
Q

What are some formulae that may be used to estimate GFR from serum creatinine?

A
  • Cockcroft Gault = ([140-age] x weight x 1.23) / SCr x (0.85 if female)
  • MDRD 4 variable equation = 175 x [SCr/88.4] -1.154 x [age] -0.203 x (0.742 if female) x (1.212 if black)
  • CKD-EPI equation
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9
Q

How do we assess kidney excretory function?

A

International CKD Classification System

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10
Q

What things do we test for kidney disease?

A
  • Filtration (excrete out) function – use estimates of GFR (eGFR) from creatinine blood test
  • Filtration (keep in) function
  • Anatomy
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11
Q

what things can cross the glomerular basement membrane (GBM)?

A

–Water

–Electrolytes

–Urea

–Creatinine

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12
Q

what things cross the GBM but are reabsorbed in the proximal tubule?

A

–Glucose

–Low molecular weight proteins (α2 microglobulin)

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13
Q

what things do not cross the GBM?

A

–Cells (RBC, WBC)

–High molecular weight proteins (albumin, globulins)

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14
Q

what should there be none of in the urine if it is being filtered properly?

A

•Should be no blood or protein measurable in urine if filtering properly

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15
Q

• Urinalysis (“dipstick”) can detect what in the urine?

A

blood

protein

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16
Q

How is protein quantification done?

A

Protein creatinine ratio (PCR)

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17
Q

How do we check filtration (excrete out) function?

A

use estimates of GFR (eGFR) from creatinine blood test

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18
Q

How do we assess filtration (keep in) function?

A

check for presence of blood or protein in urine

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19
Q

how do we check the anatomy?

A

histology

imaging

20
Q

What is the current CKD definition?

A

• Chronic kidney disease (CKD) is defined by either the presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR<60 ml/min/1.73m2 that is present for ≥3 months

Must have at least 2 samples spaced out by a couple of months to be called chronic kidney disease

21
Q

Prevalence of CKD

A
22
Q

what is the prevelance of CDK and what does it increase with?

A
  • Increases with age
  • ~8-12% UK
23
Q

Why is CKD important?

A
24
Q

does CDK cost a lot of money?

A

yes costs lots of money to care for a patient

25
Q

Are numbers for Renal replacement therapy
(for end stage renal disease) increasing or decreasing?

A

Prevalent numbers on RRT are increasing every year

Numbers of dialysis not increasing over last few years due to increased transplant

26
Q

what is the mortality of CDK like?

A

High mortality with patients with chronic kidney disease as often underlying condition hat are increased cardiac risk

Increases with worsening renal function

27
Q

Aetiology of CKD

A
28
Q

what is the aetiology of CDK?

A

lots of different causes

Depends on the population studied

Often difficult to establish

But if we can find out the cause…could be important to management and outcome

29
Q

what is the clinical approach to dealing with CDK?

A
  • Detection of the underlying aetiology - Treatment for specific disease
  • Slowing the rate of renal decline - Generic therapies
  • Assessment of complications related to reduced GFR - Prevention and Treatment
  • Preparation for Renal Replacement Therapy
30
Q

Clinical assessment

A
31
Q

What are the symptoms and signs of CKD?

A

Mainly asymptomatic

Often incidentally picked up on blood test for things like diabetes management or in hospital

Don’t have signs till very advanced

This shows some of the things that someone may have

32
Q

Detection of the underlying aetiology - how is this done?

A
33
Q

what investigations may be used for the detection of underlying aetiology?

A

biopsy last, others are for when you dont know exactly what is going on

34
Q

what chemistry investigations can be used to detect aetiology?

A

–Urea, creatinine, electrolytes (Na, K, Cl)

–Bicarbonate

–Total protein, albumin

–Calcium, phosphate

– Liver function tests

–Creatine kinase

–Immunoglobulins, serum protein electrophoresis

35
Q

what haemotology investigations can be used to detect underlying aetiology?

A

Full blood count:

  • Hb
  • MCV
  • MCH
  • WBC
  • Platelets
  • % hypochromic RBCs

Coagulation screen:

  • PT
  • APPT
  • +/- Fibrinogen
36
Q

what are some urine investigations to detect aetiology?

A

• Urinalysis (“dipstick”):

  • Blood
  • Protein

• Protein quantification:

  • Protein creatinine ratio (PCR)
  • Albumin creatinine ratio
  • 24 hour urine collection
37
Q

Renal disease is often __________ – only sign may be abnormal __ or ________

A

asymptomatic

BP

urinalysis

38
Q

one imaging technique used to detect aetiology is ultrasound, what are the positives of this? and what are the negatives?

A

Non-invasive

No ionising radiation

May provide information about chronicity of renal disease

No functional data

Operator dependant

39
Q

what pathology technique can be used to detect aetiology?

A

kidney boiopsy

40
Q

Management

A
41
Q

what are some potential interventions to slowing down the rate of kidney decline?

A
  • BP control ****most important***
  • Control proteinuria (particularly ACE inhibitors / ARBs)
  • Treat underlying cause
  • Others
42
Q

Assessment of complications related to reduced GFR - what are some potential ones?

A
  • Acidosis
  • Anaemia
  • Bone disease
  • CV risk
  • Death & Dialysis
  • Electrolytes
  • Fluid overload
  • Gout
  • Hypertension
  • Iatrogenic issues
43
Q

complications ar emor elikely with a wrosening ____

A

eGFR

44
Q

What is the management of complications related to reduced GFR?

A
  • Acidosis - bicarb
  • Anaemia – EPO and iron
  • Bone disease – diet and phosphate binders
  • CV risk – BP, aspirin, cholesterol, exercise, weight
  • Death & Dialysis – counsel and prepare
  • Electrolytes – diet and consider drugs
  • Fluid overload – salt and fluid restriction, diuretics
  • Gout – optimise +/- meds
  • Hypertension – weight, diet, fluid balance, drugs
  • Iatrogenic issues – BE AWARE
45
Q

Most important thing I think about __ risk as many people will die form that before they reach end stage kidney disease

A

CV

46
Q

What preperation may be required for end stage renal disease and renal replacement therapy

A
  • Education & information
  • Selection of modality - HD / PD ?transplant ??conservative care
  • Planning access
  • Deciding when to start RRT (renal replacement therapy)
  • Multidisciplinary team
47
Q

Summary:

  • CKD is _______
  • Kidney function is assessed with ___ (often estimated) in stages
  • There is a ____ morbidity (RRT, CV events) and mortality
  • Worse kidney _______ and more _________ is associated with worse outcomes
  • Early identification and management should ____ rate of decline
  • In health the kidneys contribute to many ___________ functions – loss of these with ___ leads to many complications including anaemia, acidosis and bone disease.
  • Good CKD care involves the _____________ team to help manage these complications and help make choices for end stage renal disease and RRT
A

Summary:

  • CKD is common
  • Kidney function is assessed with GFR (often estimated) in stages
  • There is a high morbidity (RRT, CV events) and mortality
  • Worse kidney function and more proteinuria is associated with worse outcomes
  • Early identification and management should slow rate of decline
  • In health the kidneys contribute to many homeostatic functions – loss of these with CKD leads to many complications including anaemia, acidosis and bone disease.
  • Good CKD care involves the multidisciplinary team to help manage these complications and help make choices for end stage renal disease and RRT

year 2 renal (26 decks)

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