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Kidneys > Chronic Kidney Injury > Flashcards

Chronic Kidney Injury Flashcards

0
Q

Causes of CKD

A

Commonest - diabetic or hypertension
Poly-cystic kidney
Long term Nephrotoxic drugs (gentamicin or NSAIDs)
Autoimmune diseases (SLE) and glomerulonephritis
Recurrent UTIs or Hx of kidney trauma

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1
Q

Stages of CKD

A 
Stage 1 - eGFR > 90ml/min
Stage 2 - eGFR 60-89ml/min
Stage 3 - eGFR 30-59ml/min
Stage 4 - eGFR 15-29ml/min (usually only symptomatic after here)
Stage 5 - eGFR <15ml/min
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2
Q

Symptoms of CKD

A

Asymptomatic until stage 4
Uraemia
Hyperkalaemia
Low erythropoietin Abnormal Vit D metabolism
Fluid overload (oedema)
Metabolic acidosis (increased RR, treat with oral bicarbonate)

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3
Q

Symptoms of Uraemia

A 
Confusion
Pruritus
Restless legs/Cramps
Nausea
Parasthesia
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4
Q

Symptoms of low erythropoietin

A

Anaemia, Dyspnoea, Fatigue
Need to be monitor Hb and if below 11 give weekly EPO injections + iron
If below 8Hb transfuse to 11

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5
Q

Stages of CKD

A 
Stage 1 - eGFR > 90ml/min
Stage 2 - eGFR 60-89ml/min
Stage 3 - eGFR 30-59ml/min
Stage 4 - eGFR 15-29ml/min (usually only symptomatic after here)
Stage 5 - eGFR <15ml/min
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6
Q

Chronic kidney Disease (CKD)

A

A gradual decline in renal function over months to years, classified by a decrease in eGFR

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7
Q

Symptoms of disrupted Vit D metabolism

A

Osteomalacia (bone pain)
Secondary or tertiary hyperparathyroidism
Treat with calcium and cholecalciferol and monitor PTH levels
Phosphate binders can be used to treat hyperphosphataemia

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8
Q

Treating hypertension in patients with CKD

A

ACEi can be used if K+ is below 6

If above then use a loop diuretic –> if resistant add thiazides

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9
Q

Treatment of stage 4/5 of CKD

A

Transplant or haemodialysis

Especially if –> serum creatinine >500mmol/L OR GI symptoms OR peripheral neuropathy OR pericarditis OR malnutrition

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10
Q

Polycystic kidney disease (PCKD)

A

One cause of chronic kidney disease –> genetic condition
Can be painful or asymptomatic –> multiple cysts in kidney but can also be in liver, brain or heart
Can autosomal dominant (commonest, onset in early adulthood) or recessive (rarer with worse prognosis, onset in infancy)

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11
Q

Causes of pain in polycystic kidney disease (PCKD)

A

Cyst haemorrhage or infection
Pyelonephritis
Kidney stones
Chronic cyst pain

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12
Q

Common presentations of PCKD

A

Asymptomatic cysts on imaging or family screening –> genetics too complex to screen
Renal pain, haematuria/proteinuria, hypertension or CKD
Non-renal manifestations –> cerebral aneurysms, liver cysts/failure, pancreatic cysts, valvular disease, diverticulitis

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13
Q

Cyst haemorrhage

A

Sudden onset, sharp localised pain over 2-5 days
Afrebrile, blood cultures and MSU -ve –> N+V with occasional haematuria
Diagnose by CT or MRI
Analgesia and rest, hydration, compression+transfusion if major

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14
Q

Cyst infection

A

Sub-acute, localised sharp pain
Pyrexial, N+V and blood cultures often +ve but MSU -ve
Diagnose by CT or MRI
Requires at least 4 weeks of antibiotics (long-term+penetrating)

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15
Q

Pyelonephritis

A

Sudden onset, progressive, diffuse pain
High grade Pyrexia, N+V, rigours and dysuria
Blood cultures and MSU Both +ve
USS may show perinephric
Requires prolonged up to 4 weeks of Antibiotics

16
Q

Symptoms of kidney stones

A

Sudden onset, localised, sharp but intermittent colic
Apyrexial, N+V, and frank haemorrhage
Blood culture and MSU both negative
KUB,IVP, CT, MRI and X-ray
Analgesia, rest and hydration. Treat with PCUL or surgery

17
Q

Chronic cyst pain

A

Poorly understood
Constant, positional, diffuse pain with gradual onset
Apyrexial and occasionally with chronic haematuria
Blood cultures and MSU negative, imaging not helpful
Analgesia, aspiration if due to a single cyst or surgery

18
Q

CKD as a complication of polycystic kidney disease

A

Onset in 40’s –> 65% progress to end stage disease (ESRD) needing renal replacement therapy (RRT) of some form –> dialysis or transplant
Generally leave the original kidneys in unless –>need the space, painful, recurrently bleeding or infected or cancerous

19
Q

ESRD

A

End stage renal disease

20
Q

RRT

A

Renal replacement therapy

Either dialysis or transplant

21
Q

Hypertension in patients with PCKD

A

Almost 100% of patients will have it by 4th decade

22
Q

Causes of CKD

A

Commonest - diabetic or hypertension
Poly-cystic ovaries
Long term Nephrotoxic drugs (gentamicin or NSAIDs)
Autoimmune diseases (SLE) and glomerulonephritis
Recurrent UTIs or Hx of kidney trauma

23
Q

Symptoms of CKD

A

Asymptomatic until stage 4
Uraemia Hyperkalaemia
Low erythropoietin Abnormal Vit D metabolism
Fluid overload
Metabolic acidosis

24
Q

Symptoms of Uraemia

A 
Confusion
Pruritus
Restless legs/Cramps
Nausea
Parasthesia
25
Q

Symptoms of low erythropoietin

A

Anaemia
Dyspnoea
Fatigue
Need to be monitor Hb and if below 11 give weekly EPO injections

26
Q

Symptoms of hyperkalaemia

A

Palpitations and/or ECG Changes
May be asymptomatic
Treat if K+ over 6 by stopping all K+ sparing drugs
ACEi cannot be used if K+ remains elevated

27
Q

Stages of CKD

A 
Stage 1 - eGFR > 90ml/min
Stage 2 - eGFR 60-89ml/min
Stage 3 - eGFR 30-59ml/min
Stage 4 - eGFR 15-29ml/min (usually only symptomatic after here)
Stage 5 - eGFR <15ml/min
28
Q

Causes of CKD

A

Commonest - diabetic or hypertension
Poly-cystic ovaries
Long term Nephrotoxic drugs (gentamicin or NSAIDs)
Autoimmune diseases (SLE) and glomerulonephritis
Recurrent UTIs or Hx of kidney trauma

29
Q

Symptoms of CKD

A

Asymptomatic until stage 4
Uraemia Hyperkalaemia
Low erythropoietin Abnormal Vit D metabolism
Fluid overload
Metabolic acidosis

30
Q

Symptoms of Uraemia

A 
Confusion
Pruritus
Restless legs/Cramps
Nausea
Parasthesia
31
Q

Symptoms of low erythropoietin

A

Anaemia
Dyspnoea
Fatigue
Need to be monitor Hb and if below 11 give weekly EPO injections

32
Q

Stages of CKD

A 
Stage 1 - eGFR > 90ml/min
Stage 2 - eGFR 60-89ml/min
Stage 3 - eGFR 30-59ml/min
Stage 4 - eGFR 15-29ml/min (usually only symptomatic after here)
Stage 5 - eGFR <15ml/min
33
Q

Causes of CKD

A

Commonest - diabetic or hypertension
Poly-cystic ovaries
Long term Nephrotoxic drugs (gentamicin or NSAIDs)
Autoimmune diseases (SLE) and glomerulonephritis
Recurrent UTIs or Hx of kidney trauma

34
Q

Symptoms of CKD

A

Asymptomatic until stage 4
Uraemia Hyperkalaemia
Low erythropoietin Abnormal Vit D metabolism
Fluid overload
Metabolic acidosis

35
Q

Symptoms of Uraemia

A 
Confusion
Pruritus
Restless legs/Cramps
Nausea
Parasthesia
36
Q

Symptoms of low erythropoietin

A

Anaemia
Dyspnoea
Fatigue
Need to be monitor Hb and if below 11 give weekly EPO injections

37
Q

Treatment of acute pyelonephritis

A

Broad spectrum cephalosporin or quinolone

Kidneys (6 decks)

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