Chronic Kidney Disease Flashcards
What 2 things may be found in the blood as a marker of kidney damage?
What GFR would the patient have to be under for over 3 months to be classed as having CKD?
Under what GFR does the patient begin experiencing symptoms?
Haematuria
Proteinuria*****
<60
<30
Stages:
How many stages are there?
What is it based on?
What does the patient also need to have to classed as stage 1 and 2?
What stages are asymptomatic?
5 stages
Look them up
2 GFR readings 3 months apart
Presence of kidney damage - i.e. persistent proteinuria, or unexplained haematuria, structural disease, or glomerulonephritis.
Stages 1-4
Causes:
The most COMMON cause it diabetes. How does diabetes cause CKD?
What inflammatory disease of the kidneys may also be a cause?
What disease, via another system may also cause it?
High blood glucose, also called blood sugar, can damage the blood vessels in your kidneys. When the blood vessels are damaged, they don’t work as well. Many people with diabetes also develop high blood pressure, which can also damage your kidneys.
Glomerulonephritis
Hypertension leading to microvascular damage
S+S:
What happens to BP and why?
Why do they get anaemia?
Hypertension - kidney less able to regulate BP - lack of fluid control
When you have kidney disease, your kidneys cannot make enough (Erythropoietin) EPO. Low EPO levels cause your red blood cell count to drop and anaemia to develop. Most people with kidney disease will develop anaemia. Anaemia can happen early in the course of kidney disease and grow worse as kidneys fail and can no longer make EPO.
Erythropoietin (EPO) is a hormone produced by the kidney that promotes the formation of red blood cells by the bone marrow. The kidney cells that make erythropoietin are sensitive to low oxygen levels in the blood that travels through the kidney.
S+S:
What would you expect if they were unable to control fluids?
What electrolyte is expected to become raised in the blood?
What sort of neurological symptoms do they have?
Why do they get neuro symptoms?
Oedema - peripheral and pulmonary
Hyperkalemia can happen if your kidneys do not work well. It is the job of the kidneys to balance the amount of potassium taken in with the amount lost in urine. Potassium is taken in through the foods you eat and the liquids you drink. It is filtered by the kidneys and lost through the urine.
Peripheral polyneuropathy Restless legs Confusion Seizures Coma
Due to toxins accumulation and to complications like sepsis, haemorrhage, malignant hypertension, pH and hydroelectrolytic disturbances.
S+S:
Why do they get pericarditis?
What will the patient complain about which is due to raised urea in the blood?
What happens to the skin?
Uremic pericarditis is thought to result from inflammation of the visceral and parietal layers of the pericardium by metabolic toxins that accumulate in the body owing to kidney failure.
Itch
Many reported cases of discoloured skin, or hyperpigmentation, happen to people with ESRD. One cause of skin discolouration is related to pigments called urochromes being retained in the skin. Normally these are excreted by healthy kidneys.
S+S:
Why do they polyuria in later disease?
How does renal failure cause hyperlipidaemia?
What bone disease happens?
Why dot hey get proximal muscle weakness?
A number of kidney problems make tubules less efficient at filtrate processing and water reabsorption. In these conditions, urine output may actually increase because the damaged tubules cannot handle the filtrate load.
CKD leads to a downregulation of lipoprotein lipase and the LDL-receptor, and increased triglycerides in CKD are due to delayed catabolism of triglyceride-rich lipoproteins, with no differences in production rate(9).
Osteoporosis - When kidneys do not function properly, extra parathyroid hormone is released in the blood to move calcium from inside the bones into the blood. Chronic kidney disease causes mineral and bone disorder because the kidneys do not properly balance the mineral levels in the body.
Severe loss of kidney function causes metabolic wastes to build up to higher levels in the blood. Damage to muscles and nerves can cause muscle twitches, muscle weakness, cramps, and pain.
S+S:
Why do they metabolic acidosis?
What GI symptoms do they get?
Why do they lose weight?
In patients with chronic kidney disease (CKD), the causes of metabolic acidosis include:
- impaired ammonia excretion
- decreased tubular reabsorption of HCO3-
- insufficient production of HCO3-in relation to the number of acids synthesised in the body and ingested with food.
D&V
Anorexia
People with kidney disease begin to build up compounds that suppress the appetite. These changes can also alter your sense of taste. Many people begin to avoid protein foods like meat, which can result in muscle wasting. All of these changes can result in weight loss (both fat and muscle).
Investigations:
What 2 things can be used to screen for CKD in those with risk factors and may also be used in monitoring disease?
Bloods:
- FBC - what type of anaemia is expected?
- U&E - what do you expect?
- Why is hypocalcaemia present? - DRAW CALCIUM CYCLE
- Why is there high phosphate?
- What are ANA, ANCA and anti-GBM tests used fordone?
Kidney USS:
- What could be found?
ACR - albumin : creatinine ratio
Albumin is more sensitive than total protein
Normocytic anaemia - low Hb
Raised urea, creatinine, potassium
Hypocalcemia in chronic renal failure is due to two primary causes - increased serum phosphorus and decreased renal production of 1,25 (OH)2 vitamin D. The former causes hypocalcemia by complexing with serum calcium and depositing it into the bone and other tissues
To look for intrinsic kidney disease
Smaller
Hydronephrosis
Management:
Most with mild CKD will not progress to dialysis!!!!
Most are managed at GP. When is a referral to nephrology needed?
Late stages
Accelerated progress
Resistant HTN
Management - Aim of Rx is to slow disease progression:
- Antihypertensives are given for HTN!
- What is given for bone protection?
- What is given for hyperlipidaemia?
- What CVD prevention can be done?
- Why should salt intake be reduced?
- What is cardiac drug is given to reduce proteinuria therefore slowing progress!?
Drug contraindications:
- What pain med should be avoided?
- What ABs should be avoided?
- Why are ACE inhibitors avoided?
ACE inhibitors and ARB’s
Biphosphates
Vitamin D
Statins
Weight loss
Exercise
Smoking cessation
Kidneys won’t be able to handle excess salt
NSAIDs
Tetracyclines
Nitrofurantoin
ACE inhibitors suppress the production of erythropoietin in a dose-dependent manner, which presents a particular problem when ACE inhibitors are administered in the presence of renal failure.
Management - Complications:
- What type of diet will they need to go on to prevent electrolyte imbalances? - 2
- What is given for the normocytic anaemia?
- What is given for the neuropathic nerve pain?
- What is given for the gastroparesis?
Low phosphate diet - need to seek dietician
Phosphate binders can also be offered
Low potassium diet
EPO - erythropoietin - usually done as ESA - erythropoietin stimulating agents
Gabapentin
Metaclopamide
Complications:
What is the biggest cause of death in those with CKD?
What do they LVH? - 2
What are people at ESRD at risk of?
CVD
Anaemia and HTN
Infections - they are immunocompromised
RRT - Haemofiltration:
How is it different from dialysis?
THIS IS WHAT IS DONE IN AKI
It uses a pressure gradient instead of a conc gradient which is done in dialysis.
THIS IS WHAT IS DONE IN AKI
Dialysis:
What type of gradient is used to move molecules?
What are the 2 types?
What is dialysate?
Concentration gradiant
Haemodialysis and peritoneal dialysis
Dialysate, also called dialysis fluid, dialysis solution or bath, is a solution of pure water, electrolytes and salts, such as bicarbonate and sodium. The purpose of dialysate is to pull toxins from the blood into the dialysate. The way this works is through a process called diffusion.
