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Yr 2 - Renal > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney disease (CKD)?

A

A slow decline in kidney function or structure (months to years)

To label someone as having chronic kidney disease they should have two readings taken at least 90 days apart

This term now replaces chronic renal failure

Patients may not develop symptoms until an advanced stage

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2
Q

How is CKD staged?

A

Using a measured or estimate of the glomerular filtration rate

5 stages of CKD

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3
Q

What is eGFR?

A

Estimated glomerular filtration rate

Requires age, sex, serum creatinine and ethnicity

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4
Q

What are the causes of CKD?

A
  1. Congenital and inherited disease
  2. Glomerular disease
  3. Vascular disease
  4. Tubulo-interstitial disease
  5. Acute kidney injury
  6. Urinary tract obstruction
  7. Hypertension
  8. Diabetes
  9. Infections
  10. Trauma
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5
Q

What is a congenital/inherited kidney disease?

A

Autosomal dominant polycystic kidney disease

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6
Q

What are examples of glomerular disease?

A

1ary: e.g. membranous nephropathy
2ary: diabetes, lupus nephritis

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7
Q

What are examples of vascular disease?

A

Renovascular disease

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8
Q

What is tubulo-interstitial disease commonly caused by?

A

Allergic reaction to drugs

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9
Q

What are examples of urinary tract obstruction?

A

Renal stone disease

Prostatic disease

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10
Q

What are symptoms of CKD?

A 
 Nausea
 Lethargy
 Insomnia
 Nocturia
 Pruritis
 Paraesthesia
 Restless legs
 Bone pain
 Oedema
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11
Q

What is nocturia caused by?

A

Decreased ability to concentrate urine

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12
Q

What is bone pain caused by?

A

Metabolic bone disease

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13
Q

How can urinalysis be used to investigate CKD?

A

Looking for blood and/or protein suggestive of glomerular disease

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14
Q

What are U&E results in CKD?

A

Elevated urea and creatinine

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15
Q

What are calcium and phosphate results in CKD?

A

Hypocalcaemia

Hyperphosphataemia

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16
Q

What are results of haematology in CKD?

A

Anaemia associated with renal disease

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17
Q

How can immunology be used to investigate CKD?

A

Myeloma screen (immunoglobulins, serum electrophoreseis, urine for Bence Jones Protein)

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18
Q

How can radiology myeloma screen be used to investigate CKD?

A

Renal tract ultrasound scan (USS) to rule out obstruction

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19
Q

How can hyperkalaemia associated with CKD be treated?

A
  • Reduced dietary intake

- Potassium binding resins

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20
Q

How can acidosis associated with CKD be treated?

A

Sodium bicarb tablets

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21
Q

How can metabolic bone disease associated with CKD be treated?

A

Phosphate binders (tablets taken with meals that bind to phosphate from food in the gut and allow it to be excreted and not absorbed)

Vitamin D tables

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22
Q

How can anaemia associated with CKD be treated?

A

Subcutaneous erythropoietin therapy

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23
Q

What do some patients go on to develop?

A

End stage kidney disease (ESKD)

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24
Q

What is treatment for ESKD?

A
  • Renal replacement (dialysis)
  • Renal transplant
  • Symptom control (palliative care)
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25
Q

What must eGFR be for CKD?

A

> 60ml/min

Along with other signs of kidney damage

  • Urine abnormalities (protein, blood)
  • Structural abnormalities
  • Electrolyte abnormalities due to tubular disorders
  • Genetic disease
  • Kidney transplant
  • Histological abnormalities
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26
Q

What is CKD strongly associated with?

A

CV complications

27
Q

Which ethnic minorities is CKD more prevalent in?

A

South asians (DM), black people (HTN)

28
Q

How can diabetes lead to CKD?

A

Diabetic kidney disease induces structural changes, including thickening of the glomerular basement membrane

29
Q

How can raised intra-glomerular pressure lead to CKD?

A

Nephrons scar and drop out

Compensatory adaptation of remaining nephrons. Increased blood flow per nephron and hyperfiltration

Can lead to changes in capillary wall permeability (leads to proteinuria)

30
Q

What can raised intra-glomerular pressure lead to?

A

Glomerulosclerosis: scarring of glomeruli which can lead to proteinuria as filtration doesn’t occur properly

expansion of glomerular mesangium and deposition of EC matrix??

Tubulointerstitial fibrosis: tubular atrophy, interstitial inflammatory cell infiltrate, deposition of EC matrix in the interstitium

Loss of renal cortex

Shrunken kidneys

31
Q

What are the structural and functional changes in kidneys as we get older?

A

Renal mass declines and glomerulosclerosis leads to a decrease in renal weight.

Reduced glomeruli number.

Decrease in renal blood flow

Redistribution of blood flow which favours renal medulla. Shunting of blood from afferent to efferent

32
Q

How to test for CKD?

A
  1. Bloods: eGFR
  2. Urinalysis: blood/protein, uACR annually
  3. Blood pressure
33
Q

Who to test for CKD?

A
  1. Diabetes
  2. Hypertension
  3. AKI
  4. CVD
  5. Structural renal tract disease e.g. bladder outflow obstruction, recurrent renal calculi or prostatic hypertrophy
  6. Multisystem diseases with potential kidney involvement e.g. SLE, myeloma
  7. Family history of stage 5 kidney disease
  8. Hereditary kidney disease
  9. Opportunistic detection of haematuria (urologically unexplained) or proteinuria
  10. Chronic nephrotoxin use e.g. NSAIDs, lithium
34
Q

CKD can lead to uraemia. What can this lead to?

A

Pericarditis (=>cardiac tamponade)

Encephalopathy (reduced GCS, impaired cognition, confusion, coma, seizures)

Uraemic frost (urea and urate deposits on skin)

35
Q

What can a renal ultrasound present?

A

Structural information; PKD

Urinary tract obstruction

Chronicity - renal size

36
Q

What is PKD?

A

Polycystic kidney disease

A genetic disorder that causes many fluid-filled cysts to grow in your kidneys. Unlike the usually harmless simple kidney cysts that can form in the kidneys later in life, PKD cysts can change the shape of your kidneys, including making them much larger

37
Q

What can cause kidneys to become enlarged?

A

Hyperfiltration (seen in diabetes)

38
Q

What is blood pressure typically like in CKD?

A

Almost always elevated

Raised BP = increased glomerular filtration pressure = increased proteinuria z

39
Q

What is a higher degree of urinary protein excretion associated with?

A

More rapid decline in kidney function

40
Q

What is hyperphosphataemia?

A

There is an elevated level of phosphate in the blood. Most people have no symptoms while others develop calcium deposits in the soft tissue. Often there is also low calcium levels which can result in muscle spasms.

41
Q

Why do patients with CKD tend to develop hyperphosphataemia?

A

Kidneys usually remove extra phosphorus in blood

42
Q

What is effect of high phosphorus levels on calcium?

A

High phosphorus lowers calcium levels, which activates parathyroid glands (this pulls extra calcium out of bones)

43
Q

What can hyperphosphataemia lead to?

A

Calcium phosphate deposition –> interstitial fibrosis and tubular atrophy

44
Q

Why does metabolic acidosis occur?

A

Less reabosorbtion and less production of bicarb

Increased acid secretion (as ammonia not present to excrete endogenous acid in form of ammonium)

45
Q

How do sodium bicarbonate buffers work?

A
  • Buffer acid
  • Prevent oesopenia
  • Prevent muscle wasting (acidosis promotes catabolism by induction of proteolysis and resistance to growth hormones)
46
Q

How can CKD lead to anaemia?

A

Erythropoeitin deficiency

BUT there are also other causes so be sure to look for other causes of iron deficiency

  • Nutritional deficiency
  • Accumulation of inhibitors of erythropoeisis
  • Increased bleeding tendency from uraemia induced platelet dysfunction (blood loss)
47
Q

What are symptoms of anaemia?

A

Fatigue, muscle cramps, dizziness

48
Q

What is CKD-MBD?

A

CKD mineral bone disorder

49
Q

How can CKD lead to MBD?

A

A normal kidney will hydroxylate 25-hydroxyvitamin D (which has already been to the liver)

In CKD, there is reduced renal hydroxylation of 25-hydroxyvitamin D

This, along with hyperphosphataemia, leads to reduced calcium absorption which stimulates 2ary hyperparathyroidism

50
Q

What is treatment for CKD-MBD regarding phosphate levels?

A

Dietary restriction, phosphate binders, dialysis

51
Q

What are other treatments for CKD-MD?

A
  • Vit D replacement
  • Calcium supplements
  • Parathyroidectomy
52
Q

What is hyperparathyroidism triggered by?

A

Low Ca, high phosphate

53
Q

What is calcitrol?

A

Used to treat and prevent low levels of calcium and bone disease in patients whose kidneys or parathyroid glands are not working normally.

54
Q

How can CVD associated with CKD be treated?

A
  • Antiplatelets
  • Antihypertensives
  • Statins
55
Q

How can volume overload associated with CKD be treated?

A
  • Fluid and salt restriction
  • Diuretics
  • RRT
56
Q

What are the indicators that RRT is required?

A
  • Uraemia
  • Severe metabolic acidosis
  • Hyperkalaemia
  • Fluid overload
57
Q

How can hypertension affect kidneys?

A

Uncontrolled high blood pressure can cause arteries around the kidneys to narrow, weaken or harden (scarring). These damaged arteries are not able to deliver enough blood to the kidney tissue.

  • Nephrons don’t receive the oxygen and nutrients they need to function well.
  • Kidneys are not able to remove all wastes and extra fluid from your body.

Extra fluid in the blood vessels can raise your blood pressure even more.

58
Q

What is diabetic nephropathy?

A

Diabetes that leads to kidney disease

Affects about 20-30% of diabetics

59
Q

How can diabetes lead to nephropathy?

A

High blood glucose can damage the blood vessels in your kidneys. Many people with diabetes also develop high blood pressure, which can also damage your kidneys.

60
Q

What is an easy test used to confirm diabetic nephropathy?

A

Urinalysis –> proteinuria

61
Q

What does proteinuria reflect?

A

Glomerular injury and increased glomerular permeability to macromolecules

62
Q

Why is it important to examine feet in diabetic patients?

A

Peripheral arterial disease (PAD) and/or sensory neuropathy affecting diabetic patients

Don’t feel when they injure feet –> lead to ulcers

63
Q

What is C Reactive protein?

A

A substance produced by the liver in response to inflammation.

64
Q

What is a C reactive protein test used for?

A

A high level of CRP in the blood is a marker of inflammation or infection.

Yr 2 - Renal (16 decks)

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