Chronic Kidney Injury CKI Flashcards
Definition
Reduced GFR and/or evidence of kidney damage
Risk factors
Increasing age Cardiovascular disease Diabetes Hypertension Smoking AKI Polycystic kidney disease Chronic NSAID use
Blood pressure aim for patient that have NO proteinuria
Below 140/90
Blood pressure aim for patients that have proteinuria and/or CKD
Below 130/80
Stages
stage 1 - eGFR > 90ml/min (normal) Stage 2 - eGFR 60-89ml/min Stage 3a - eGFR 45-59ml/min Stage 3b - eGFR 30-44ml/min Stage 4 - eGFR 15-29ml/min Stage 5 - <15ml/min OR pt on dialysis
Progression
Patients with early CKD (stages 1-3) are likely to progress to advanced CKD especially if
- young
- if patient has proteinuria
The majority of patients with CKD will not reach ESRF - true or false?
True
Clinical features
Symptoms occur late (i.e. when GFR <20ml/min) Fatigue Muscle weakness Poor appetite Pain Weight loss Pallor (anaemia) Itch Sleep disturbance
Investigations
Urinalysis
- proteinuria
eGFR
- decreasing
- do eGFRstatinC to confirm or rule out CKD. If this is above 60, the patient does not have CKD
Creatinine clearance
- decreased (this is your GFR)
- ie peeing out less creatinine
ACR
Albumin Creatinine ratio (ACR) levels
A1 = ACR <3 ml/mmol
A2 = ACR 3-30 ml/mmol
A3 = ACR >30 ml/mmol
Nephrotic range would be ACR 300-350 ml/mmol
ACR of >70ml/mmol should be referred to a specialist
Management
Slow down the progression of CKD
- Assess CV risk
- statin (atorvastatin 20mg)
Reduce BP + control proteinuria
- ACE inhibitors
- ARBs
- spironolactone
RRT
- for established ESRF
- consider when GFR around 20ml/min
Conservative management
Diet control to prevent excess
- potassium
- sodium
- phosphate (choco, cheese)
Change the WAY you cook
Restrict fluid intake
- 1L per day
