Chronic kidney disease (CKD) Flashcards
Define chronic kidney disease.
Abnormality of kidney structure or function present for _>_3months with implications for health. Defined by:
- or a reduction in the glomerular filtration rate to <60 mL/minute/1.73 m² OR
- presence of markers of kidney damage e.g. ACR, protein, haematuria
How common is CKD? Who is most affected?
- Incidence is rising due to ageing population, diabetes and hypertension
- Black and Hispanic have higher prevalence than general population
What is the aetiology of CKD?
Diabetes - most common cause in adults. One third will develop CKD (defined by macroalbuminuria >200mg alb/day) and/or reduction in GFR to <90ml/min/1.73m^2 within 5-10yrs of diagnosis of diabetes.
Hypertension - 2nd most common cause
Less common:
- PCKD - commonest inherited cause of CKD
- Obstructive uropathy
- Glomerular nephrotic and nephritic syndromes e.g. FSGS, MN, lupus, amyloidosis, rapidly progressive glomerulonephritis.
What are the stages of CKD?
CKD is divided into 6 distinct stages based on GFR, as follows: (KD = kidney damage)
- Stage 1:normal or increased GFR, ≥90
- Stage 2: decrease in GFR, 60-89
- Stage 3a: moderate decrease in GFR, 45-59
- Stage 3b: moderate decrease in GFR, 30- 44
- Stage 4: severe decrease in GFR, 15 - 29
- Stage 5: kidney failure (end-stage kidney disease), with GFR <15
AER/ACR:
Units = mL/minute/1.73m²
<3mmHg - A1
3-30mmHg - A2
>30mmHg - A3
What are the risk factors for CKD?
- DM
- HTN
- CVS
- Structural renal disease
- Multisystem disorders involving kidney
- FHx
- Recurrent UTI
- Vesicoureteric reflux
- Smoking
- Obesity
- Black/Hispanic
- AI disorders
- Male sex
- Long tern NSAID use
What are the clinical feaures of CKD?
Symptoms:
- Often ASYMPTOMATIC until very final stages
- Fatigue
- Malaise
- Pruritis
- Anorexia
May show complications of CKD (e.g. anaemia, uraemia, bone disease)
- Skin pigmentation - Uraemia
- Excoriation marks - Uraemia
- Pallor – Anaemia of chronic disease
- Hypertension
- Peripheral oedema
- Peripheral vascular disease
- Renal Bone Disease
What are the 4 consequences of CKD?
- Progressive failure of homeostatic function
- Acidosis
- Hyperkalaemia
- Progressive failure of hormonal function
- Anaemia
- Renal Bone Disease - Osteomalacia, pain, fractures
- Hypocalcaemia - failure to convert Vit D3 into calcitriol –> 2o hyperparathyroidism
- Cardiovascular disease
- Vascular calcification
- Uraemic cardiomyopathy
- Uraemia and Death
What investigations would you do for CKD?
Bloods:
- FBC - low Hb (normocytic anaemia)
- U&Es - high urea and creatinine, GFR low
- Glucose - ?DM
- Serum calcium - low
- Serum phosphate - high
- AlkPhos (ALP) - high in renal osteodystrophy
- PTH - high in severe CKD
- Urinalysis - dipstick, MC&S, protein:Cr ratio
Imaging:
- USS - check size, anatomy and cortico-medullary differentiation and eliminate obstruction. In CKD kidneys are small (<9cm) but may be enlarged in infiltrative disorders
- CXR - pericardial effusion or pulmonary oedema
- Biopsy for histology - consider if rapidly progressing or unclear cause (C/I for small kidneys)
What are the aims of CKD management? (3)
- Limit progression/complications
- Symptom control
- Preparation for RRT (renal replacement therapy)
How do you limit progression/complications of CKD?
Reduce progression:
- ACEi or ARBs - BP control; guideline targets vary
- SGLT-2 inhibitors - reduce intraglomerular pressure
- Tight glucose control in DM - HbA1c <6.5%
- Decrease CVS risk - lipid lowering drugs, stop smoking, lose weight
- Diet: multidisciplinary team: moderate protein, restrict K+, avoid high phosphate foods.
AVOID NSAIDS
Renal osteodystrophy:
TREATMENT:
- Calcichew - Ca supplement
- Calcium acetate - phosphate binders
- Cinacalcet (calcimimetic) – reduce PTH levels
How do you control symptoms of CKD?
- Anaemia: Human EPO might be required
- Acidosis: Consider sodium bicarbonate supplements for patients with low serum bicarbonate or dialysis.
- Oedema: loop diuretics, restriction of fluids, or dialysis
Name 2 types of renal replacement therapy.
- Haemodialysis or peritoneal dialysis – Vascular access required for haemodialysis
- Transplantation – Gold standard treatment, major surgery and long term immunosuppression.
What is the single best treatment for end-stage kidney failure?
Live-donor transplant
What are the types of transplant?
Deceased-donor transplant
Live-donor transplant
- Related
- Unrelated
