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Medicine & Surgery: Renal & Urology > CKD > Flashcards

CKD Flashcards

1
Q

What is the definition of chronic kidney disease?

A

Haematuria and proteinuria, or a reduction in eGFR <60ml/min/1.73m^2 for >3 months.

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2
Q

What are the most common causes of CKD?

A
  1. Diabetes mellitus and hypertension top two

2. PKD, obstructive uropathy, glomerular nephrotic/nephritic syndromes.

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3
Q

What are the factors considered when classifying CKD?

A
  1. eGFR category - creatinine, age, gender, ethnicity
  2. Presence of albuminuria
  3. Cause of kidney disease
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4
Q

What are the eGFR categories in CKD?

A 
G1 - normal or high >90
G2 - mildly decreased 60-89
G3a - mildly-moderately decreased 45-59
G3b - moderately to severely decreased 30-44
G4 - severely decreased 15-29
G5 - kidney failure <15
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5
Q

What are the persistent albuminuria categories in CKD?

A

A1 - normal to mildly increased <30mg/g
A2 - moderately increased 30-300mg/g
A3 - severely increased >300mg/g

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6
Q

When might CKD become symptomatic and what are the signs and symptoms?

A
  1. If eGFR <30
  2. Fluid overload - SOB/peripheral oedema
  3. Anorexia, N&V, restless legs, fatigue, weakness, pruritus, bone pain, amenorrhoea, impotence.
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7
Q

What are the risk factors for developing CKD?

A
  1. > 50 years old, obese, male
  2. Diabetes mellitus, smoking, HTN, PMHx autoimmunity
  3. Black, Hispanic, FHx
  4. Long term analgesia use
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8
Q

How is a suspected CKD investigated?

A
  1. FBC (normocytic, normochromic anaemia), U&Es (low Ca, high phosphate, high PTH), bone profile, vitamin D.
  2. Autoantibodies if suspect systemic disease (ANA, antiphospholipid)
  3. Urinalysis - Bence Jones/casts
  4. Urine albumin - creatinine ratio
  5. USS kidney
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9
Q

What is considered a rapid progression of CKD?

A

Fall in eGFR >5/year

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10
Q

What is the most common cause of death in CKD and thus what needs to be managed first?

A
  1. Cardiovascular disease

2. Optimise glycaemia, BP, and lipids.

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11
Q

What is the target BP and salt intake for a CKD patient?

A
  1. Systolic <140mmHg, <130mmHg in diabetics.

2. <2g per day of salt

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12
Q

What is the first line medication for BP control in CKD?

A

ACEi, in chronic cough switch to ARB.

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13
Q

Why should you not combine RAAS blockade medications in CKD?

A

Risk of hyperkalaemia:

  1. Measure K+ before and after starting
  2. Stop if K+ >6, or eGFR falls by 25%
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14
Q

What is the target HbA1c in glycaemic control of CKD?

A

7.0% (53mmol/mol)

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15
Q

What medications should you give for CVD secondary prevention in CKD?

A
  1. Atorvastatin 20mg

2. Anti-platelet - if risk outweighs risk of bleeding

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16
Q

What is the management for oedema in CKD?

A
  1. Restrict fluid and sodium intake

2. Loop and thiazide diuretics may be used

17
Q

What is the treatment for anaemia in CKD?

A
  1. Consider EPO when eGFR <30, Hb <100 (target 100-110)
  2. Must exclude other causes of anaemia before giving EPO
  3. Iron may be given IV due to anaemia of chronic disease
18
Q

What is the treatment for acidosis in CKD?

A

Sodium bicarbonate

19
Q

What is the treatment for bone disease in CKD?

A
  1. Calcium low, phosphate high, vitamin D low, PTH high.
  2. Dietary modification and phosphate binders
  3. Activated vitamin D supplements if PTH high (1a-calcidol/calcitriol)
20
Q

What are the complications of an AV fistula and what are the downsides of haemodialysis?

A
  1. Thrombosis, stenosis, infection, blockage.

2. Hypotension, time consuming.

21
Q

What is haemodialysis?

A

Blood passed over semi-permeable membrane against dialysis fluid flowing in opposite direction.

22
Q

What is peritoneal dialysis?

A

Uses peritoneum as semi permeable membrane, ultrafiltration achieved by adding osmotic agents (glucose polymers) to fluid.

23
Q

What are the two types of peritoneal dialysis?

A
  1. Ambulatory - bag changes

2. Automated - machine

24
Q

What are the side effects of peritoneal dialysis?

A

Catheter site infection, peritonitis, hernia, loss of membrane function over time.

25
Q

What is an absolute contraindication to renal transplant?

A

Cancer with metastases

26
Q

What are some temporary contraindications to renal transplant?

A

Active infection, HIV with high viral load, unstable cardiovascular disease.

27
Q

In which conditions is there a relative contraindication to renal transplant?

A

Congestive heart failure, cardiovascular disease.

28
Q

What are the four types of graft for a renal transplant?

A
  1. Living donor
    2a. Donor after brain death (heart beating)
    2b. Deceased donor but old/CVD/BP to CKD
    2c. Donor after cardiac death
29
Q

What are the options for immunosuppression in CKD renal transplant, and how do they work?

A
  1. Calcineurin inhibitors (tacrolimus, ciclosporin) - inhibits T-cell activation and proliferation
  2. Mycophenolate mofetil - inhibits DNA in T and B cells
  3. Glucocorticoids are 1st line for acute rejection
30
Q

What are the complications of renal transplant?

A
  1. Surgical - bleed, thrombosis, infection, urinary leaks, hernia
  2. Delayed graft function - affects 40%, more common in deceased cardiac dead
  3. Rejection - acutely Ab mediated/cellular or chronically donor Ab mediated
  4. Infection - CMV and PCP prophylaxis given
  5. Malignancy - lymphoproliferative, skin, and gynaecological
  6. CVD - 3-5x increased risk

Medicine & Surgery: Renal & Urology (28 decks)

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