CHRONIC KIDNEY DISEASE Flashcards
WHAT IS CHRONIC KIDNYE DISEASE?
- decreased kidney function that has been present for > 3 months
WHAT ARE THE CAUSES OF CKD?
1) diabetes
2) hypertension
3) glomerulonephritis
4) renovascular disease
5) chronic pyelonephritis
WHAT ARE THE COMPLICATIONS OF CKD?
1) anaemia of CKD
2) hypertension
3) cardiovascular disease
4) malnutrition
5) as it progresses: electrolyte disturbances/ fluid overload/ metabolic acidosis
6) mineral and bone disease - increase serum phosphate and reduce hydroxylation of vitamin D to its active form, calcitriol leading to low calcium levels (function of kidney). Increase phosphorous pulls calcium out of bone and binds to it.
WHAT IS ANAEMIA OF CHRONIC KIDNEY DISEASE?
Kidneys are damaged so they cannot produce erythropoietin. EPO stimulates stem cells to make RBC in the bone marrow. Therefore, reduced EPO means reduced RBC production.
HOW WOULD YOU TREAT THE UNDERLYING CAUSE OF CKD?
1) Treat and monitor diabetic control
2) Treat hypertension
3) Immunosuppression for glomerulonephritis
HOW WOULD YOU REDUCE THE CARDIOVASCULAR RISK OF CKD?
1) start on statin
2) control blood pressure
3) improve diabetic control
4) advise weight loss
5) advise exercise
6) stop smoking
HOW WOULD YOU PREVENT/ TREAT COMPLICATIONS OF CKD?
1) Anaemia - IV iron/ folate/ vitamin B12 replacement
2) Metabolic acidosis - consider sodium bicarbonate supplements
3) Oedema - restrict fluid and sodium intake/ loop diuretic
4) Bone- mineral disorders - phosphate binders and calcium mimetics
5) Diet - reduce K+/ reduce phosphate/ salt restriction
HOW DO ACEI AND ARBS REDUCE PROTEINURIA?
reduce intraglomerular pressure by inhibiting angiotensin II ̶ mediated efferent arteriolar vasoconstriction.
HOW DO ACEI AND ARBS REDUCE PROTEINURIA?
- reduce intraglomerular pressure by inhibiting angiotensin II ̶ mediated efferent arteriolar vasoconstriction.
HOW ARE NSAIDS A RISK FACTOR FOR AKI?
- NSAIDs, by inhibition of prostaglandins and bradykinin, produce vasoconstriction of the afferent renal arteriole and reduce the ability of the kidney to regulate (increase) glomerular blood flow.
WHY IS THERE AN INCREASE IN PHOSPHATE IN CKD?
- kidneys responsible for phosphate excretion
HOW DO YOU MONITOR RENAL FUNCTION IN CKD?
- eGFR and albuminuria should be monitored regularly
WHAT ARE THE CLINICAL FEATURES OF CKD?
1) fatigue
2) oedema
3) nausea +/- vomiting
4) pruritus
5) anorexia
WHAT INVESTIGATIONS DO YOU CARRY OUT FOR CKD?
1) serum creatinine - elevated (usually creatinine is filtered and excreted by kidney)
2) urinalysis- haematuria and proteinuria
3) renal USS - small kidney size, kidney stones, hydronephrosis
4) eGFR- reduced
5) urine microalbumin (also known as albumin:creatinine ratio) - raised (albumin should not be found in urine)
6) bone profile - calcium, phosphate, PTH, alkaline phosphatase
WHAT ARE THE GENERAL RENAL FUNCTION BLOOD TESTS?
Bloods
- FBC (anaemia, infection)
- U+Es (potassium, urea, creatinine, bicarbonate)
- Bone profile (calcium, phosphatase, PTH, ALP)
- CRP (infection and inflammation)
- Hba1c (diabetic control)
