CKD Flashcards

1
Q

What are the two main causes of CKD?

A

hypertension and diabetes

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2
Q

what investigations should you do in someone with CKD?

A

U&Es
Renin and erythropoetin
GFR
FBC - anaemia

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3
Q

pruritus, restless legs, oedema, nausea and signs of fatigue with a history of DM and hypertension point towards which diagnosis?

A

CKD

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4
Q

CKD is classed as a GFR

A

90

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5
Q

Below what GFR is irreversible damage caused in CKD?

A

60

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6
Q

build-up of toxins and urea in CKD can lead to which common symptoms?

A

pruritus, restless legs, fatigue, nausea and anorexia

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7
Q

why does CKD cause hyperkalaemia?

A

less K+ excreted in kidney

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8
Q

why does CKD cause hypocalcaemia and high PTH?

A

less cholecalciferol activated by kidneys; PTH increases as a result

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9
Q

Why does renin increase in CKD?

A

blood pressure in kidney decreases, releasing more renin

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10
Q

why do people with CKD get anaemia?

A

reduced erythropoietin levels

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11
Q

In CKD, at what level of proteinuria should a referral to nephrology be made?

When else should a referral be made?

A

A:CR > 70 or >30 with haematuria

declining eGFR
BP not controlled despite >= 4 antihypertensive drugs
Known or suspected rare cause of CKD

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12
Q

When should an ACEi or ARB be used in CKD?

A

DM and A:CR >3mg/mmol
Hypertension and A:CR >30mg/mmol
CKD and A:CR >70mg/mmol

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13
Q

why should you not combine renin-angiotensin antagonists in CKD?

A

risk of hyperkalaemia and hypotension

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14
Q

what is the HbA1c target for someone with CKD?

A

53mmol/mol

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15
Q

What are the guidelines for sodium intake?

A

<2g/day or <5g sodium chloride/day

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16
Q

What is the treatment for anaemia in someone with CKD?

A

iron therapy or erythropoietin stimulating agent

17
Q

What do you prescribe for acidosis in someone with CKD? Under what conditions?

A

sodium bicarbonate if low and eGFR <30

18
Q

how do you treat oedema in patients with CKD?

A

restrict fluid and sodium intake

loop diuretics +- thiazide diuretics

19
Q

how do you treat bone mineral disorders in CKD?

A

dietary restriction of phosphate, and phosphate binders not containing calcium
Vitamin D supplements or activated vitamin D

20
Q

How do you treat restless leg syndrome in CKD?

A

exclude iron deficiency

sleep hygiene advice

21
Q

how do you advise someone with CKD on diet?

A

protein intake
K+ if hyperkalaemic
phosphate restriction

22
Q

how do you treat cardiovascular disease in CKD?

A

low dose aspirin
atorvastatin
monitoring GFR and K+

23
Q

When do you prepare someone with CKD for RRT and what do you do?

A
  • Refer to nephrology at least 1 year before RRT is required

- List for deceased donor transplantation 6 months before start of RRT

24
Q

What is GFR at the commencement of dialysis usually?

A

5-10

25
Q

what is an absolute contraindication for transplantation?

A

cancer with metastases