Chronic renal failure Flashcards
How common is it?
CKD stage 3-5 is 8.5%.
Who does it affect?
10.6% in females and 5.8% in males. Prevalence increases dramatically with age.
What causes it?
Conditions associated with intrinsic kidney disease: Hypertension, diabetes mellitus
Nephrotoxic drugs such as: Lithium, Ciclosporin, Calcineurin inhibitors (such as tacrolimus). Aminoglycosides. Mesalazine.
Conditions associated with obstructive kidney disease: Bladder voiding dysfunction such as neurogenic bladder, BPH, urinary division surgery and recurrent urinary stones.
Multisystem disease that may involve the kidney, such as: SLE, vasculitis, myeloma, autosomal dominant polycystic kidney disease, Alports syndrome and familial glomerulonephritis.
Diabetes.
Polycystic kidney disease.
What risk factors are there?
AKI
CVD (Heart failure, chronic, peripheral arterial disease, and angina).
Hypertension and/or proteinuria.
Diabetes.
Smoking.
Chronic use of NSAIDs.
Nephrotoxic drugs such as lithium, ciclosporin and diuretics.
Untreated urinary outflow obstruction such as BPH.
Structural renal tract disease and renal calculi.
SLE.
How does it present?
Anaemia: Pallor, lethargy, breathlessness on exercise.
Thrombocytopaenia: Epistaxis, bruising
Skin: Pigmentation, pruritus (itch)
GI tract: Anorexia, nausea, vomiting, diarrhoea
Endocrine/gonads: Amenorrhoea, erectile dysfunction, infertility
Polyneuropathy
CNS: Confusion, coma, first (severe uraemia)
CVS: Uraemic pericarditis, Hypertension, peripheral vascular disease, heart failure
Renal: Nocturia, polyuria, salt and water retention, oedema
Renal osteodystrophy: Osteomalacia, muscle weakness, bone pain, hyperparathyroidism, osteosclerosis (abnormal hardening of bones), adynamic bone disease
Investigations
Serum creatinine monitoring.
Urinary electrolytes may establish a pre-renal element.
Blood count: Anaemia and a very high ESR may suggest a myeloma or a vasculitis as the underlying cause.
Urine and blood cultures to exclude infection.
Urine dipstick testing and microscopy: glomerulonephritis is suggested by haematuria and proteinuria on dipstick testing and red cell casts on microscopy. Renal ultrasound to assess for size.
Histological investigations: renal biopsy should be performed in every patient with unexplained AKI and normal-sized kidneys.
Treatment
Specific therapy directed at the underlying cause of renal disease e.g.
Immunosuppressive agents for vasculitis.
Reduce nephrotoxic drugs.
Control blood pressure. Atorvastatin 20mg for CVD.
Probably an antiplatelet for primary prevention of cardiovascular disease.
Control sugar levels if you have diabetes.
Lifestyle advice.
