Chronic Kidney Disease Flashcards
What are the main causes of CKD?
Diabetes Hypertension Age related decline Glomerulonephritis Polycystic kidney disease Medications e.g. NSAIDs, PPIs, lithium
Which signs/symptoms may be present in CKD?
Pruritis Loss of appetite Nausea Oedema Muscle cramps Peripheral neuropathy Pallor Hypertension
Which investigations should be done for CKD?
eGFR –> two tests, 3 months apart to confirm diagnosis
Urine albumin:creatinine ratio (>3 is significant for proteinuria)
Urinalysis for haematuria
Renal USS if:
- accelerated CKD, haematuria, FHx of PKD or obstruction
How is CKD staged?
G score –> based on eGFR
A score –> based on albumin:creatinine ratio
What are the G score stages?
G1 = >90 G2 = 60-89 G3a = 45-59 G3b = 30-44 G4 = 15-29 G5 = < 15 (end stage renal failure)
What are the A score stages?
A1 = <3 A2 = 3-30 A3 = >30
How are the G and A scores interpreted to diagnose CKD?
Must have at least an eGFR or <60 or proteinuria for a diagnosis of CKD
- if score of A1 combined with G1 or G2 –> does not have CKD
What are the complications of CKD?
Anaemia Renal bone disease Cardiovascular disease Peripheral neuropathy Dialysis related problems
When should a patient with CKD be referred to a specialist?
eGFR < 30
albumin:creatinine ratio >70
Accelerated progression defined as decrease in eGRF of…. in one year:
- 15
- 25%
- or 15ml/min
Uncontrolled hypertension despite 4 antihypertensives
What are the aims of management in CKD?
Slow progression
Reduce risk of CVD
Reduce risk of complications
Treat complications
What are the management components for slowing progression of CKD?
Optimise diabetic control
Optimise hypertensive control
Treat glomerulonephritis
How is the risk of complications reduced in CKD?
Exercise, weight loss + stop smoking
Dietary advice re phosphate, sodium, potassium + water intake
Offer atorvastatin 20mg for primary prevention of CVD
How is metabolic acidosis treated in CKD?
Sodium bicarbonate
How is anaemia treated in CKD?
IV iron (oral is alternative) Then Epo
How is renal bone disease treated?
Vitamin D
Low phosphate diet
How is end stage renal disease treated?
Dialysis
Renal transplant
What is the first line management for hypertension in CKD?
ACE inhibitors
What needs to be monitored when patients with CKD are taking an ACE inhibitor and why?
Potassium
–> both CKD and ACE inhibitors cause hyperkalaemia
Why should blood transfusions be limited in anaemia of CKD?
Sensitise the immune system so that transplanted organs are more likely to be rejected
What are the features of renal bone disease?
Osteomalacia (softening of bones)
Osteoporosis (brittle bones)
Osteosclerosis (hardening of bones)
What are the xray changes in renal bone disease?
Spine xray:
- sclerosis of both ends of the vertebra (denser white)
- osteomalacia in centre of vertebra (less white)
- -> ‘rugger jersey spine’
What will the bone profile look like in renal bone disease?
High phosphate (reduced excretion)
Low active vitamin D (kidney essential for activation)
Low calcium –>
Secondary hyperparathyroidism
What are the features of diabetic nephropathy?
Glomerulosclerosis –> proteinuria
What is the management form diabetic nephropathy?
Optimise blood glucose + BP ACE inhibitors (even if BP normal)
