Chronic Kidney Disease Flashcards

1
Q

What is chronic kidney disease?

A

The progressive and irreversible loss of renal function, shrinking of kidney and replacement of healthy tissue with scar tissue

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2
Q

In which populations is CKD more common?

A

Th elderly, certain ethnic minorities, people with other morbities, socially deprived

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3
Q

What are the two most common causes of CKD?

A

Diabetes and hypertension

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4
Q

What are the most important things to measure when investigating CKD?

A

Blood pressure and proteinuria

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5
Q

What investigations can be used to diagnose CKD?

A

Blood tests, ultrasound (size and obstruction?), kidney biopsy, other scans looking for specific causes

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6
Q

What are the modifiable risk factors for CKD?

A

Lifestyle, smoking, obesity and lack of exercise

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7
Q

What are non-modifiable risk factors which we can control to delay progression of CKD?

A

Proteinuria- give ACE inhibitors/angiotensin receptor blockers
Hypertension- give anti-hypertensives
Diabetes- ensure well managed

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8
Q

Within what target ranges do we want to keep the blood pressure of CKD patients with and without diabetes?

A

CKD without diabetes: 120-140/90

CKD with diabetes: 120-129/80

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9
Q

Why is it that patients with CKD have nocturia?

A

Reduced concentrating ability and reduced response to ADH

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10
Q

With regards to water handling in CKD, why are patients at such high risk of fluid overload?

A

Reduced maximum ability to excrete urine

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11
Q

What are some of the complications associated with CKD?

A

Hyperkalaemia, bone mineral disease, anaemia, hypertension, metabolic acidosis, altered drug metabolism and accumulation of waste products

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12
Q

How would you treat the hyperkalaemia associated with CKD?

A

Maintain good urine output

May need to : stop ACE inhibitors or other drugs increasing K+ levels, altering diet to low potassium

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13
Q

How do you treat the acidosis associated with CKD?

A

Oral NaHCO3 tablets

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14
Q

Why is it beneficial to treat anaemia with CKD patients?

A

Slows progression of renal disease, reduces mortality and helps improve patients quality of life (increased exercise capacity and cognitive function)

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15
Q

How would you go about treating anaemia associated with CKD?

A

First check iron stores and if low replace, then re-check Haemoglobin. If Haemoglobin low give erythropoietin stimulating agent ESA

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16
Q

Why does bone mineral disease occur with CKD?

A

Less less activation of vitamin D, so less calcium absorption in gut, low calcium plasma stimulates PTH so increase bone reabsorption.
Less excretion of phosphate, increased phosphate levels also stimulate parathyroid

17
Q

How would you manage CKD-BMD?

A

Reduce phosphate intake, give phosphate binders and vitamin D (may need to be already activated)

18
Q

Why is it that lots of drugs require dose alteration in CKD?

A

Reduced metabolism and/or elimination by kidney

19
Q

What symptoms does the accumulation of waste products give rise to in CKD?

A

Reduced appetite, nausea, vomiting pruritus

20
Q

How is end stage renal failure defined?

A

Death is likely without renal replacement therapy, eGFR <15 mls/min

21
Q

What are the different types of renal replacement therapy?

A

Hemodialysis, peritoneal dialysis, transplant