Chronic Kidney Injury Flashcards
How is kidney function measured?
Kidney function is best measured using GFR. GFR is best estimated using urine creatinine ( a formula has been derived).
Can EGFR be used in Acute Kidney Injury?
EGFR should only be used in steady state serum creatinine ( i.e. not in acute kidney injury)
What is the definition of Chronic Kidney Disease
It is an EGFR 3 months
- Microalbuminuria
- Proteinuria
- Glomeural Haematuria
- Pathological abnormalities (e.g. on renal biopsy)
- Anatomical Abnormalties (e.g. cysts on ultrasound)
On the whole it is quite a silent condition and signs and symptoms are only found when levels get below 15 in terms of eGFR
What are the various stages of CKD, what are the GFR parameters and extra caveats? What is ACR? What are the values of ACR which are normal for males and females? What constitutes micro/ macro? Why is this staging important?
Stage 1 = 25 in Males
> 35 in females
Albuminuria/ proteinuria are key markers of renal damage, but may also indicate specific renal pathology
- Staging identifies risk of progression of kidney disease
- Risk of cardiovascular complications
What is the investigation which allows you to determine Albuminuria/ Proteinuria
Urinalysis - dipstick
Allows you to quantify
ACR
PCR
24 hour urine colection
Name the risk factors responsible for chronic kidney disease?
Old age > 55 Hypertension Diabetes Smoking First degree family relative Obesity
What first line bloods are indicated in the evaluation of a CKD patient?
Bloods:
- FBE
- Calcium and phosphate
- Parathyroid Hormone
- HbA1c
- LFTs
- Uric acid
- Iron Studies, B12, folate
- Other systemic disease depending on the clinical scenario
What Urine is indicated?
- Urinalysis with microscopy
- Spot Urine to determine ACR/PCR
- +/- urine collection for protein and creatinine clearance
What imaging is indicated?
- Renal Tract Ultrasound
- CT +/- contrast
Nuclear isotope scan
- DMSA
- MAG-3 Scan
- DTPA
How is adult polycystic kidney disease inherited?
Autosomal Dominant, where cysts are found in the kidneys.
What is the basic management principles of patients with chronic kidney disease?
- To identify and treat the underlying cause of the kidney disease
- Reduce progression of kidney disease (BP, Lipids, Glucose control)
- Reduce cardiovascular risk (BP, lipids, Glucose control)
- Early detection and management of metabolic complications such as ( anaemia, Ca/PO4/ PTH, acidosis)
- Medication adjustment/ avoidance of renally excreted and nephrotoxic medications
A lady has hypertension, 1.5 gm proteinuria ( normal is less than 0,2 gm/day) and glomerular haematuria on urine microscopy.
On ultrasound her kidneys are small is size and hyperechogenic
What is the underlying cause of kidney disease?
What is the risk of CVD/ ESKD?
What are the management principles?
Differentials for Haematuria
- Glomerular pathology
- Malignancy
- Ureteric stones
- UTI
- Menstrual periods
Urine microscopy may identify haematuria which is glomerular in origin and distinguish it from non glomerular. Can be distinguished from micro vs macroscopic.
A renal biopsy shows glomeruli with mesangial exapnasion and mesangial cell proliferation
Immunofluoresence is positive for IgA deposits in the mesangium. A diagnosis of IgA nephropathy is made.
What are modifiable factors we can change to improve the outcomes of CKD? What are two most important factors?
- Weight reduction ( greater than 5 % if obese_
- Healthy diet
- Dietary salt restriction (
Name the metabolic complications of CKD
- Anaemia (Aim for Hb around 100-120)
- Metabolic acidosis
- Calcium/phosphate/PTH management
- Dyslipidemia
- Nutrition
Metabolic Acidosis
Problems: Muscle catabolism, metabolic bone disease. reduced immune function
Metabolic bone disease - treatment with phosphate binders, control of hyperparathyroidism (1, 25 OH vit D, cinacalcet)
Treatment with serum bicarb
Watch for sodium loading
- Volume expansion
- Hypertension
- Treatment with bicarb will slow down the renal progression
