Chronic Kidney Disease Flashcards
CKD is defined as impaired renal function for how long?
> 3 months
CKD can be diagnosed with or without evidence of kidney damage if the GFR is less than what?
60ml/min
Symptoms only tend to occur once what stage of CKD is reached? What GFR does this correspond to?
Stage 4, GFR < 30ml/min
End stage renal failure is defined as what?
GFR < 15ml/min or the need for RRT
Describe stage 1 CKD?
Normal or increased GFR (> 90ml/min) with other evidence of renal damage
What GFR range corresponds to stage 2 CKD?
60 - 89
If GFR is > 60ml/min, there must be ‘other evidence of renal damage’ for CKD to be diagnosed. What are some examples of this evidence?
Proteinuria, haematuria, abnormal anatomy or systemic disease
CKD is most likely to occur with which type of diabetes?
Type 2
For how long after an AKI should an individual’s renal function be monitored for the development of CKD?
2-3 years
Uraemia initially causes many general symptoms. What are some examples of these?
N+V/loss of appetite/weight loss, fatigue, pruritus, muscle cramps
What are some life-threatening complications of uraemia?
Encephalopathy and pericarditis
In the majority of patients, CKD leads to salt and water retention. What symptoms does this cause?
Hypertension and oedema (peripheral and pulmonary)
What happens to potassium levels in CKD?
Increased (hyperkalaemia)
What happens to calcium levels in CKD?
Decreased (hypocalcaemia)
The secretion of what increases to compensate for the loss of calcium in CKD?
Parathyroid hormone (hyperparathyroidism)
Hyperparathyroidism ultimately leads to what complication of CKD?
Renal osteodystrophy
Patients with CKD are prone to developing which acid-base disorder?
Metabolic acidosis
Why do patients with CKD become anaemic?
The kidneys no longer secrete enough erythropoietin
CKD may cause what additional symptom in women of child-bearing age?
Amenorrhoea
CKD may cause what additional symptom in males?
Impotence
What type of anaemia occurs in CKD?
Normochromic, normocytic
What pattern is shown on bone biochemistry of individuals with CKD who have developed renal osteodystrophy?
Low calcium, high phosphate, high ALP
PTH is typically raised in individuals with what stage of CKD and worse?
Stage 3
In most cases of CKD, what happens to the size of the kidneys?
They are small (< 9cm)
When would a renal biopsy be indicated in individuals with CKD?
If there is rapidly progressive disease, or if there is an unknown cause with normal sized kidneys
What is the target blood pressure for individuals with CKD?
< 130/80
All patients with diabetic nephropathy should be given what drug, even if their blood pressure is normal?
ACE inhibitor (or ARB)
What happens to renal function when an ACE inhibitor is started?
There is a temporary drop in GFR
What is the most important dietary modification for individuals with CKD?
Phosphate reduction
What are some examples of foods containing phosphate which should be avoided in individuals with CKD?
Cheese, milk, eggs
What medications can be given to reduce the risk of renal bone disease?
Phosphate binders, and calcium and vitamin D supplements
Why should vitamin D supplements not be given to individuals with hypercalcaemia?
Risk of vascular calcification
If iron/folate/B12 levels are all normal, how should anaemia in CKD be treated?
Epo replacement
What medication can be used to help manage symptoms of acidosis in individuals with CKD?
Sodium bicarbonate
Sodium bicarbonate treatment should be given with caution in who? Why?
Patients with hypertension, as the increased sodium can raise the blood pressure further
How can oedema be managed in patients with CKD both pharmacologically and non-pharmacologically?
Loop diuretics, and a restricted salt/fluid intake
What are some medications which may help with symptoms of restless/crampy legs in CKD?
Clonezepam, gabapentin, quinine sulphate
