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RENAL > Chronic Kidney Disease (CKD) > Flashcards

Chronic Kidney Disease (CKD) Flashcards

1
Q

Chronic kidney disease can also describe abnormal kidney structure as well as abnormal function. TRUE/FALSE?

A

TRUE

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2
Q

CKD often co-exists with what 2 common diseases?

A

Cardiovascular disease

Diabetes

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3
Q

Moderate to severe CKD increases the risk of what complications?

A

acute kidney injury
falls
frailty
mortality

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4
Q

What makes kidney disease “chronic”?

A

Abnormal U and Es after 90 days

  • creatinine still raised
  • eGFR still low
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5
Q

eGFR is based upon what 4 factors?

A

serum creatinine
age
sex
race

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6
Q

How is renal failure graded, and what grade indicates end stage renal failure?

A

G1-G5

G5 = eGFR <15= end stage renal failure

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7
Q

What is used to investigate proteinuria?

A

Albumin:Creatinine Ratio (ACR)

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8
Q

Microalbuminuria is an indication of generalised vascular endothelial damage. TRUE/FALSE?

A

TRUE

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9
Q

What type of protein is albumin?

A

Glomerular

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10
Q

An ACR of <3 is abnormal. TRUE/FALSE?

A

FALSE

<3 is normal

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11
Q

An ACR of >30 indicates what category of ACR?

A

A3 => at risk of progressive loss of kidney function

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12
Q

People who experience an acute kidney injury are at increased risk of developing CKD. TRUE/FALSE?

A

TRUE

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13
Q

How should patients with AKI be monitored for development of CKD?

A

Monitor for at least 2–3years after AKI

** even if serum creatinine has returned to baseline**

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14
Q

If eGFR is between 45 and 59 but there are no other signs of CKD, what can be measured to double check for CKD?

A

Cystatin C

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15
Q

Cystatin C must be under what level for there to be no evidence of CKD?

A

<60

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16
Q

What is an ACCELERATED progression of CKD?

A

Decrease in GFR of 25% or more
Change in GFR category
- within 1 year

OR

  • decrease in GFR of 15 ml/min/1.73m2 per year
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17
Q

What are the risk factors for CKD progression?

A
  • CVD/ Hypertension
  • Proteinuria
  • AKI
  • Diabetes
  • Smoking
  • African, African-Caribbean or Asian family origin
  • Chronic use of NSAIDs
  • Untreated urinary obstruction
18
Q

When should patients with CKD be referred for specialist assessment?

A
  • GFR <30 (=> G4 or G5 +/- diabetes)
  • ACR 70 mg or more
  • ACR 30 mg + haematuria (ACR category A3)
  • Accelerated progression of CKD
  • Hypertension = Poorly controlled despite use of 4 antihypertensive drugs
  • Suspected renal artery stenosis
19
Q

What is the aim for blood pressure in CKD patients who have diabetes or an ACR of 70 or more?

A

130/80mmHg

20
Q

What factors must be considered when increasing the dose of an ACE Inhibitor or Angiotensin Receptor Blocker?

A

Difference in GFR and serum creatinine from the baseline

21
Q

Patients with CKD do not need to have had a primary cardiovascular event to be put on Atorvastatin 20mg. TRUE/FALSE?

A

TRUE

22
Q

What are the causes of CKD?

A
  • Glomerulonephritides
  • Vascular Disease(macro and micro)
  • Small Vessel Vasculitis
  • Post-Renal Obstruction
  • Tubulointerstitial Disease
23
Q

What are the clinical signs of CKD?

A
  • Anaemia
  • Weight loss
  • Uraemia
  • Lemon yellow tinge (not jaundice)
  • Uraemic frost (sweating out uraemic toxins
  • Encephalopathic flap
  • Twitching
  • Confusion
  • Pericardial rub or effusion
  • Kussmaul breathing
24
Q

A pericardial rub or effusion is a direct indication for what?

A

Dialysis to get rid of uraemic toxins and prevent cardiac tamponade

25
Q

What are the 3 classifications of symptoms in CKD?

A

Uraemic (N+V, twitching, wt loss)
Anaemic (fatugue, muscle weakness)
Pain

26
Q

What complications of CKD can occur locally?

A

pain/ haemorrhage/ infection

27
Q

What are the urinary complications of CKD?

A

haematuria/ proteinuria

Impaired salt and water handling

28
Q

What is the eventual complication of CKD?

A

End stage renal failure

29
Q

What are the extra-renal complications of CKD?

A
  • Cardiovascular disease (CVD)
  • Mineral and Bone Disease (CKD-MBD)
  • Anaemia
30
Q

What modalities are considered Renal Replacement Therapies (RRT)?

A

Haemodialysis (HD)
Peritoneal Dialysis (PD)
Transplantation

31
Q

Patients have the choice of Renal Replacement Therapy or Conservative Management to maximise what?

A

Their “hospital free” days

32
Q

A 25-34 year old patient on dialysis has the same cardiovascular risk as a non-dialysis patient who is around 85 years of age. TRUE/FALSE?

A

TRUE

33
Q

What compounds are involved in CKD Mineral and Bone Disorder?

A 
Calcium
Phosphate
PTH
Vit D
FGF-23
34
Q

What are the main consequences of CKD Mineral and Bone Disorder?

A

Secondary/ tertiary Hyperparathyroidism

Vascular calcification

Bone pain

Fractures

CV events

35
Q

What dietary advice may be useful in CKD Mineral and Bone Disorder?

A
  • Phosphate restriction (if high)
  • Salt reduction
  • Potassium restriction
  • Fluid restriction
36
Q

What medications can be used in CKD Mineral and Bone Disorder?

A
  • Alfacalcidol (‘Active’ vitamin D)
  • Phosphate binders
  • Calcimimetic (Cinacalcet)
37
Q

What patient groups are more at risk of anaemia in CKD?

A
  • those with eGFR <45

- diabetics

38
Q

What are the target Hb levels for CKD patients and why?

A

Hb 100 – 120 (slight anaemia)

=> makes blood less sludgy and easier to push around body

39
Q

What other causes of anaemia must be considered in CKD?

A

Exclude B12 and folate deficiency

Check ferritin and Iron

40
Q

What forumlation of iron does not work effectively to replete iron stores in renal anaemia?

A

ORAL

RENAL (24 decks)

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