CKD Flashcards
What are the risk factors for CKD?
diabetes, HTN, CVD, AKI, fam hx, systemic disease e.g. SLE
What is the most common cause of CKD?
diabetic nephropathy
Which is the best test to assess for proteinuria?
albumin:creatinine ratio
What is the management of CKD?
BP control
Glycaemic control
Name a feature of advanced CKD?
renal anaemia- due to reduced production of EPO
renal bone disease
Give four results that would help to determine whether renal failure is acute or chronic
USS- small kidneys, duplex collecting duct
FBC- anaemia of chronic disease
PTH- raised in chronic renal failure
Bone profile- low calcium, high phosphate
Give four clinical features/lab findings that would help you decide whether dialysis is necessary
U+Es: hyperkalaemia
SOB: pulmonary oedema
VBG: metabolic acidosis
Confusion/flap/chest pain: uraemic complications e.g. pericarditis, encephalopathy
Three causes of chronic renal failure/ disease?
DM HTN GN Polycystic disease Drugs Pyelonephritis SLE Myeloma and amyloidosis
Burr cells are a feature of which condition?
CKD
Sea urchin edges/shape of RBC on blood film
Three investigations for CKD?
Blood tests Urine dips, PCR, bence jones proteins CXR Renal US CT KUB Bone XR Renal biopsy
Name five blood tests you would conduct when investigating CKD
Bone profile Glucose FBC PTH Immune- ANA, ANCA, GBM, C3, C4, Ig, Hep Blood film
Three complications of CKD?
CDV disease Oedema HTN Electrolyte disturbances Anaemia (of chronic disease) Sensory neuropathy Leg restlessness Renal osteodystrophy
Name two features of renal osteodystrophy
Osteoporosis: ↓ bone density
Osteomalacia: ↓ mineralisation of osteoid (matrix)
2/3 HPT → osteitis fibrosa cystica
Subperiosteal bone resorption
Acral osteolysis: short stubby fingers
Pepperpot skull
Pepperpot skull is a sign of which condition?
Hyperparathyroidism
A urine:albumin ratio above which level is significant?
> 3 mg/mmol
Below which eGFR is required to diagnosed CKD?
<60, therefore G2, or proteinuria
Is Albumin: Creatinine (ACR) a blood or urine test?
urine, albumin should not be present in urine, creatinine is cleared steadily
Three aims of CKD management?
slow progression of disease
reduced CVD risk
Reduce risk of complications
Treat complications
What is the definition of CKD?
kidney damage or GFR <60 ml/min/ 1.73m2 for 3 months or more
List two issues associated with creatinine as a parameter for measuring disease
- Slow recognition of loss of the first 70% of renal function 2. Surprise at the sudden rise in creatinine with late renal referral 3. Overestimation of function in women 4. Overestimation of function in elderly 5. Overestimation in other low muscle mass groups e.g. amputuees, RA, para/quadraplegics
List three problems with using eGFR
- Not validated in elderly 2. Only accurate below 60ml/min 3. Not valid in AKI 4. Pregnancy 5. Only validated in whites and african americans
State 5 measures to slow progression of CKD
- BP control 2. Diabetic control 3. Diet 4. Smoking cessation 5. Lower cholesterol
Name two problems seen in CKD patients are not helped by dialysis?
anaemia, renal bone disease, endocrine disturbances, neuropathy
In the context of CKD, explain why someone might appear breathless
low bicarbonate due to failing kidneys, resp compensation by lowering CO2
