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Renal > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What does chronic kidney disease describe?

A

Abnormal kidney and/or structure

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2
Q

What are some features of chronic kidney disease?

A

Common, frequently goes unrecognised, often co-exists with other conditions (e.g diabetes), risk increases with age

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3
Q

What is moderate/severe chronic kidney disease associated with?

A

Increased risk of acute kidney injury, falls, frailty and mortality

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4
Q

How many samples are needed to define chronic kidney disease?

A

At least two samples taken at least 90 days apart

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5
Q

What is the best way of defining chronic kidney disease?

A

eGFR = more accurate measure of renal function than creatine, units are mg/ml/1.73 metres squared

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6
Q

What is eGFR based on?

A

Serum creatine level, age, sex and race

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7
Q

What is used to estimate the GFR of creatine?

A

The CKD-EPI creatine equation

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8
Q

What is stage G1 of CKD?

A

eGFR >90

Normal kidney function but urine findings/structural abnormalities/genetic trait point to kidney disease

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9
Q

What is stage G2 of CKD?

A

eGFR of 60-89

Mildly reduced kidney function but urine findings/structural abnormalities/genetic trait point to kidney disease

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10
Q

What is stage G3 of CKD?

A

Moderately reduced kidney function
3a = eGFR of 45-59
3b = eGFR of 30-44

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11
Q

What is stage G4 of CKD?

A

eGFR of 15-29

Severely reduced kidney function

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12
Q

What is stage G5 of CKD?

A

eGFR < 15

Established renal failure

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13
Q

How can the albumin/creatine ratio be used to stage CKD?

A 
A1 = ACR <3 mg/mmol
A2 = ACR of 3-30 mg/mmol
A3 = ACR >30 mg/mmol
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14
Q

How long should patients who have suffered from an acute kidney injury be monitored for CKD?

A

At least 2-3 years after (even if serum creatine returns to baseline)

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15
Q

What should be used to confirm CKD?

A

eGFRcystatinC

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16
Q

When should you consider diagnosing CKD?

A

Patients with an eGFR creatine of 45-59 sustained for at least 90 days and no proteinuria (ACR <3 mg/mmol)

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17
Q

What patients should you not diagnose CKD in?

A

eGFR creatine of 45-59
eGFRcystatinC >60
No other marker of kidney disease

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18
Q

When should you offer testing for chronic kidney disease?

A

Diabetes, hypertension, acute kidney injury, CV disease, structural renal tract disease, recurrent renal calculi, prostatic hypertrophy, multi-system diseases that can involve the kidneys (e.g SLE), family history of end age CKD or hereditary kidney disease

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19
Q

What indicates that chronic kidney disease is progressing?

A

Sustained decrease in GFR or 25% or more and a change in GFR category within 12 months OR sustained decrease in GFR of 15% per year

20
Q

What are the risk factors for chronic kidney disease progression?

A

CV disease, proteinuria, acute kidney injury, hypertension, diabetes, smoking, African/Afro-Caribbean/Asian, chronic use of NSAIDs

21
Q

When should you consider referring a patient?

A

GFR <30 with or without diabetes
ACR >= 70 mg/mmol (unless caused by diabetes)
ACR >= 30 mg/mmol together with haematuria
Evidence of progression
Hypertension that remains poorly controlled despite the use of 4 anti-hypertensive drugs
Known/suspected rare or genetic cause of CKD

22
Q

What is the target blood pressure for people with chronic kidney disease?

A

Systolic <140 mmHg (target is 120-139 mmHg)

Diastolic <90 mmHg

23
Q

What is the target blood pressure for patients with CKD and diabetes/ACR >= 70 mg/mmol?

A

Systolic <130 mmHg (target is 120-129 mmHg)

Diastolic < 80mmHg

24
Q

When should you not consider lowering the dose of RAAS inhibitors (e.g ACEi)?

A

If GFR decreases from pre-treatment baseline by less than 25% or the serum creatine increases from baseline by <30%

25
Q

What is the first choice drug for lowering lipids in patients with CKD?

A

Atorvastatin = 20mg for prevention of CVD

26
Q

When should you consider increasing the dose of atorvastatin?

A

If >40% reduction in HDL-cholesterol isn’t achieved and eGFR is >=30

27
Q

What is the prevalence of CKD in England?

A

Stage 3-5 is 6%
1% of males and 2% of females aged 16-54
31% of males and 36% of females aged >=75

28
Q

What are some causes of CKD?

A

Diabetes, hypertension, calculi, ischaemic/hypertensive nephrosclerosis, cancer, GPA, EGPA, MPA

29
Q

What are the clinical signs of chronic kidney disease?

A

Anaemia = conjunctival and palmar pallor

Weight loss and signs of advanced uraemia

30
Q

What are the signs of advanced uraemia?

A

Lemon yellow, uraemic frost, twitching, confusion, encephalopathic flap, pericardial rub or effusion, metabolic acidosis

31
Q

What are the symptoms of chronic kidney disease?

A 
Uraemic = nausea/vomiting, anorexia, fatigue, itch, altered taste, restless legs, difficulty concentrating
Anaemia = fatigue, muscle weakness
Pain = bony, neuropathic, ischaemic, visceral
32
Q

What are some renal consequences of chronic kidney disease?

A

Pain, haemorrhage, infection, haematuria, proteinuria, impaired salt and water handling, hypertension, electrolyte abnormalities, acid-base disturbance

33
Q

What are some extra-renal consequences of CKD?

A

CV disease, mineral and bone disease (CKD-MBD), anaemia, nutrition

34
Q

How may end stage renal disease (ESRD) be treated?

A

Renal replacement therapies (RRT) = haemodialysis, peritoneal dialysis, transplantation
Conservative management

35
Q

When does CV disease associated with chronic kidney disease begin?

A

Starts from eGFR <50 ml/min

Risk increases with albuminuria (even if eGFR normal)

36
Q

How useful are CV risk calculators for predicting the risk of CKD patients developing CV disease?

A

Not very useful = significantly underestimate risk

37
Q

How can risk of developing CV disease be reduced?

A

General = smoking cessation, weight loss, aerobic exercise, limiting salt intake
Control of hypertension and lipid lowering therapy
Consider aspirin for secondary prevention

38
Q

What causes mineral and bone disease?

A

Adaptive changes in calcium, phosphate, PTH, vitamin D and FGF-23 = compromises homeostatic mechanism

39
Q

What are the consequences of mineral and bone disease?

A

Secondary/tertiary HPT, vascular calcification, bone pain, fractures, CV events, metabolic acidosis

40
Q

What dietary advice is given to patients with mineral and bone pain?

A

Phosphate restriction (if high), salt reduction, potassium reduction (if >5.5 mmol/l), fluid restriction to 1-1.5 l/day

41
Q

What are some medications given to treat mineral and bone disease?

A

Alfacalcidol = active vitamin D
Phosphate binders = calcium based (Adcal/PhosLo), aluminium (Alucaps), non-calcium based (Lanthanum)
Calcimimetic (Cinacalet)

42
Q

What patients with CKD are most at risk of developing anaemia?

A

Those with diabetes = less common in patients with eGFR >45

43
Q

What are the targets for patients with anaemia?

A

Hb = 100-120 g/l
Ferritin >100
TSats >20%

44
Q

What must be ruled out in patients with anaemia?

A

B12 and folate deficiencies

45
Q

What ion therapy is used in patients with anaemia?

A

Ferinject (ferric carboxymaltose) or Venofer (iron sucrose)

46
Q

When is IV iron offered to patients with anaemia?

A

If oral iron fails to replete stores or isn’t tolerated

47
Q

When are ESAs offered to patients with anaemia?

A

If Hb <100-110 g/dl despite no iron or haematinic deficiencies

Renal (36 decks)

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