Chronic kidney disease (CKD) Flashcards
Define chronic kidney disease (& basis)
Progressive loss of kidney function over a period of months or years
Based on presence of kidney damage or decreased kidney function (eGFR <60ml/min per 1.73m2) for 3+ months
Features of CKD
4
Granular surface
Decreased function
Smaller
High urine output
Staging of CKD
Stage 1 - normal
eGFR >90ml/min per 1.73m2 w/ other evidence of CKD
Other evidence - microalbuminuria, proteinuria, haematuria, structural abnormalities, tipsy showing glomerulonephritis
Stage 2 - mild impairment
eGFR 60-89 ml/min per 1.73m2 w/ other evidence of CKD
Stage 3a - moderate impairment
eGFR 45-59 ml/min per 1.73m2
Stage 3b - moderate impairment
eGFR 30-44 ml/min per 1.73m2
Stage 4 - severe impairment
eGFR 15-29 ml/min per 1.73m2
Stage 5 - established renal failure
eGFR <15ml/min per 1.73m2 or on dialysis
Main risk factors for CKD
5
Age Diabetes mellitus Hypertension Obesity Cardiovascular disease
Other risk factors for CKD
8
Arteriopathic renal disease Nephropathies FH Neoplasia Myeloma Systemic disease (e.g. SLE) Smoking Chronic use of NSAIDs
Epidemiology of CKD
prevalence, age, association
COMMON
Risk increases w/ age
Often associated w/ other disease
Presenting symptoms of CKD
3 general + 7 severe
Often ASYMPTOMATIC
May be incidental finding on routine blood or urine test
Symptoms of severe CKD Anorexia N&V Fatigue Pruritus Peripheral oedema Muscle cramps Pulmonary oedema
Sexual dysfunction common
Signs of CKD on physical examination
2 general + 6
Rarely reveals many clues
May show signs of underlying disease (e.g. SLE) or complications of CKD (E.g. anaemia)
Skin pigmentation Excoriation marks Pallor Hypertension Peripheral oedema Peripheral vascular disease
Investigations for CKD
6
Assessment of renal function Biochemistry Serology Urinalysis Imaging Renal biopsy
Investigations for CKD - assessment of renal function
3
Urea
Creatinine
Isotopic GFR
Investigations for CKD - biochemistry
3
Glucose - for undiagnosed diabetes & glycaemic control
Potassium - raised
Also check sodium, bicarbonate, calcium, phosphate
Investigations for CKD - serology
3 +2
Antibodies ANA (SLE) c-ANCA (granulomatosis w/ polyangitis: Wegener's) anti-GBM (Goodpasture's syndrome) Hepatitis serology HIV serology
Investigations for CKD - urinalysis
3
Check for proteinuria/haematuria
24hr urine collection
Serum or urine protein electrophoresis - check for multiple myeloma
Investigations for CKD - imaging
3
US - for structural abnormalities
CT/MRI
Xray KUB - for stones
