Chronic Kidney Disease Flashcards
What is chronic kidney disease?
Abnormal kidney function/structure lasting more than 3 months
How many samples are required to diagnose CKD and how far apart should they be measured?
2 samples at least 90 days apart
What is measured to diagnose CKD?
eGFR and ACR
What factors does eGFR take into account?
Creatinine, age, sex and race
In terms of GFR describe CKD stage 1-5
1 >90 2 60-89 3a 45-59 3b 30-44 4 15-29 5 <15
What are the three categories of ACR?
<3, 3-30, >30
How often post AKI should patients be monitored?
Regularly for at least 2-3 years even if creatinine is normal
What can be used if eGFR creatinine is borderline?
eGRF cystantinC
Define accelerated progression
- 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
State the risk factors for CKD
- CVD
- Proteinuria
- AKI
- Hypertension
- Diabetes
- Smoking
- Chronic NSAID use
- Urinary Outflow Obstruction
- African/Caribbean/Asian
When should a patient be referred to renal?
GFR<30 ACR >70 ACR 30 + with haematuria Accelerated progression Poorly controlled hypertension (unresponsive to four drugs) Rare/genetic CKD Renal Artery Stenosis
What is the target BP in CKD patients?
120-139 systolic
<90 diastolic
What is the target BP in diabetics or ACR of 70+?
Systolic <130
Diastolic <80
What can be given to CKD patients in order to prevent CVD?
Atorvastatin
How does diabetes cause CKD?
Non-enzymatic glycation and hyaline arteriosclerosis leads to hyper filtration and glomerulosclerosis
How does hypertension cause CKD?
Thickening, ischaemia and immune response leads to glomerulosclerosis
Other than diabetes and hypertension what else can cause CKD?
Glomerulonephritis Renal artery stenosis Small vessel vasculitis Tubulointerstitial Post-renal - calculi, prostatic or bladder pathology
What are the signs of advanced uraemia?
Lemon yellow, uraemic frost (urea crystals deposit in skin), twitching, confusion, encephalopathic flap, confusion, pericardial rub/effusion, kussmaul’s breathing
Why does anaemia occur in CKD?
Due to decreased erythropoietin
Where can pain present in CKD?
Bony
Neuropathic
Ischaemic
Visceral
Name the renal consequences of CKD
- local pain/haemorrhage/infection
- haematuria/proteinuria
- impaired salt/water handling
- hypertension
- electrolyte abnormality
- acid-base disturbance
Name four extra-renal consequences of CKD
Cardiovascular
Bone and mineral
Anaemia
Nutrition
Describe the cardiovascular consequence of CKD and how it is managed
eGFR <50ml/min, microalbuminuria
Aim to control hypertension, smoking and reduce salt intake
What chemicals are affected by bone and mineral disease?
Calcium Phosphate PTH Vit D FGF-23
