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Renal > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney disease?

A

Abnormal kidney function/structure lasting more than 3 months

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2
Q

How many samples are required to diagnose CKD and how far apart should they be measured?

A

2 samples at least 90 days apart

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3
Q

What is measured to diagnose CKD?

A

eGFR and ACR

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4
Q

What factors does eGFR take into account?

A

Creatinine, age, sex and race

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5
Q

In terms of GFR describe CKD stage 1-5

A 
1 >90
2 60-89
3a 45-59
3b 30-44
4 15-29
5 <15
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6
Q

What are the three categories of ACR?

A

<3, 3-30, >30

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7
Q

How often post AKI should patients be monitored?

A

Regularly for at least 2-3 years even if creatinine is normal

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8
Q

What can be used if eGFR creatinine is borderline?

A

eGRF cystantinC

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9
Q

Define accelerated progression

A
  • Sustained decrease in GFR of 25% or more and change of GFR category within 12 months
    OR
  • sustained decrease in GFR of 15ml/min/1.72m/year
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10
Q

State the risk factors for CKD

A
  • CVD
  • Proteinuria
  • AKI
  • Hypertension
  • Diabetes
  • Smoking
  • Chronic NSAID use
  • Urinary Outflow Obstruction
  • African/Caribbean/Asian
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11
Q

When should a patient be referred to renal?

A 
GFR<30 
ACR >70
ACR 30 + with haematuria 
Accelerated progression 
Poorly controlled hypertension (unresponsive to four drugs)
Rare/genetic CKD 
Renal Artery Stenosis
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12
Q

What is the target BP in CKD patients?

A

120-139 systolic

<90 diastolic

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13
Q

What is the target BP in diabetics or ACR of 70+?

A

Systolic <130

Diastolic <80

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14
Q

What can be given to CKD patients in order to prevent CVD?

A

Atorvastatin

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15
Q

How does diabetes cause CKD?

A

Non-enzymatic glycation and hyaline arteriosclerosis leads to hyper filtration and glomerulosclerosis

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16
Q

How does hypertension cause CKD?

A

Thickening, ischaemia and immune response leads to glomerulosclerosis

17
Q

Other than diabetes and hypertension what else can cause CKD?

A 
Glomerulonephritis 
Renal artery stenosis 
Small vessel vasculitis 
Tubulointerstitial 
Post-renal - calculi, prostatic or bladder pathology
18
Q

What are the signs of advanced uraemia?

A

Lemon yellow, uraemic frost (urea crystals deposit in skin), twitching, confusion, encephalopathic flap, confusion, pericardial rub/effusion, kussmaul’s breathing

19
Q

Why does anaemia occur in CKD?

A

Due to decreased erythropoietin

20
Q

Where can pain present in CKD?

A

Bony
Neuropathic
Ischaemic
Visceral

21
Q

Name the renal consequences of CKD

A
  • local pain/haemorrhage/infection
  • haematuria/proteinuria
  • impaired salt/water handling
  • hypertension
  • electrolyte abnormality
  • acid-base disturbance
22
Q

Name four extra-renal consequences of CKD

A

Cardiovascular
Bone and mineral
Anaemia
Nutrition

23
Q

Describe the cardiovascular consequence of CKD and how it is managed

A

eGFR <50ml/min, microalbuminuria

Aim to control hypertension, smoking and reduce salt intake

24
Q

What chemicals are affected by bone and mineral disease?

A 
Calcium 
Phosphate
PTH 
Vit D 
FGF-23
25
Q

What does bone and mineral disease lead to?

A

Compromised homeostatic mechanisms

  • hypertension
  • vascular calcification
  • bone pain
  • fractures
  • CV events
  • lower quality of life
  • increased morbidity and mortality
26
Q

How is bone and mineral disease managed?

A 
Phosphate restriction 
Salt reduction 
Potassium restriction 
Fluid restriction 
Correction of metabolic acidosis
27
Q

What mediations can be given in bone and mineral disease?

A

Alfacalcidol
Phosphate binders
Calcimimetic

28
Q

What is the purpose of a calcimimetic?

A

Hypocalaemia can lead to increased PTH and weak/brittle bones (renal osteodystrophy)

29
Q

At what eGFR is anaemia less common?

A

> 45

30
Q

What is the target Hb?

A

100-120g/l

31
Q

If oral iron does not sufficiently treat anaemia what can be given?

A

IV Iron

32
Q

What are the treatment options for end stage renal disease?

A
  • haemodialysis
  • peritoneal dialysis
  • transplantation
  • conservative management
33
Q

Name three factors that impact eGFR

A

Pregnancy
Red meat consumed in last 12 hours
Extreme muscle mass

34
Q

Why is erythropoiesis reduced in CKD end stage?

A

Toxic effect of urea on bone marrow

Renal (20 decks)

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