Chronic Kidney Disease Flashcards
Define CKD
Abnormalities of kidney structure or function, present for ≥3 months, with implications for health.
i.e. a GFR< 60 mL/minute/1.73 m²
….or the presence of one or more of the following markers of kidney damage:
- albuminuria/proteinuria
- urine sediment abnormalities (e.g., haematuria)
- electrolyte abnormalities due to tubular disorders
- abnormalities detected by histology
- structural abnormalities detected by imaging
- history of kidney transplantation
How is CKD classified?
Stage 1: Normal
- eGFR > 90 ml/min per 1.73 m2 with other evidence of CKD
- (microalbuminuria, proteinuria, haematuria, structural abnormalities, biopsy showing glomerulonephritis)
Stage 2: Mild Impairment
- eGFR 60-89 ml/min per 1.73 m2 with other evidence of CKD
Stage 3a: Moderate Impairment
- eGFR 45-59 ml/min per 1.73 m2
Stage 3b: Moderate Impairment
- eGFR 30-44 ml/min per 1.73 m2
Stage 4: Severe Impairment
- eGFR 15-29 ml/min per 1.73 m2
Stage 5: Established Renal Failure
- eGFR < 15 ml/min per 1.73 m2 or on dialysis
What are the risk factors for CKD?
- Most common cause in adults is diabetes- 1/3rd patients with diabetes will develop kidney disease within 15yrs
- Hypertension is the second most common cause (and also a consequence)
- Other risk factors include:
- age >50 years
- male sex
- black or Hispanic ethnicity
- family history
- smoking
- obesity
- long-term analgesic use
- autoimmune disorders.
Summarise the epidemiology of CKD
Common condition that is often unrecognised until the most
9-13% of the adult population worldwide has CKD
Incidence- due to an ageing population- a higher incidence of diseases such as diabetes and hypertension
Black people, Hispanic people, FHx = higher incidence
Recognise the presenting symptoms of mild CKD
Often ASYMPTOMATIC
May be an incidental finding of a routine blood or urine test (elevated serum creatinine, haematuria, proteinuria, red. GFR)
- Fatigue (related to uraemia or the anaemia associated with CKD)
Recognise the presenting symptoms of advanced/severe CKD
Only later in CKD when the kidneys can no longer cope with significant reduction in function do the following symptoms occur
This leads to the accumulation of toxic waste products in the circulation and under the skin, such as urea:
- Anorexia, weight loss
- Nausea + vomiting
- Oedema- peripheral and pulmonary, leading to SOB, due to fluid overload (from salt and water retention)
- Pruritis
- Insomnia, restless legs
- Sexual dysfunction
- Headaches- in latest stages → seizures and coma
- Muscle cramps
Recognise the signs of CKD
- Hypertension
- Peripheral oedema (due to sodium retention and exacerbated by hypoalbuminuria)
- Pallor due to anaemia- associated with CKD due to the lack of erythropoietin produced by the kidney, usually once the glomerular filtration rate declines to <50 mL/minute/1.73 m²
- Uraemic tinge to skin – yellowish
- Excoriation marks
- Arthralgia- if patient has concomitant autoimmune disorder
- Enlarged prostate- if patient has obstructive uropathy.
What investigations would you do for suspected CKD?
-
Assessment of Renal Function
- Urea
- Creatinine
- Isotopic GFR - GOLD STANDARD but expensive
-
Bloods – Hb, ESR, U&Es (sodium, potassium, chloride, bicarbonate, urea, creatinine), glucose
- Glucose - check for undiagnosed diabetes and diabetic control
-
Serology
- Antibodies
- ANA - SLE
- c-ANCA - granulomatosis with polyangiitis (Wegener’s)
- Anti-GBM - Goodpasture’s syndrome
- Hepatitis serology
- HIV serology
- Antibodies
-
Urinalysis
- Check for proteinuria/haematuria
- 24 hr urine collection
- Serum or urine protein electrophoresis - check for multiple myeloma
- moderately increased urinary ulbumin
-
Imaging
- Ultrasound - check for structural abnormalities
- CT/MRI
- X-Ray KUB - check for stones
- Renal Biopsy – if rapidly progressive disease or unclear cause and normal sized kidneys
Causes of CKD?
What are we worried about in patients with progressing CKD? Hw do we manage this?
Cardiovascular disease
BP, vascular calcification
Best treatment for CKD?
