Chronic Kidney Disease (CKD) Flashcards
What is the definition of CKD?
eGFR is less than 60ml /min/1.73m2 for at least 3 months
What is the relevance of 1.73 m2?
The mean body surface area, taking body size into account
What are the best readings to quantify CKD?
eGFR and ACR (albumin to creatinine ratio)
How many stages classify CKD?
5
What is stage 1 CKD?
eGFR of 90+ ml/min/1.73m^2 with renal signs
What is stage 2 CKD?
eGFR = 60-89 with renal signs
What is stage 3A CKD?
eGFR = 45-59
What is stage 3B CKD?
eGFR = 30-44
What is stage 4 CKD?
eGFR = 15-29
What is stage 5 CKD?
eGFR = under 15 ml/min/1.73m2
What stage of CKD if the GFR is 60 ml/min/1.73 m2?
If renal signs accompany eGFR then stage 2. Otherwise not CKD.
What are risk factors for chronic kidney disease?
DM
Hypertension
Glomerulonephritis
PKD (polycystic kidney disease)
Nephrotoxic drugs
In CKD, there are many damaged nephrons resulting in increased burden on the remaining nephrons and decreased
GFR
What compensatory mechanism tries to increase the GFR?
RAAS
How can activation of RAAS system worsen CKD?
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
Angiotensin II upregulates transforming growth factor-beta (TGF-b) and plasminogen activator-inhibitor 1causing m____ (supportive tissue) s____
mesangial scarring
True or false: most patients with CKD are asymptomatic?
True
How may a patient with CKD present?
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
Why may CKD cause peripheral neuropathy?
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.
What is the eGFR based on?
Serum creatinine, age and gender.
What investigations can be taken for suspected CKD?
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
When is ACR value indicates significant proteinuria?
> 3
What can haematuria suggest?
Infection
Malignancy
Glomerulonephritis
Kidney stones
What are complications of CKD?
Anaemia
Renal bone disease
CVD
Peripheral neuropathy
ESKD (end-stage kidney disease)
dialysis-related complications
Why can CKD cause anaemia?
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.
What is renal bone disease?
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.
What can the Kidney Failure Risk Equation estimate?
Estimate the 5-year risk of kidney failure needing dialysis
How can CKD be managed?
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
What can be done to reduce the risk of complications?
Exercise
Maintains healthy weight
Stop smoking
Atorvastatin 20mg for primary prevention of CVD.
True or false:
ACE-inhibitors are helpful in both AKI and CKD?
False
Exacerbate cause of AKI
Help manage CKD
How do ACE-i help CKD?
Lowers bp to prevent hypertension continuing to damage kidneys.
Also reduce proteinuria and dilate blood vessels, improving blood flow to kidneys for maintaining function.
How do ACE-i exacerbate AKI?
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.
How can CKD lead to secondary hyperparathyroidism?
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.
What can be used to treat osteoporosis?
Bisphosphonates
