Chronic kidney disease Flashcards
What is chronic kidney disease?
chronic reduction in kidney function
permanent and progressive
causes of CKD?
diabetes hypertension age glomerulonephritis PKD medications eg PPI, NSAIDs
Risk factors
older age hypertension smoking diabetes medications
presentation
asymptomatic - diagnosed on routine testing
pruritus, loss of appetite, nausea, oedema, muscle cramps, peripheral neuropathy, pallor, hypertension
Investigations
eGFR - blood test. 2 tests 3 months apart to confirm diagnosis
proteinuria (urine albumin:creatinine ratio) >3mg/mmol is significant
urine dipstick
renal USS
Stages of CKD
Based on eGFR 1 = >90 2= 60-89 3a = 45-59 3b = 30-44 4 = 15-29 5 = <15
What is stage 5 CKD also known as?
end stage renal failure
What is the A score based on?
albumin:creatinine ratio
A score
A1 = <3mg/mmol A2 = 3-30mg/mmol A3 = >30mg/mmol
Complications of CKD
anaemia renal bone disease cardiovascular disease peripheral neuropathy dialysis related problems
When to refer to a specialist
eGFR <30
ACR >70mg/mmol
accelerated progression
uncontrolled hypertension despite >4 hypertensives
Management
optimise diabetic and hypertensive control
treat glomerulonephritis
stop smoking
diet - water, potassium, sodium and phosphate
atorvostatin 20mg
Treating complications
oral sodium bicarbonate - metabolic acidosis iron supplement and EPO vitamin D dialysis renal transplant
What antihypertensives are first line for CKD patients?
ACEI
Why does potassium need to be monitored?
CKD and ACEI cause hyperkalaemia
