Chronic Kidney Disease Flashcards
What defines CKD?
kidney damage (ie albuminuria) or decreased kidney function (GFR <60 ml/minute per 1·73 m²) for 3 months or more
Give 2 epidemiological facts on CKD
Common, frequently unrecognised + often exists together with other conditions (CVD + diabetes).
List 6 unmodifiable risk factors for CKD
Age African, African-Caribbean or Asian family origin. Male FH AI diseases e.g. SLE Chronic NSAIDs use
List 2 modifiable risk factors for CKD
Smoking.
Obesity
List 4 conditions that are risk factors for CKD
DM
HTN
CVD.
AKI
What is kidney function assessed on?
GFR + albumin:creatinine ratio (ACR)
What characterises stage 1 and stage 5 of CKD?
Stage 1: normal eGFR >90 ml/min/1.73 m2 with other evidence of chronic kidney damage
Stage 5: eGFR < 15 ml/min/1.73 m2 or on dialysis.
List 5 examples of evidence of chronic kidney damage
Persistent microalbuminuria.
Persistent proteinuria.
Persistent haematuria
Structural abnormalities of the kidneys eg, PKD, reflux nephropathy.
Biopsy: proven chronic glomerulonephritis.
List 5 symptoms that may present in severe CKD
Fatigue N+V Pruritus Anorexia Late disease: Dyspnoea
What may be revealed on examination in CKD?
Underlying cause (eg, SLE, severe arteriosclerosis, HTN) Complications of CKD (eg, anaemia, bleeding diathesis, pericarditis).
What 7 signs of CKD may be found on examination?
Pulmonary + peripheral oedema HTN Postural hypotension LV hypertrophy Peripheral vascular disease Peripheral neuropathy Restless legs syndrome.
Why are both serum urea and creatinine not good assessments of renal function?
Urea: varies with hydration + diet, is not produced constantly + is reabsorbed by the kidney.
Creatinine: can remain within the normal range despite loss of >50% of renal function.
What is the gold standard assessment of renal function? What is used in practice?
Isotopic GFR (expensive + not widely available.) eGFR used in primary care
Which serum electrolytes are tested in CKD? What are the levels seen
Na: N/ L K: HIGH HCO3: LOW. Ca: N, L or H Phosphate HIGH
What other biochemical markers are tested in suspected CKD? What may levels of these indicate?
Plasma glucose: identify/ assess diabetes
ALP: high when bone disease develops.
PTH: high with declining renal function.
Cholesterol + triglycerides: dyslipidaemia common.
Albumin: hypoalbuminaemia in nephrotic +/or malnourished
What is the haematological picture in CKD?
Normochromic normocytic anaemia; Hb falls with progressive CKD.
White cells + platelets usually normal.
What is checked for in serology in suspected CKD?
Autoantibodies: ANA (SLE), c-ANCA (granulomatosis with polyangiitis), Anti-GBM (Goodpasture’s syndrome)
Hepatitis serology
HIV serology
What is checked for in urinalysis in CKD? Why?
Proteinuria + haematuria
Degree of proteinuria correlates with rate of progression of underlying kidney disease + is the most reliable prognostic factor in CKD.
Why perform serum and urine protein electrophoresis in suspected CKD?
to screen for multiple myeloma.
What imaging investigations may be performed in CKD? What can be detected in each?
US: small/ large kidneys, structural abnormalities
CT/MRI: renal stones/ renal artery stenosis
X-Ray: renal stones
Describe 7 features in management of CKD
eGFR monitoring
BP control
Lifestyle: Exercise, Lose weight, Smoking cessation
Good glycaemic control in DM
Review all prescribed medication
Avoidance of nephrotoxins: eg, NSAIDs, aminoglycosides.
Immunise against influenza + pneumococcus.
In decreasing order, what are the most common causes of CKD in the UK?
Diabetes 24%
Glomerulonephritis 13%
High BP/ renovascular disease 11%
