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4th Year Gen Med > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

List some causes of CKD?

A 
Congenital Diseases e.g. PCKD
Glomerular disease
Vascular disease
Hypertension
Autoimmune
UTI
Tubulointerstitial diseases
Age
Diabetes
Chronic NSAID use and other medications
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2
Q

How does CKD typically present?

A 
Patients are usually asymptomatic and it is an incidental finding or diagnosed on routine check up
Main symptoms include: 
- Pruritus
- Nausea
- Oedema
- Muscle cramps
- Peripheral neuropathy
- Pallor
- Hypertension
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3
Q

What are the typical investigations for CKD?

A

eGFR
urine albumin:creatinine ratio for proteinuria (>3mg/mmol)
Renal USS can be indicated in patients with accelerated CKD / family history or evidence of obstruction

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4
Q

At hat level of eGFR does the patient qualify as CKD?

A

eGFR <60 (stage 3a)
OR
positive proteinuria

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5
Q

What are some common complications of CKD?

A 
Anaemia
Renal bone disease
Renal dialysis complications
Peripheral neuropathy
Cardiovascular disease
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6
Q

What can be given to help manage metabolic acidosis?

A

Sodium bicarbonate

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7
Q

Why does a patient with CKD need their serum potassium monitored?

A

CKD and ACE inhibitors are both causes of hyperkalemia so patients need to be regularly monitored for that

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8
Q

What medication (and dose) can be offered in CKD as primary cardiovascular disease prevention?

A

Atorvastatin 20mg

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9
Q

What are the three features of renal bone disease?

A

Osteoporosis
Osteomalacia
Osteosclerosis

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10
Q

How does CKD lead to anaemia?

A

The damaged kidney cells have a reduced production of erythropoietin which leads to a depletion in the production of red blood cells.

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11
Q

How can we manage CKD related anaemia?

A

Erythropoietin stimulating agents such as exogenous erythropoietin

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12
Q

Why should blood transfusions be avoided if possible in CKD related anaemia?

A

Allosensitization

when the immune system is sensitised and can lead to organ rejection at a later date

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13
Q

If haematuria is detected in an older patient, even those who are asymptomatic, what must be ruled out?

A

Cancer (bladder)

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14
Q

What is the A score?

A

This is a score based on the albumin:creatinine ratio
A1 - <3 mg/mmol
A2 - 3-30 mg/mmol
A3 - >30 mg/mmol

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15
Q

An A1 score is definitive of chronic kidney disease. True or false?

A

False
An A 1 score is indicative of <3 mg/mmol, which is not proteinuria. For a patient to be classified as chronic kidney disease, a score of A2 or more is required.

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16
Q

How do we slow the progression of CKD?

A

Optimise diabetic control
Optimise hypertensive control
Treat any glomerulonephritis

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17
Q

What antihypertensive medication is first line in CKD?

A

ACE inhibitors

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18
Q

What is the three main categories for an ACE inhibitor to be prescribed for hypertension in CKD?

A

Diabetes plus ACR >3 mg/mmol
Hypertension plus ACR >30 mg/mmol
ALL patients with ACR >70 mg/mmol

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19
Q

What is another term for renal bone disease?

A

Chronic kidney disease-mineral and bone disorder (CKDMBD)

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20
Q

What hormone is produced by healthy kidney cells, which when reduced in CKD can lead to anaemia?

A

Erythropoietin

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21
Q

What does erythropoietin stimulat?

A

It stimulates the production of red blood cells

22
Q

What must be managed before initiating exogenous erythropoietin and how is this done?

A

Iron deficiency

intravenous iron especially in dialysis patients

23
Q

In patients with renal bone disease (CKD-MBD) what x-ray features might you see and what is this classically known as?

A
  • Sclerosis of both ends of the vertebrae
  • Osteomalacia of the centre of the vertebra
    aka “rugger jersey” (looks stripey)

(NOTE: this is each individual vertebrae - the centre of each one will be dark and their outsides will be bright white)

24
Q

Why do patients with CKD have low active vitamin D levels?

A

The kidneys play an important role in metabolism responsible for activating vitamin D from its inactive form

25
Q

Low levels of active vit D lead to the reduction in absorption of _____ from the intestines

A

Calcium

26
Q

What is the main responsibilities of active Vitamin D?

A

Aiding absorption of calcium from intestines

Regulating bone turnover

27
Q

In CKD there is a high level of serum ______ due to decreased excretion.

A

Phosphate

28
Q

What causes secondary hyperparathyroidism in CKD?

A

High levels of phosphate and low serum calcium. This stimulates the production of parathyroid hormone

29
Q

An increased secretion of parathyroid hormone leads to increased ______ activity?

A

Osteoclast

30
Q

Osteoclast activity is responsible for the increased absorption of what from where?

A

Calcium from the bones

31
Q

WHy does osteomalacia occur in CKD-MBD?

A

Increased bone turnover without the adequate calcium supply

32
Q

What is the mechanism behind the development of osteosclerosis in CKD MBD?

A

The osteoblasts respond to the increased activity of the osteoclasts. This in turn leads to increased bone turnover and bone tissue development which is not properly mineralised.

33
Q

Why does osteoporosis occur in CKD MBD?

A

This actually occurs to secondary factors including age and steroid use. It is not directly associated with the mineral bone disease itself

34
Q

Give some examples of active vitamin D supplements?

A

Alfacalcidol

Calcitriol

35
Q

A low ______ diet is essential in bone protection for patients with CKD?

A

Low Phosphate diet

36
Q

What medications can be used to treat osteoporosis?

A

Bisphosphonates e.g. alendronic acid

37
Q

What is the basic mechanism of action for bisphosphonates?

A

Reduce osteoclast activity which reduces the rate of bone turnover, in the aim of increasing bone density.

38
Q

What is the chief cause of death in CKD?

A

Cardiovascular event

39
Q

What are the three forms of kidney donation for transplant?

A

DCD - donor cardiac death
DBD - donor brain death
LD - living donor

40
Q

How is donor matching done?

A

Human Leukocyte Antigen (HLA) types A, B, and C

Dont need to be perfect - the closer the higher the chance of success

41
Q

Where is the HLA gene found?

A

Chromosome 6

42
Q

What type of scar is seen in renal transplant patients?

A

Hockey stick scar

43
Q

Where is a donor kidney placed?

A

Anteriorly in the abdomen, often can be palpated in the iliac fossa region.

44
Q

How is a donor kidney transplanted?

A

The own kidney is left in its place
New kidney placed anteriorly
Donor kidneys blood vessels are anastomosed to the pelvic vessels
Donor ureter anastomosed directly to the bladder

45
Q

What vessels are often used to anastomose a donor kidneys blood supply to?

A

External iliac vessels

46
Q

What is the usual immunosuppression regime following kidney transplant?

A

Tacrolimus
Mycophenolate
Prednisalone

47
Q

Give some examples of other immunosuppressants which can be used post transplant?

A

Cyclosporine
Sirolimus
Azathioprine

48
Q

What are the main complications following renal transplant?

A

Acute / hyperacute / chronic transplant rejection
TRansplant failure
Electrolyte embalances

49
Q

What are some complications which can occur from long term immunosuppression?

A 
Squamous cell carcinoma
T2 DM
Ischaemic heart disease
Unusual infections e.g. PCP, CMV, TB
Non hodgkin lymphoma
Infections in general
50
Q

What are the survival rates like for kidney transplant?

A

1 year 91-96% (depending on type of donation)

10 year 60-80%

4th Year Gen Med (10 decks)

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