Chronic kidney disease (CKD) Flashcards
Define chronic kidney disease (CKD)
Progressive loss of kidney function over a period of months or years
The definition is based on the presence of kidney damage or decreased kidney function (i.e. eGFR < 60 ml/min per 1.73 m2) for three months or more
Explain the aetiology/risk factors of CKD
In developed countries it is mainly associated with: Age Diabetes mellitus Hypertension Obesity Cardiovascular disease
Other risk factors: Arteriopathic renal disease Nephropathies Family history Neoplasia Myeloma Systemic disease (e.g. SLE) Smoking Chronic use of NSAIDs
Summarise the epidemiology of CKD
COMMON
Risk increases with age
Often associated with other diseases (e.g. CVS disease)
Recognise the presenting symptoms of CKD
Often ASYMPTOMATIC
May be an incidental finding of a routine blood or urine test
Symptoms of Severe CKD: Anorexia Nausea and vomiting Fatigue Pruritus Peripheral oedema Muscle cramps Pulmonary oedema Sexual dysfunction is common
Recognise the signs of CKD on physical examination
Physical examination rarely reveals many clues
May show signs of underlying disease (e.g. SLE)
May show complications of CKD (e.g. anaemia)
Signs of CKD: Skin pigmentation Excoriation marks Pallor Hypertension Peripheral oedema Peripheral vascular disease
Identify appropriate investigations for CKD
Assessment of Renal Function
Urea - not ideal because it varies massively depending on hydration status and diet
Creatinine - useful but has limitations. Renal function can drop considerably with minimal change in serum creatinine
Isotopic GFR - GOLD STANDARD but expensive
Biochemistry
Glucose - check for undiagnosed diabetes and diabetic control
Potassium - raised
Also check sodium, bicarbonate, calcium, phosphate
Serology Antibodies ANA - SLE c-ANCA - granulomatosis with polyangiitis (Wegener's) Anti-GBM - Goodpasture's syndrome Hepatitis serology HIV serology
Urinalysis
Check for proteinuria/haematuria
24 hr urine collection
Serum or urine protein electrophoresis - check for multiple myeloma
Imaging Ultrasound-check for structural abnormalities CT/MRI X-Ray KUB -check for stones Renal Biopsy
