Chronic Kidney Disease Flashcards
Why do you get fluid overload in CKD?
When your kidneys are not working as well as they should, they cannot take out enough fluid. This can cause the extra fluid in your blood to build up in your body. Having too much fluid in your body can cause problems with your heart and lung
What is CKD?
CKD describes abnormal kidney function and/ or structure, abnormalities must be present for more than 3 months. Often co-exists with other conditions such as CVD and diabetes.
Risk of CKD ______ with age
Increases with age as kidney function declines in the elderly
What does CKD diagnosis require?
A minimum of 2 samples at least 90 days apart. eGFR is reported along side creatinine levels
Define accelerated progression of CKD?
A sustained decrease in GFR of 25% or more
and a change in GFR category within 12 months
OR A sustained decrease in GFR of 15ml/min/1.73 squared per year
Describe the stages and severity of CKD?
G1-G2: A1 = no CKD in absence of kidney damage markers G1-2:A2= mild G3a: A1= mild G1-G2: A3= moderate G3A: A2= moderate G3b: A1= moderate G3a: A3= severe G3b: A2-3= severe G4-G5: A1-3= severe
Describe 9 risk factors for CKD progression?
CVD, Hypertension, African/ Afro Caribbean/ Asian Descent, proteinuria, diabetes, chronic NSAIDs use, AKI, Smoking, untreated urinary outflow tract obstruction
Globally 2/3 of CKD is caused by ________
Diabetes Mellitus and hypertension
Describe some clinical signs of CKD
Anaemia > conjunctival pallor and palmar pallor
Signs of weight loss
Advanced uraemia > lemon yellow skin, uraemia frost, twitching, encephalopathy flap, confusion, pericardial rub or effusion, kussmaul breathing in metabolic acidosis
Why does anaemia occur in CKD?
Kidneys are producing less erythropoietin which is needed to make RBCs
Why does weight loss occur in CKD?
Build of urea can cause nausea, vomiting and loss of appetite
What is lemon yellow skin and uraemic frost due to?
deposition of urea in the skin
In uraemic frost crystals are deposited on the surface which results in a frosted appearance as sweat evaporates
Describe some symptoms of CKD?
DUE TO URAEMIA: Nausea, vomiting, anorexia, weight loss, fatigue, itch, altered taste, restless legs and muscle twitching, difficulties concentrating, confusion.
DUE TO ANAEMIA: Fatigue, Muscle weakness
PAIN: can be bony, neuropathic, ischaemic or visceral
Nocturia due to decreased urine concentrating ability
Describe some renal consequences of CKD?
Pain, haemorrhage, infection, haematuria, proteinuria, impaired salt and water handling, hypertension, electrolyte abnormalities, acid base disturbance, ESRD
Describe some extra renal consequences of CKD?
CVD, Mineral and Bone disease, anaemia, nutritional consequences
Describe CVD in CKD?
Pericarditis can occur due to high urea or phosphate or is severe hyperparathyroidism. Fluid overload and hypertension can cause LVH or dilated cardiomyopathy.
General management of CVD in CKD?
Advice on smoking cessation, weight loss, aerobic exercise, limiting salt intake, control of hypertension and hyperlipidaemia
Describe why bone disease occurs in CKD?
Due to poorly functioning kidneys get renal phosphate retention and inadequate renal vitamin D activation resulting in poor calcium absorption from the gut so decrease in calcium and increase in phosphate. This causes a rise in PTH causing secondary hyperparathyroidism.
Eventually PTH secretion can become autonomous and fail to fall even when hypocalcaemia is treated. This is termed tertiary hyperparathyroidism.
Treatment of bone disease in CKD?
Phosphate, salt, potassium and fluid restriction potentially. Correct any metabolic acidosis. May need active vitamin D supplements, phosphate binders (Adcal, phoslo, alucaps, lanthanum)
Who is more at risk of renal anaemia?
Diabetics more at risk
Management of renal anaemia?
Must exclude other causes of anaemia
Synthetic human erythropoiesis stimulating agents (ESAs) can be given
Describe BP control in CKD?
Aim to keep systolic < 140mmHG and diastolic < 90mmHg
With CKD and diabetes or ACR of 70mmHg or more aim for systolic <130mmHg and diastolic < 80mmHg
Describe dosing of ACEi and ARBs in CKD?
Watch GFR
If GFR decrease less than 25% or serum creatinine increase > 30% don’t modify the dose (ie don’t want GFR decreasing by > 25% or creatinine increasing by > 30%)
Describe lipid lowering therapy in CKD?
Offer Atorvostatin 20 mg for the primary or secondary prevention of CVD to people with CKD
