Chronic Kidney Disease Flashcards
Define Chronic Kidney Disease (CKD)?
Progressuve loss of kidney fucntion over a period of months or years
Presence of kidney damage or decreased kidney function (i.e. eGFR < 60 mL/min per 1.73 m^2) for three months or more
What is the classification of CKD?
Stage 1: Normal Stage 2: Mild Impairment Stage 3a: Moderate Impairment Stage 3b: Moderate Impairment Stage 4: Severe Impairment Stage 5: Established Renal Failure
What is Stage 1 of CKD?
eGFR > 90 ml/min per 1.73 m^2 with other evidence of CKD (microalbuminuria, proteinuria, haematuria, structural abnormalities, biopsy showing glomerulonephritis)
What is Stage 2 of CKD?
Mild Impairement:
eGFR 60-89 mL/min per 1.73 m^2 with other evidence of CKD
What is Stage 3a of CKD?
eGFR: 45-59 mL/min per 1.73 m^2
What is Stage 3b of CKD?
eGFR: 30-44 mL/min per 1.73 m^2
What is Stage 4 of CKD?
Severe Impairment
eGFR: 15-29 mL/min per 1.73 m^2
What is Stage 5 of CKD?
Established renal failure
eGFR < 15 mL/min per 1.73 m^2 or on dialysis
What is CKD mainly associated with in developed countries?
Age Diabetes mellitus Hypertension Obesity Cardiovascular Disease
What are the other risk factors of CKD?
Arteriopathic renal disease Nephropathies Family History Neoplasia Myeloma Systemic disease (e.g. SLE) Smoking Chronic use of NSAIDs
What is the epidemiology of CKD?
COMMON
Risk increases with age
Often associated with other diseases (e.g. Cardiovascular disease)
What are the presenting symptoms of normal CKD?
Often Asymtomatic
May be an incidental finding of a routine blood or urine test
Sexual dysfunction is common
What are the symptoms of Severe CKD?
Anorexia Nausea and vomiting Fatigue Pruritus Peripheral Oedema Muscle Cramps Pulmonary Oedema
What is the problem with CKD?
Physical examination rarely reveals many clues
May show signs of underlying disease (e.g. SLE)
May show complications of CKD (e.g. anaemia)
What are the signs of CKD?
Skin pigmentation Excorciation marks Pallor Hypertension Peripheral oedema Peripheral vascular disease
What investigations do we do for CKD?
Assessment of Renal Function Biochemistry Serology Urinalysis Imaging Renal Biopsy
What investigations do we do to assess renal function?
Urea
Creatinine
Isotopic GFR
What is the problem of Urea as an investigation for CKD?
Not ideal because it varies massively depending on hydration status and diet
What are the characteristics of Creatinine as an investigation for CKD?
Useful but has limitations
Renal function can drop considerably with minimal change in serum creatinine
What are the characteristics of Isotopic GFR as an investigation for CKD?
GOLD STANDARD but expensive
What Biochemistry investigations do we do for CKD?
Glucose - check for undiagnosed diabetes and diabetic control
Potassium - raised
Also check sodium, bicarbonate, calcium, phosphate
What antibodies do we test for in CKD?
ANA - SLE
c-ANCA - granulomatosis with polyangiitis (Wegener’s)
Anti-GBM - Goodpasture’s syndrome
What other serology’s do we invesigate for CKD?
Hepatitis
HIV
What do we look for in Urinalysis for CKD?
Check for proteinuria/haematuria
24 hr urine collection
Serum or urine protein electrophoresis - check for multiple myeloma
What Imaging investigations do we do for CKD?
US - check for structural abnormalities
CT/MRI
X-Ray KUB - check for stones
