Chronic Kidney Disease (CKD) Flashcards
What is CKD. (2)
Impaired renal function for >3months based on abnormal structure or function.
Or GFR 3months with or without evidence of kidney damage.
What is CKD. (2)
Impaired renal function for >3months based on abnormal structure or function.
Or GFR 3months with or without evidence of kidney damage.
How many stages of CKD are there.
5.
When do symptoms usually occur in CKD.
At around stage 4.
What is the GFR for end-stage renal failure.
What is the GFR for stage 4 kidney disease.
What is the definition of end stage CKD. (2)
GFR
What are the causes of CKD. (5)
Diabetes (20% in the UK, T2>T1).
Glomerulonephritis (commonly IgA nephropathy, also some rarer disorders such as SLE, vasculitis.
Unknown (up to 20% in UK have no obvious cause of CKD).
Hypertension or renovascular disease.
Pyelonephritis and reflux nephropathy.
What are some of the rare causes of CKD. (5)
Obstructive uropathy - often reversible.
Chronic interstitial nephritis (myeloma, amyloid).
Following previous AKI.
Adult polycystic kidney disease (APKD) is the most common inherited cause of CKD.
Rare inherited conditions (Alport’s syndrome, Fabry’s disease).
Who is screening for CKD recommended to. (8)
DM.
Hypertension.
Cardiovascular disease (IHD, peripheral vascular disease, cerebrovascular disease).
Structural renal disease, known stones or BPH.
Recurrent UTIs.
Multisystem disorders (SLE).
Opportunistic detection of haematuria or proteinuria.
What two aspects need to be investigated in a patient with CKD. (2)
Possible cause.
Current state.
What sort of things do you need to ask about to determine the possible cause of CKD. (8)
FH and DH. Systemic disorders. DM. Raised BP. PMH. Previous UTIs. Lower urinary tract symptoms. Rena colic.
What sort of things do you need to ask about to determine the current state of a patient with CKD. (8)
Uraemic symptoms such as: Anorexia. Vomiting. Restless legs. Fatigue. Weakness. Pruritis. Bone pain. Amenorrhoea/impotence.
What should you check a patient for in CKD. (3)
Oliguria.
Dyspnoea.
Ankle swelling.
What can untreated patients with CKD present with. (2)
Severe uraemia and hyperkalaemia (causing arrhythmias, encephalopathy, seizures or coma).
What can untreated patients with CKD present with. (2)
Severe uraemia and hyperkalaemia (causing arrhythmias, encephalopathy, seizures or coma).
How many stages of CKD are there.
5.
When do symptoms usually occur in CKD.
At around stage 4.
What is the GFR for end-stage renal failure.
When should you consider taking a renal biopsy in a patient with CKD. (2)
If rapidly progressive disease.
Unclear cause and normal sized kidneys.
What is the definition of end stage CKD. (2)
GFR
What are the causes of CKD. (5)
Diabetes (20% in the UK, T2>T1).
Glomerulonephritis (commonly IgA nephropathy, also some rarer disorders such as SLE, vasculitis.
Unknown (up to 20% in UK have no obvious cause of CKD).
Hypertension or renovascular disease.
Pyelonephritis and reflux nephropathy.
What are some of the rare causes of CKD. (5)
Obstructive uropathy - often reversible.
Chronic interstitial nephritis (myeloma, amyloid).
Following previous AKI.
Adult polycystic kidney disease (APKD) is the most common inherited cause of CKD.
Rare inherited conditions (Alport’s syndrome, Fabry’s disease).
Who is screening for CKD recommended to. (8)
DM.
Hypertension.
Cardiovascular disease (IHD, peripheral vascular disease, cerebrovascular disease).
Structural renal disease, known stones or BPH.
Recurrent UTIs.
Multisystem disorders (SLE).
Opportunistic detection of haematuria or proteinuria.
What two aspects need to be investigated in a patient with CKD. (2)
Possible cause.
Current state.
What criteria warrants a referral to a nephrologist in CKD. (7)
Stage 4 and 5 CKD.
Moderate proteinuria.
Proteinuria with haematuria.
Rapidly falling eGFR.
Raised BP poorly controlled despite >4 antihypertensives.
Known or suspected rare of genetic causes of CKD.
Suspected renal artery stenosis.
What sort of things do you need to ask about to determine the current state of a patient with CKD. (8)
Uraemic symptoms such as: Anorexia. Vomiting. Restless legs. Fatigue. Weakness. Pruritis. Bone pain. Amenorrhoea/impotence.
What should you check a patient for in CKD. (3)
Oliguria.
Dyspnoea.
Ankle swelling.
What should you look for on initial examination of a patient with CKD. (8)
Palor. Uraemic tinge to the skin (yellowish). Purpura. Excoriations. Raised BP. Cardiomegaly. Signs of fluid overload. Signs of possible cause.
What can untreated patients with CKD present with. (2)
Severe uraemia and hyperkalaemia (causing arrhythmias, encephalopathy, seizures or coma).
What are the aspects of symptom control in CKD. (4)
Anaemia (replace iron/B12/folate if necessary).
Acidosis (consider sodium bicarbonate supplemets for patients with low serum bicarbonate).
Oedema (loop diuretics).
Restless legs/cramps (check ferritin, give clonazepam or gabapentin. Quinine sulfate may help with cramps).
What do you expect to see in the blood tests of a patient with CKD. (5)
Normochromic normocytic anaemia. Raised glucose (if DM). Low calcium. High phosphate. High alkaline phosphate. High PTH (if CKD stage 3 or more).
What tests should be done to the urine of a patent with CKD. (3)
Dipstick.
MSandC.
Albumin:creatinine ratio or protein:creatinine ratio.
What imaging should be done in a patient with CKD. (2)
Ultrasound to check size, anatomy and corticomedullary differentiation.
In CKD kidneys are usually small (
When should you consider taking a renal biopsy in a patient with CKD. (2)
If rapidly progressive disease.
Unclear cause and normal sized kidneys.
In a patient with known CKD, what are you looking for in the periphery. (3)
Hypertension.
Arteriovenous fistula (thrill, bruit, has it been recently needled).
Signs of previous transplant (bruising from steroids, skin malignancy from immunosuppression).
In a patient with known CKD, what are you looking for in the face. (4)
Pallor of anaemia.
Yellow tinge of uraemia.
Gum hypertrophy from cyclosporine.
Cushingoid appearance from steroids.
In a patient with known CKD, what are you looking for in the neck.
Current or previous tunnelled line insertion.
In a patient with known CKD, what are you looking for in the abdomen. (3)
PD catheter or sign of previous catheter.
Signs of previous transplant.
Ballotable polycystic kidneys and liver.
In a patient with known CKD, what are you looking for elsewhere. (4)
Signs of diabetic neuropathy, retinopathy, cardiovascular or peripheral vascular disease.
What criteria warrants a referral to a nephrologist in CKD. (7)
Stage 4 and 5 CKD.
Moderate proteinuria.
Proteinuria with haematuria.
Rapidly falling eGFR.
Raised BP poorly controlled despite >4 antihypertensives.
Known or suspected rare of genetic causes of CKD.
Suspected renal artery stenosis.
What are the four main approaches to management of a patient with CKD.
Investigation.
Limiting progression/complications.
Symptom control.
Preparing for RRT.
What are the investigation aspects of managing CKD.
Identifying and treating the reversible causes.
What are some reversible causes of CKD. (5)
Relieve obstruction. Stop nephrotoxic drugs. Deal with high calcium. Deal with ccardiovascular risk factors. Tighten glucose control in DM.
What are the aspects of limiting progression/complications in CKD. (4)
BP (target BP is
What are the aspects of symptom control in CKD. (4)
Anaemia (replace iron/B12/folate if necessary).
Acidosis (consider sodium bicarbonate supplemets for patients with low serum bicarbonate).
Oedema (loop diuretics).
Restless legs/cramps (check ferritin, give clonazepam or gabapentin. Quinine sulfate may help with cramps).
What are the forms of RRT. (3)
Haemodialysis.
Haemofiltration.
Peritoneal dialysis.
What are some complications of RRT (6)
Cardiovascular disease (MI and CVA are commoner in RRT patients).
Protein-calorie malnutrition is common in HD.
Renal bone disease (high bone turnover, renal osteodystrophy and osteitis fibrosa).
Infection (uraemia causes granulocyte dysfunction).
Amyloid accumulates in long term dialysis patients and may cause carpel tunnel syndrome.
Malignancy is commoner in dialysis patients.
What is the treatment of choice for end stage renal failure.
Renal transplant.
What are the absolute contraindications for renal transplant. (3)
Active infection.
Severe comorbidities.
Cancer.
What is the prognosis for patients who have had a renal transplant.
10 year graft survival is 60% from DCD. up to 80% from a living donor.
