Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Genitourinary > Chronic Kidney Disease (CKD) > Flashcards

Chronic Kidney Disease (CKD) Flashcards

1
Q

Define Chronic Kidney Disease (CKD).

A

Longstanding, usually progressive, impairment in renal function
(haematuria, proteinuria or anatomical abnormality) for more than 3 months.

  • Defined as a GFR < 60mL/min/1.73 m2 for more than 3 months with/without evidence of kidney damage (haematuria, proteinuria or anatomical abnormality).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the classification of CKD stages?

A

Stages:
1 - kidney damage but GFR >90
2. - kidney damage GFR 60-90
3A - GFR 45-60
3b - GFR 30-45
4 - GFR 15-30
5 - established renal failure with GFR <15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the GFR for end stage renal failure?

A

15 or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How is GFR calculated?

A

eGFR - creatinine
gold standard - inulin - but v invasive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Give 4 pathophysiological effects of declining kidney function.

A
  1. Fluid balance/BP regulation disrupted - hypervolaemia / hypertension
  2. Vitamin D metabolism poor - bone reabsorbed
  3. Hyperkalaemia, uraemia
  4. Decreased EPO = normocytic anaemia
  5. Metabolic acidosis - as less H+ excretion and less bicarbonate production
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Give 5 causes of CKD.

A
  1. Diabetes mellitus.
  2. Hypertension.
  3. Atherosclerotic renal vascular disease.
  4. Congenital e.g. PKD, VHL
  5. Urinary tract obstruction - stones, tumours, BPH
  6. Nephrotoxic drugs - NSAIDs, ACEIs, PPIs, lithium, many antibiotics
  7. Glomerulonephritis - nephrotic VS nephritic
  8. Age-related decline
  9. Persistent pyelonephritis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the most common cause of CKD?

A

Diabetes Mellitus
(Damage to efferent arteriole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Give 5 risk factors for CKD.

A
  1. Diabetes Mellitus
  2. Smoking
  3. Hypertension
  4. Old age
  5. SLE
  6. Recurrent UTIs
  7. AKI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Give 5 signs + symptoms of CKD.

A
  1. Fluid retention - oedema and raised JVP
  2. Nocturia + polyuria - 0.5 mL/kg/h or <500mL/day
  3. Effects of uraemia:
    • Pruritus
    • Uraemic frost, yellow/grey complexion
    • Nausea
    • Reduced appetite
  4. Cardiac arrhythmias and muscle cramps- hyper K+
  5. Fatigue, pallor - anaemia
  6. Bone pain - hyperphosphatemia (CKD-MBD)
  7. Hypertension
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Investigations for CKD.

A
  1. Bloods
    - FBC (anaemia)
  2. Urinalysis
    - Urine dipstick = a significant result is 1+ of blood = haematuria
  • Urine albumin:creatinine ratio (ACR) = A result of ≥ 3mg/mmol is significant = proteinuria
  • Glycosuria
  • UTI
  1. Renal ultrasound
  2. Serum biochemistry
    - U+Es = HIGH urea + creatinine, phosphate, potassium
    - Low eGFR
    - Raised alkaline phosphatase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What does FBC show in CKD?

A

Normocytic anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is ACR and what does it show/mean?

A

Albumin/creatinine ratio.
More than 3 means proteinuria.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is phosphate affected in CKD?

A

Hyperphosphataemia.
The kidneys normally excrete phosphate, they can’t do that as well in CKD.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What happens to calcium in CKD?

A

Hypocalcaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Why might someone with advanced CKD also have hyperparathyroidism?

A

Advanced CKD = calcitriol deficiency.

Calcitriol suppresses PTH therefore deficiency -> hyperparathyroidism.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Describe the management for CKD.

A
  1. Treat the underlying cause.
  2. Limit progression + complications.
  3. Control symptoms.
  4. Reduce CV risk.
  5. ESRF -> dialysis or transplant.
17
Q

Management of CKD 1: Identify & treat reversible causes.

A
  • Relieve obstruction
  • Stop nephrotoxic drugs
  • Stop smoking and achieve healthy weight to deal with cardiovascular risk
  • Tight glucose control in diabetes
18
Q

Management of CKD 2: Limit progression & complications.

A
  1. BP
    - Optimise hypertensive control
    - Target BP is < 130/80
    - ACEi / ARB / Diuretic / CCB
  2. Renal Bone disease
    (Chronic kidney disease-mineral and bone disorder (CKD-MBD))
    - Check PTH and treat if raised - phosphate further increases PTH
    - Restrict diet
    - Give phosphate binders to decrease gut absorption and avoidance of phosphate food e.g. milk, cheese, eggs
    - Vitamin D e.g. CALCITRIOL and Ca2+ supplements
    - Bisphosphonates can be used to treat osteoporosis
  3. Optimise diabetic control
    - Metformin, pioglitazone, sulphonylurea
  4. Treat glomerulonephritis
19
Q

Management of CKD 3: Control symptoms.

A
  1. Anaemia
    - Iron/folate/folic acid
    - Exogenous Erythropoietin (EPO)
  2. Metabolic Acidosis
    - Systemic acidosis accompanies the decline in kidney function and may contribute to increased serum potassium levels as well as dyspneoa and lethargy
    - Treat with SODIUM BICARBONATE
  3. Oedema
    - Furosemide
    - Fluid and sodium restriction
20
Q

Management of CKD 4: Reduce CVD.

A
  • Lower cholesterol with statins e.g. Simvastatin
  • Give ASPIRIN
  • Smoking cessation
21
Q

Management of CKD 5: End-stage renal failure.

A
  1. Renal replacement therapy (RRT) - transplant
  2. Dialysis
22
Q

What are the 3 types of dialysis?

A
  1. Haemofiltration
  2. Haemodialysis
  3. Peritoneal dialysis
23
Q

Why do advanced CKD patients need regular fluid assessment?

A

They may be oligouric or anuric.

24
Q

What are the indications for dialysis?

A
  • Symptomatic uraemia including pericarditis or tamponade
  • Hyperkalaemia not controlled by conservative measures
  • Pulmonary oedema thats unresponsive to diuretics
  • Severe acids
  • High potassium
  • Tall T waves, low flat p waves, broad QRS or arrhythmias on ECG
  • Metabolic acidosis
  • Fluid overload that is resistant to diuretics
25
Q

Which form of dialysis is most commonly used??

A

Haemofiltration

26
Q

Which form of dialysis is mainly used for CKD?

A

Peritoneal dialysis
(Rarely used in AKI)

27
Q

Give 4 complications for CKD.

A
  1. Anaemia
  2. Renal bone disease
  3. Cardiovascular disease
    (particularly MI, cardiac failure, sudden cardiac death and stroke)
  4. Peripheral neuropathy
  5. Dialysis related problems
  6. Skin problems - pruritus + brown discolouration of nails

Genitourinary (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions