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Yr 3 renal > ckd > Flashcards

ckd Flashcards

1
Q

def CKD

A

either kidney damage or GFR<60 mL/min/1.73 m2for 3 months with health implications

Kidney damage is defined as pathologic abnormalities or markers of damage, including abnormalities in blood or urine tests or imaging studies.

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2
Q

classification of ckd

A

classified based on GFR category, presence of albuminuria and cause of kidney disease

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3
Q

classification based on cause of ckd

A

glomerular

  • primary - minimal change, membranous
  • systemic - dm, amyloid

tubulointersititial

  • primary - UTI, pyelonephritis, stones
  • secondary - drugs, toxins, sarcoid

blood flow/vessels

  • primary - renal limited vasculitus,
  • systemic - HF, TTP

cystic/congenital

  • primary - renal dysplasia
  • systemic - alport syndrome, Fabry disease

transplant

  • primary - recurrence of renal disease
  • systemic - rejection, calcineurin toxicity
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4
Q

aetiology ckd

A

dm and HTN - most common causes

vascular disease - HTN, renal artery atheroma, vasculitis

gloimerular disease - glomerulonephritis, dm, amyloid, SLE

tubulointerstitial disease - pyelonephritis/interstitial nephritus, nephrocalcinosis, TB

obstruction and others - myeloma, HIV nephropathy, scleroderma, gout, renal tumour, inborn errors of metabolism (Fabry’s disease)

congenital/inherited - polycystic kidney disease, Alport’s syndrome, congenital hypoplasia

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5
Q

epi ckd

A

Incidence of end-stage CRF in England>110 per million population per year.

Higher incidence in Asian immigrants than native British population.

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6
Q

sx ckd

A

anorexia

nausea

malaise

pruritus

later:

  • diarrhoea
  • drowsiness
  • convulsions
  • coma

symptoms of cause and complications

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7
Q

face signs ckd

A

signs of anaemia

xanthelasma

ureamia - yellow tinge

jaundice - hepatorenal

gum hypertrophy - ciclosporin

cushingoid - steroids

periorbital oedema - nephrotic syndrome

taut skin/telangiectasia - scleroderma

facial lipodystrophy - glomerulonephritis

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8
Q

neck signs ckd

A

JVP for fluid state

tunnelled line (if removed, look for small scar over in-ternal jugular, and a larger scar in ‘breast pocket’ area),

scar from parathyroidectomy,

lymphadenopathy.

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9
Q

resp signs ckd

A

pul oedema or effusion

kussmaul’s breathing - acidosis

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10
Q

abdo signs ckd

A

PD catheter or scars from previous catheter (small scars just below umbilicus and to side of midline)

signs of previous transplant - scar, palpable graft

ballotable polycystic kidneys +- palpable liver

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11
Q

cvs signs ckd

A

BP

sternotomy

cardiomegaly

If right-sided heart failure/tricuspid regurgitation, JVP does not refl ect fl uid state.

stigmata of endocarditis

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12
Q

hand signs ckd

A

leuconychia

brown line at distal end of nail

There may be an arteriovenous fistula (buzzing lump in wrist or forearm).

Uraemic flap/encephalopathy if GFR <15.

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13
Q

general signs ckd

A
  • peripheral oedema
  • signs of peripheral vascular disease or neuropathy
  • vasculitic rash
  • gouty tophi
  • joint disease
  • pigmentation
  • scratch marks
  • Signs of immunosuppression: bruising from steroids, skin malignancy.
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14
Q

blood ckd

A

low Hb normochromic, normocytic

UE - low urea and creatinine - compare with previous

eGFR (can be derived from creatinine and age using the MDRD calculator)

low ca,

high phos, alkPhos and PTH (renal osteodystrophy)

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15
Q

ix aetiology ckd

A
  • ANCA
  • ANA
  • antiphospholipid Ab
  • paraprotein
  • complement
  • cyroglobin
  • anti-GBM
  • hepatitis serology
  • anti-PLA2R (membranous nephropathy)
  • glucose
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16
Q

24hr urine collection ckd

A

protein

creatinine clearance - rough estimate of GFR

MC&S

Bence jones

17
Q

imaging ckd

A

osteomalacia and hyperparathyroidism.

CXR may show pericardial effusionor pulmonary oedema

18
Q

renal us ckd

A

measure size - may be small <9cm, except in infi ltrative disorders (amyloid, myeloma), APKD,and DM

symmetry - if asymmetrical consider renovascular disease

corticomedullary differentiation

exclude obstruction

visualise structure

scarring may be seen - isotope scans are more sensitive

19
Q

renal biopsy ckd

A

for changes specific to the underlying disease

in progressive disease, nephrotic syndrome, systemic disease, AKI w/o recovery

DM with neuropathy/retinopathy may not need biopsy unless atypical, ie nephrotic, haematuria, other systemic symptoms.

unlikely to change treatment if GFR stable and P:CR <150.

CI for small kidneys

20
Q

monitoring ckd

A

GFR and albuminuria should be monitored at least annually, according to risk. If high risk, monitor every 6 months, if V high risk - monitor at least every 3-4mo

Small fluctuations are common but a drop in eGFR stage with drop eGFR≥ 25% is significant. Rapid progression is drop eGFR >5/yr.

21
Q

RF for ckd decline

A
  • htn
  • dm
  • metabolic disturbance
  • volume depletion
  • infection
  • NSAIDS
  • smoking
  • all CKD has increased risk of superimposed AKI and needs monitoring and prompt treatment during intercurrent illness
22
Q

interpretation ckd

A

got to think whether the eGFR reflects the true GFR - ie corrected for ethnicity/drugs eg trimethoprim alters creatinine concentration but not GFR

is there a previous creatinine on record

think about possible cause

  • previous UTI
  • LUTI
  • PMH of HTN, DM, IHD, systemic disorder, renal colic
  • check drug history and when meds started
  • FH - renal disease, subarachnoid haemorrhage
  • Systems review: look out for more than is immediately obvious, consider rare causes, ask about eyes, skin, joints, ask about symptoms suggestive of systemic disorder (‘When did you last feel well?’) and malignancy

current state

23
Q

interpreting ckd based on current state

A

many pts have symptomatic CKD if GFR<30

symptoms of fluid overload - SOB, peripheral oedema

anorexia

nausea

vomiting

restless legs

fatigue

weakness

pruritis

bone pain

amenorrhoea

impotence

24
Q

mx of ckd

A
  1. ACEi
  2. statin
  3. control of RFs
  4. consider dapagliflozin
  5. epoetin alfa if necessary
  6. if hyperparathyroidism - diet modification +- phosphate binding drug
  7. dialysis
  8. transplant
25
Q

complications of CKD

A

Yr 3 renal (18 decks)

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