Chronic Kidney Disease L12 Flashcards
What are the functions of the kidneys?
- homeostasis
- excretion of drugs and drug metabolites
- metabolic/endocrine
Which hormones does the kidney synthesise?
EPO, renin, vit D
Why is eGFR a better measure of kidney function than serum creatinine?
takes into account the age, gender, ethinicity of patient as well as serum creatinine level > better measured to population
*two patients of different ages, genders and ethnicities may both have normal serum creatinine but one may have a much higher eGFR than the other. Both eGFRs however may be considered in the normal population eGFR range.
What is Chronic Kidney Disease?
A progressive, irreversible loss of kidney function
Describe the five stages of CKD and the ranges of eGFR they fall into.
Stage 1
- kidney damage, GFR normal
- > 90
Stage 2
- kidney damage, mild decrease in GFR
- 60-89
Stage 3
- moderate decrease in GFR
- 30-59
Stage 4
- severe decrease in GFR
- 15-29
Stage 5
- kidney failure
- <15
What is the definition of stage 5 CKD?
insufficient renal function to sustain life/health
What are options of treatment for someone with stage 5 CKD?
- haemodialysis
- peritoneal dialysis
- kidney tranplantation
-or palliative care leading to death.
What factors increase your risk of getting CKD?
- increased age
- poor education (deprived background)
- hypertension
- diabetes
- smoking
- black or indo-asian ethnicity
Name some of the systemic diseases that can cause CKD.
diabetes, hypertension, atherosclerotic disease
What are some of the immune mediated diseases that can cause CKD?
membranous nephropathy, IgA nephropathy
Give examples of infectious diseases that can cause CKD?
HIV, Hep B, Hep C, TB
what are some genetic diseases that can cause CKD?
polycystic kidneys, cystinosis
Obstruction of the urinary tract can cause CKD due to back-pressure damaging the kidneys. In what ways can the tract be obstructed?
- stones (kidney,bladder)
- benign prostate
- tumours - intrinsic or extrinsic
- fibrosis (of walls etc.)
What is diabetic nephropathy?
progressive damage to kidneys seem in some people with long-standing diabetes. Excessive leakage of protein into urine is followed by gradual decline of kidney function and even kidney failure. Can be prevented/reversed before completely lose kidney function. Pathology includes thickening of basement membrane, mesangial expansion and glomerulosclerosis.
What are some of the complications of CKD?
- anaemia
- cardiovascular disease
- bone disease
- hypertension
- bleeding tendency
- disturbed calcium/phosphate homeostasis
- immune suppression
- abnormal handling of drugs
- complications of treatment