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2a Genitourinary > Chronic Kidney Disease (CKD) > Flashcards

Chronic Kidney Disease (CKD) Flashcards

1
Q

What is the definition of CKD?

A

eGFR is less than 60ml /min/1.73m2 for at least 3 months

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2
Q

What is the relevance of 1.73 m2?

A

The mean body surface area, taking body size into account

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3
Q

What are the best readings to quantify CKD?

A

eGFR and ACR (albumin to creatinine ratio)

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4
Q

How many stages classify CKD?

A

5

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5
Q

What is stage 1 CKD?

A

eGFR of 90+ ml/min/1.73m^2 with renal signs

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6
Q

What is stage 2 CKD?

A

eGFR = 60-89 with renal signs

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7
Q

What is stage 3A CKD?

A

eGFR = 45-59

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8
Q

What is stage 3B CKD?

A

eGFR = 30-44

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9
Q

What is stage 4 CKD?

A

eGFR = 15-29

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10
Q

What is stage 5 CKD?

A

eGFR = under 15 ml/min/1.73m2

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11
Q

What stage of CKD if the GFR is 60 ml/min/1.73 m2?

A

If renal signs accompany eGFR then stage 2. Otherwise not CKD.

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12
Q

What are risk factors for chronic kidney disease?

A

DM
Hypertension
Glomerulonephritis
PKD (polycystic kidney disease)
Nephrotoxic drugs

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13
Q

In CKD, there are many damaged nephrons resulting in increased burden on the remaining nephrons and decreased

A

GFR

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14
Q

What compensatory mechanism tries to increase the GFR?

A

RAAS

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15
Q

How can activation of RAAS system worsen CKD?

A

Increases the transglomerular pressure, the shearing force and loss of basement membrane selective permeability means that proteins and blood can pass into filtrate
Therefore causes proteinuria/ haematuria

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16
Q

Angiotensin II upregulates transforming growth factor-beta (TGF-b) and plasminogen activator-inhibitor 1causing m____ (supportive tissue) s____

A

mesangial scarring

17
Q

True or false: most patients with CKD are asymptomatic?

A

True

18
Q

How may a patient with CKD present?

A

Symptoms due to substance accumulation and renal damage:

Fatigue
Pallor (due to anaemia)
Foamy urine (proteinuria)
Nausea
Loss of appetite
Pruritus
Oedema
Hypertension
Peripheral neuropathy

19
Q

Why may CKD cause peripheral neuropathy?

A

Uremic toxins can accumulate in blood and can have neurotoxic effects contributing to nerve damage.
Also disturbed electrolyte imbalance and acidosis can contribute.
CKD associated with atherosclerosis and reduced blood flow may also mean inadequate supply to nerves.

20
Q

What is the eGFR based on?

A

Serum creatinine, age and gender.

21
Q

What investigations can be taken for suspected CKD?

A

eGFR

Proteinuria quantified by ACR (urine albumin:creatinine ratio)

Haematuria via urine dipstick or microscopy

Renal ultrasound: identifies any obstructions or PKD

FBC to check if anaemic

USS: bilateral renal atrophy

Bp
HbA1c (for diabetes)
Lipid profile

22
Q

When is ACR value indicates significant proteinuria?

A

> 3

23
Q

What can haematuria suggest?

A

Infection
Malignancy
Glomerulonephritis
Kidney stones

24
Q

What are complications of CKD?

A

Anaemia
Renal bone disease
CVD
Peripheral neuropathy
ESKD (end-stage kidney disease)
dialysis-related complications

25
Q

Why can CKD cause anaemia?

A

The kidneys produce the hormone erythropoietin, primarily in response to hypoxia to stimulate BM to produce RBCs.
Reduction in EPO production in CKD.

Also disruption in iron balance leading to less iron absorbed from diet and impaired release of iron from stores.
Uremic toxins may suppress bone marrow function.

26
Q

What is renal bone disease?

A

Group of bone diseases resulting from CKD.

Kidney paly crucial role in balance of minerals and hormones including calcium and phosphorous. Disturbed balance can lead to disruption in bone mineralisation and weakened bones.
Also reduced activation of vitamin D.

27
Q

What can the Kidney Failure Risk Equation estimate?

A

Estimate the 5-year risk of kidney failure needing dialysis

28
Q

How can CKD be managed?

A

No treatment (other than transplant) so manage complications

Anaemia: EPO and Iron

Osteodystrophy: Vit D supplements

Oedema: Diuretics

ESRF: dialysis or ultimately renal transplant

Metabolic acidosis: sodium bicarbonate

Optimising diabetic and hypertension control
Avoiding nephrotoxic drugs
Treating glomerulonephritis if present

ACE-i or ARBs and SGLT-2 inhibitors can help slow disease progression

Stop NSAIDs

Atorvastatin 20mg

29
Q

What can be done to reduce the risk of complications?

A

Exercise
Maintains healthy weight
Stop smoking
Atorvastatin 20mg for primary prevention of CVD.

30
Q

True or false:
ACE-inhibitors are helpful in both AKI and CKD?

A

False
Exacerbate cause of AKI
Help manage CKD

31
Q

How do ACE-i help CKD?

A

Lowers bp to prevent hypertension continuing to damage kidneys.

Also reduce proteinuria and dilate blood vessels, improving blood flow to kidneys for maintaining function.

32
Q

How do ACE-i exacerbate AKI?

A

ACE-i can increase sodium and water excretion, contributing to volume depletion which means reduced perfusion of kidneys.

Can also increase serum potassium levels and hyperkalaemia can have adverse effect on kidneys.

33
Q

How can CKD lead to secondary hyperparathyroidism?

A

Less active vitamin D means less calcium absorption and low serum calcium.
Parathyroid glands react by excreting more PTH to stimulate osteoclast activity to increase calcium levels.

34
Q

What can be used to treat osteoporosis?

A

Bisphosphonates

2a Genitourinary (28 decks)

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