Chronic Kidney Disease Flashcards
What is chronic kidney disease?
The progressive and irreversible loss of renal function, shrinking of kidney and replacement of healthy tissue with scar tissue
In which populations is CKD more common?
Th elderly, certain ethnic minorities, people with other morbities, socially deprived
What are the two most common causes of CKD?
Diabetes and hypertension
What are the most important things to measure when investigating CKD?
Blood pressure and proteinuria
What investigations can be used to diagnose CKD?
Blood tests, ultrasound (size and obstruction?), kidney biopsy, other scans looking for specific causes
What are the modifiable risk factors for CKD?
Lifestyle, smoking, obesity and lack of exercise
What are non-modifiable risk factors which we can control to delay progression of CKD?
Proteinuria- give ACE inhibitors/angiotensin receptor blockers
Hypertension- give anti-hypertensives
Diabetes- ensure well managed
Within what target ranges do we want to keep the blood pressure of CKD patients with and without diabetes?
CKD without diabetes: 120-140/90
CKD with diabetes: 120-129/80
Why is it that patients with CKD have nocturia?
Reduced concentrating ability and reduced response to ADH
With regards to water handling in CKD, why are patients at such high risk of fluid overload?
Reduced maximum ability to excrete urine
What are some of the complications associated with CKD?
Hyperkalaemia, bone mineral disease, anaemia, hypertension, metabolic acidosis, altered drug metabolism and accumulation of waste products
How would you treat the hyperkalaemia associated with CKD?
Maintain good urine output
May need to : stop ACE inhibitors or other drugs increasing K+ levels, altering diet to low potassium
How do you treat the acidosis associated with CKD?
Oral NaHCO3 tablets
Why is it beneficial to treat anaemia with CKD patients?
Slows progression of renal disease, reduces mortality and helps improve patients quality of life (increased exercise capacity and cognitive function)
How would you go about treating anaemia associated with CKD?
First check iron stores and if low replace, then re-check Haemoglobin. If Haemoglobin low give erythropoietin stimulating agent ESA