Chronic Kidney Disease (Complete) Flashcards
Define CKD
Gradual irreversible decline in kidney function. This can be shown in either 2 ways:
1) eGFR < 60 for more than 3 months
2) Markers for kidney damage: Albuminuria, electrolyte abnormalities, structural or histological renal abnormalities. For more than 3 months
What are markers of kidney damage? (4)
Albuminuria
Electrolyte disturbance
Structural renal abnormalities
Histological renal abnormalities
What are the 5 stages of CKD based on eGFR?
Stage 1: >90 ml/min/1.73m2 with demonstrable kidney damage (e.g. haematuria or proteinuria).
Stage 2: 60-89 ml/min/1.73m2with demonstrable kidney damage (e.g. haematuria, proteinuria, or raised urine albumin/creatinine ratio).
Stage 3: 30-59
Stage 4: 15-30
Stage 5: < 15
What are the main causes of Chronic Kidney Disease?
Systemic:
Diabetes
Hypertension
HF
Vascular/ureteric:
Renal artery stenosis
Vasculitis
Chronic pyelonephritis
Glomerular causes:
IgA nephropathy
SLE
Chronic glomerulonephritis
Tubular causes:
Amyloidosis
Myeloma
Congenital:
Polycystic kidney disease
Alport syndrome
What are the most common causes of CKD? (7)
Diabetic nephropathy (Most common)
Hypertension
Chronic glomerulonephritis
Adult polycystic kidney disease
Obstructive uropathy (e.g. BPH/kidney stones)
Recurrent UTIs and pyelonephritis
Autoimmune diseases
What are the main complications of CKD?
Important to think of functions of kidney:
Waste excretion: Uraemia, hyperphosphataemia
Fluid balance: Hypertension, peripheral/pulmonary oedema
Acid base balance: Metabolic acidosis
Erythropoeitin production: Anaemia
Activation of vitamin D: Hypocalacaemia
CRF HEALS:
C: Cardiovascular disease
R: Renal osteodystrophy
F: Fluid (oedema)
H: Hypertension
E: Electrolyte disturbance (Hyperkalaemia, metabolic acidosis, hyperphosphataemia, hypocalcaemia)
A: Anaemia
L: Leg restlessness (Hypocalcaemia)
S: Sensory neuropathy (Hypocalcaemia)
What is the most common cause of death in chronic kidney disease?
Cardiovascular disease
What are the main signs/symptoms of CKD due to complications?
N.B. Tends to be assymptomatic until later stages of disease
Mainly due to electrolyte disturbances:
Lethargy (anaemia)
Pruritis (Uraemia)
Anorexia
Oedema (ankle swelling, weight gain)
Insomnia
Nausea and vomitting (uraemia)
Hypertension
What are the main features of renal osteodystrophy?
Osteoporosis (Reduced bone density)
Osteomalacia (Reduced bone mineralisation)
Secondary/tertiary hyperparathyroidism
Spinal osteosclerosis (Rugger Jersey spine)
What cause of CKD can result in microalbuminuria?
Diabetic nephropathy
What type of patients should have regular urinary albumin:creatinine ratio tests to screen for microalbuminuria?
Diabetics over 12 years of age
What urinary albumin:creatinine ratio is indicative of microalbuminuria?
> 2.5mg/mmol (Men)
> 3.0mg/mmol (Female)
What should be given to all patients with diabetes if microalbuminuria is detected?
ACE inhibitors
What investigations should be ordered for patients suspected of having chronic kidney disease?
Bedside:
Urine dipstick: Check for haematuria (unlikely to see proteinuria as it tends to be small amounts not detected by reagent strips)
Early morning ACR: Check for albuminuria
Bloods:
FBC: Check for anaemia
U&Es: detect electrolyte abnormalities
Serum creatinine: Elevated
eGFR: < 90
Imaging/Invasive:
Renal USS: Small kidney size (atrophy), renal stones, hydronephrosis (if obstruction)
Kidney biopsy: Helps to determine pathological diagnosis of CKD in glomerular nephrotic and nephritic syndromes.
What are risk factors associated CKD progression?
Cardiovascular disease
Proteinuria
Previous episode of acute kidney injury
Hypertension
Diabetes
Smoking
African, African-Caribbean or Asian family origin
Chronic use of NSAIDs
Untreated urinary outflow tract obstruction.
What is the management plan for patients with CKD?
Lifestyle management:
Smoking cessation
Exercise
Diet (Fluid and salt restriction for oedema AND restrict dietary pottasium)
Pharmacological:
Management of risk factors:
Diabetes (E.g. metformin)
CVD
Hypertension (ACE)
Management of oedema:
Furosemide (Diuretics)
Management of anaemia:
Monthly subcutaenous erythropoietin.
Management of hypocalcaemia and hyperphosphataemia:
Sevelamer (a phosphate binder)
Alfacalcidol (vit D replacement)
Surgical:
Parathyroidectomy: If tertiary hyperparathyroidism
Renal replacement therapy: For CKD progression into renal failure.
What medication can be given to manage hypocalacemia and hyperphosphataemia due to CKD?
Sevelamer (Phosphate binder)
Alfacalcidiol (Vitamin D replacement)
What renal replacement therapy options are available for CKD patients with renal failure?
Haemodialysis
Peritoneal dialysis
Renal transplant
What is haemodialysis?
Type of renal replacement therapy involving filtration of blood through a dialysis machine.
N.B. Required to be done 3 times a week and can last 3-5 hours.
What are some of the complications involved with haemodialysis? (6)
Site infection
Stenosis at site
Endocarditis
Cardiac arrythmia
Hypotension
Air embolus
What is peritoneal dialysis?
Form of renal replacement therapy where the filtration occurs within the patient’s abdomen.
Dialysis solution containing high dextrose is injected into peritoneal cavity. This draws waste products from the blood into the cavity and is then drained and exchanged with new dialysis solution.
What are some of the complications of peritoneal dailysis? (8)
Peritonitis
Catheter infection or blockage
Fluid retention
Hyperglycaemia
Constipation
Hernias
Back pain
Malnutrition
What are complications of renal transplant? (7)
Graft rejection
DVT/PE
Opportunistic infection
Malignancy (lymphoma, skin cancers)
Reccurrence of original disease
CVD
Hypertension
What are indications for renal replacement therapy?
Reduced GFR alongside:
A: Severe acidosis
E: Severe electrolyte imbalance
I: Intoxication
O: Overload
U: Uraemic symptoms
