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Renal > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney disease?

A

Defined by the presence of kidney damage (abnormal blood, urine or imaging findings) or GFR <60ml/min/1.73cm2 that has been present for more than 3 months

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2
Q

What can cause chronic kidney disease?

A

DM

Chronic glomerulonephritis

HTN

Age related decline

Polycystic kidney disease

Renovascular disease

Nephrotoxicity

Chronic pyelonephritis

Smoking

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3
Q

How does chronic kidney disease present?

A

Normally asymptomatic and diagnosed on routine testing

Pruritis, incompletely understood

Oedema

N&V, incompletely understood

Cognitive changes, due to urea build up

Pallor due to anaemia

HTN

Muscle cramps, neuronal irritation

Peripheral neuropathy

Urine symptoms

  • Polyuria
  • Oliguria
  • Nocturia
  • Proteinuria
  • Haematuria
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4
Q

What investigations are used in chronic kidney disease diagnosis and monitoring?

A

U&E

  • eGFR, two tests are required 3 months apart to confirm a diagnosis
  • Hyperkalaemia
  • Hypocalcaemia, due to lack of vitamin D

Urinalysis

  • Haematuria, significant result is 1+ of blood
  • Proteinuria, ≥ 3mg/mmol is significant

US

  • Bilateral small kidneys

Renal biopsy

FBC

  • Chronic normochromic anaemia

ABG

  • Metabolic acidosis

LFTs

  • Hypoalbuminemia detects those at risk of nephropathy earliest
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5
Q

What biopsy signs are seen in chronic kidney disease?

A

Glomerulosclerosis

Kimmelstiel-Wilson lesions in diabetic neuropathy

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6
Q

What US signs can be seen in chronic kidney disease?

A

Bilateral small kidneys with thinned cortices for intrinsic disease

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7
Q

How is chronic kidney disease managed?

A

Treat underlying cause, such as pyelonephritis

Optimise risk factors

  • DM control
  • BP control, ACEI is first line
  • Atorvastatin 20mg for primary prevention of cardiovascular disease

Lifestyle

  • Stop smoking
  • Increased exercise
  • Dietary advice about phosphate, sodium, potassium and water intake

Complication management

  • Oral sodium bicarbonate for metabolic acidosis
  • Iron supplementation and erythropoietin/ESA for anaemia
  • Vitamin D and bisphosphonates for renal bone disease
  • Gout management

Renal replacement therapy for end stage renal disease

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8
Q

When is specialist referral indicated for CKD?

A

eGFR < 30, or falls progressively by over 15 in a year

ACR ≥ 70 mg/mmol

Uncontrolled hypertension despite ≥ 4 antihypertensives

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9
Q

Describe stage 1 chronic kidney disease based on GFR

A

Kidney damage

GFR>90 and supporting evidence

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10
Q

Describe stage 2 chronic kidney disease based on GFR

A

Kidney damage

GFR 60-89 and supporting evidence

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11
Q

Desribe stage 3a chronic kidney disease based on GFR

A

Moderately impaired

GFR 45-59

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12
Q

Describe stage 3B chronic kidney disease based on GFR

A

Moderately impaired

GFR 30-44

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13
Q

Describe stage 4 chronic kidney disease based on GFR

A

Severely impaired

GFR 15-29

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14
Q

Describe stage 5 of chronic kidney disease

A

Advanced/dialysis

GFR<15

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15
Q

Describe stage 1 of chronic kidney disease based on albuminuria

A

Normal to mildly increased

<30mg/g

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16
Q

Describe stage 2 of chronic kidney disease based on albuminuria

A

Moderately increased

30-300mg/g

17
Q

Describe stage 3 of chronic kidney disease based on albuminuria

A

Severely increased

>300mg/g

18
Q

Give complications of chronic kidney disease

A

Mortality and complications worsen with decreased renal function

Gout

  • Uric acid builds up in joints due to failure of excretion

Hyperkalaemia causing arrythmias

Anaemia

  • Reduced erythropoietin production
  • Predisposes to left ventricular hypertrophy

Renal bone disease

  • Reduced vitamin D production causes hypocalcaemia which stimulates release of PTH to release calcium from bone

Peripheral neuropathy

19
Q

When is an ACEI started in CKD?

A

Raised albumin:creatine ratio, over 70mg/mmol

20
Q

When is atorvastatin used in CKD?

A

Reccomended for all CKD patients

21
Q

What is used as vitamin D supplementation in end stage renal disease and why?

A

Alfacalcidol

Does not require activation in kidneys

22
Q

Give side effects of erythropoietin

A

Accelerated HTN, leading to encephalopathy amd seizures

Bone pain

Flu symptoms

Skin rashes/urticaria

Thrombosis

Iron deficiency secondary to increased erythopoiesis

23
Q

What should be checked prior to starting EPO in patients with CKD and anaemia?

A

iron status

24
Q

How do you prevent contrast induced nephropathy?

A

IV 0.9% NaCl pre and post procedure

Renal (10 decks)

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