CKD Flashcards
What are the two main causes of CKD?
hypertension and diabetes
what investigations should you do in someone with CKD?
U&Es
Renin and erythropoetin
GFR
FBC - anaemia
pruritus, restless legs, oedema, nausea and signs of fatigue with a history of DM and hypertension point towards which diagnosis?
CKD
CKD is classed as a GFR
90
Below what GFR is irreversible damage caused in CKD?
60
build-up of toxins and urea in CKD can lead to which common symptoms?
pruritus, restless legs, fatigue, nausea and anorexia
why does CKD cause hyperkalaemia?
less K+ excreted in kidney
why does CKD cause hypocalcaemia and high PTH?
less cholecalciferol activated by kidneys; PTH increases as a result
Why does renin increase in CKD?
blood pressure in kidney decreases, releasing more renin
why do people with CKD get anaemia?
reduced erythropoietin levels
In CKD, at what level of proteinuria should a referral to nephrology be made?
When else should a referral be made?
A:CR > 70 or >30 with haematuria
declining eGFR
BP not controlled despite >= 4 antihypertensive drugs
Known or suspected rare cause of CKD
When should an ACEi or ARB be used in CKD?
DM and A:CR >3mg/mmol
Hypertension and A:CR >30mg/mmol
CKD and A:CR >70mg/mmol
why should you not combine renin-angiotensin antagonists in CKD?
risk of hyperkalaemia and hypotension
what is the HbA1c target for someone with CKD?
53mmol/mol
What are the guidelines for sodium intake?
<2g/day or <5g sodium chloride/day
What is the treatment for anaemia in someone with CKD?
iron therapy or erythropoietin stimulating agent
What do you prescribe for acidosis in someone with CKD? Under what conditions?
sodium bicarbonate if low and eGFR <30
how do you treat oedema in patients with CKD?
restrict fluid and sodium intake
loop diuretics +- thiazide diuretics
how do you treat bone mineral disorders in CKD?
dietary restriction of phosphate, and phosphate binders not containing calcium
Vitamin D supplements or activated vitamin D
How do you treat restless leg syndrome in CKD?
exclude iron deficiency
sleep hygiene advice
how do you advise someone with CKD on diet?
protein intake
K+ if hyperkalaemic
phosphate restriction
how do you treat cardiovascular disease in CKD?
low dose aspirin
atorvastatin
monitoring GFR and K+
When do you prepare someone with CKD for RRT and what do you do?
- Refer to nephrology at least 1 year before RRT is required
- List for deceased donor transplantation 6 months before start of RRT
What is GFR at the commencement of dialysis usually?
5-10
