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Tim CP3 @ UoN - Medicine & Surgery > Chronic Kidney Disease (CKD) > Flashcards

Chronic Kidney Disease (CKD) Flashcards

1
Q

What are the Sx of CKD?

A

Often asymptomatic until advanced (fatigue/anorexia)
Polyuria/nocturia
Restless legs syndrome
Sexual dysfunction
Nausea & Pruritis
Yellow pigmentation, encephalopathy, pericarditis
Pedal/pulmonary oedema

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2
Q

What are the signs of CKD?

A

Pallor due to anaemia
Excoriations due to pruritis
HTN/fluid overload signs
Pericardial rub

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3
Q

What are the appropriate initial investigations for CKD?

A

Bloods - FBC, U&E, LFTs, Ca, PO4, PTH, Glucose
Urinalysis & MCS - quantify proteinuria, exclude infection
24h urinary protein - assess severity
CXR - suspected pulmonary oedema
Renal USS - suspected obstructive causes

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4
Q

How is CKD diagnosed?

A

Two tests 3/12 apart showing reduced eGFR

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5
Q

How is CKD staged?

A

According to eGFR

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6
Q

Describe Stage 1 CKD

A

eGFR >90
Normal kidney function
Urine findings/structural abnormalities/genetic traits point to kidney disease

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7
Q

Describe Stage 2 CKD

A

eGFR 60-89
Mildly reduced kidney function
Urine findings/structural abnormalities/genetic traits point to kidney disease

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8
Q

Describe Stage 3 CKD

A

eGFR 30-59

Moderately reduced kidney function

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9
Q

Describe Stage 4 CKD

A

eGFR 15-29

Severely reduced kidney function

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10
Q

Describe Stage 5 CKD

A

eGFR <15

V. severe/established renal failure

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11
Q

What is eGFR?

A

An estimate of GFR based on a plasma level of creatinine

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12
Q

What are the common causes of CKD?

A 
DM (20-40%)
HTN
Chronic glomerulonephritis
Chronic pyelonephritis
Obstructive uropathy
Renovascular disease
Drugs (NSAIDs)
Polycystic kidney disease
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13
Q

What additional specialist investigations may be required in CKD?

A

DTPA scan (investigates vascular supply)
Renal biopsy
Bone imaging

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14
Q

What are the management options for CKD?

A 
Treat reversible causes (obstruction, nephrotoxic drugs)
BP/DM control
   -BP <130/80 OR <125/75 if proteinuric
   -ACEIs 1st line, also statin + ld aspirin
Complication control
   -EPO
   -ca/vit D supplementation
   -K+ restriction if hyperkalaemic
Renal replacement therapy (Stage 5)
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15
Q

When should renal replacement therapy be started?

A

Any symptomatic CKD Stage 5 pt

-often try to delay dialysis

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16
Q

What are the three main complications of CKD?

A

Renal anaemia
Renal bone disease
2o HTN

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17
Q

What is the underlying pathophysiology of renal anaemia in CKD?

A

Loses ability to secrete EPO –> anaemia

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18
Q

How is renal anaemia managed?

A

Recombinant EPO as part of renal replacement therapy

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19
Q

What factors contribute to renal anaemia?

A

CKD
Bone marrow toxins
Increased blood loss
Abnormal red cell membrane

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20
Q

What is the underlying pathophysiology of renal bone disease in CKD?

A

Low vit D –> hypocalcaemia, hyperphosphataemia, osteomalacia –> 2o hyperparathyroidism –> cyst formation & marrow fibrosis –> 3o hyperparathyroidism –> osteopenia

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21
Q

How can osteopenia be detected radiologically?

A

Pseudofractures

Subperiosteal erosions

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22
Q

How is renal bone disease managed?

A

Restrict dietary phosphate
Give phosphate binders
AdCal supplementation

23
Q

What is the underlying pathophysiology of 2o HTN in CKD?

A

Overactivation of RAAS –> HTN
Thickened renal artery walls (afferent)
Chronic ischaemia, progressive loss of glomeruli

24
Q

What are the different options for renal replacement therapy?

A

Haemodialysis
Peritoneal dialysis
Transplantation

25
Q

What is haemodialysis?

A

Diffusion of solutes b/w blood & dialysate

  • flow in opposite directions
  • semi-permeable membrane b/w
26
Q

How is vascular access typically achieved for haemodialysis?

A

Arteriovenous Fistula

  • wrist/cubital fossa
  • can also use double lumen venous lines
27
Q

How often must haemodialysis occur?

A

4hrs, 3x/wk, normally in hospital

28
Q

What is the main issue in haemodialysis?

A

Haemodynamic instability during dialysis

29
Q

What is haemofiltration?

A

Variant of haemodialysis where blood is continuously filtered across highly permeable membrane

  • more efficient
  • more haemodynamically stable
  • more expensive
30
Q

How is peritoneal dialysis performed?

A

2l of isotonic/hypertonic solution inserted into peritoneal cavity
-equilibrates w/ blood in peritoneal capillaries through peritoneal membrane

31
Q

How often must peritoneal dialysis occur?

A

3-4x/daily
Fluid drained after 4-6hrs
-can be performed at night (automated peritoneal dialysis)

32
Q

What is the main risk of peritoneal dialysis?

A

Peritonitis

33
Q

What are the complications of dialysis?

A 
Mortality 20%
Infection
CVD
Renal bone disease/anaemia
Bleeding
Renal malignancies
34
Q

What factors must be measured in a patient assessment pre-transplantation?

A

Virology/TB status (active infection = contraindication)
Blood group/HLA monitoring
Full systemic examination (co-morbid disease = contraindication)

35
Q

What are the potential complications of renal transplantation?

A

Operative complications
Rejection
Ciclosporin/tacrolimus toxicity (immunosuppressants)
Infection/malignancy (immunosupression)

36
Q

What are the potential operative complications of renal transplantation?

A

Bleed
Thrombosis
Infection
Urinary leaks

37
Q

Describe the risk of rejection in renal transplantation

A

Risk highest in 3mo
Lifelong immunosuppression
Episodes of rejection reversible
Immunological tolerance develops

38
Q

What malignancies are most likely post renal transplant?

A

Skin cancer
Anal cancer
Lymphoma

39
Q

What is the prognosis of a renal transplant?

A

Good

1yr graft survival rate 80-95%

40
Q

What three ways can DM affect the kidney?

A

Direct glomerular damage
Ischaemia
Ascending infection

41
Q

Describe direct glomerular damage caused by DM

A

Basement membrane thickening

  • increased leakiness of capillary wall
  • proteinuria
  • glomerular hyalinisation –> CKD
42
Q

How is polycystic kidney disease inherited?

A

AD or AR

-AD more common (1/800)

43
Q

What is the long term consequence of PKD?

A

Both kidneys replaced by enlarging fluid filled cysts

44
Q

How do ADPKD sufferers present?

A

Systemic HTN
CKD
Abdo swelling (bilateral, ballotable kidneys)
Renal failure (later in life)

45
Q

Where else may cysts develop in ADPKD?

A

Liver
Lungs
Pancreas

46
Q

How do ARPKD sufferers present?

A

Earlier onset

Chronic renal failure earlier in life

47
Q

What is the potential effect of liver cysts in PKD?

A

Portal HTN

Fibrosis

48
Q

What is the main condition associated w/ PKD?

A

Berry aneurysms –> SAH

49
Q

How is PKD managed?

A

As CKD

Screen for berry aneurysms

50
Q

What are the two forms of chronic interstitial nephritis?

A

Reflux associated

Obstructive

51
Q

Describe reflux associated chronic interstitial nephritis

A

Incompetent vesicoureteric valves
-predisposition to inflammation/scarring
Presents in eraly adulthood w/ deteriorating renal funcn

52
Q

Describe obstructive chronic interstitial nephritis?

A

Recurrent episodes of infection due to anatomical abnormality/stone

53
Q

What are the histological hallmarks of chronic interstitial nephritis?

A

Irregular areas of scarring

Chronic inflammatory infiltrate

54
Q

What drugs typically require dose reduction in the presence of a decreased eGFR?

A 
Gentamicin
Cephalosporins
Heparin
Lithium
Opiates
Digoxin

Tim CP3 @ UoN - Medicine & Surgery (136 decks)

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