CKD Flashcards
What is chronic kidney disease?
Reduced kidney function with eGFR <60 occuring for more than 3 months
What are the causes of CKD?
(3 most common)
Diabetes (diabetic nephropathy)
Hypertension
Chronic glomerulonephritis
Age-related decline Polycystic kidney disease NSAIDs PPI Lithium
What are the risk factors for developing CKD?
Older age Hypertension Diabetes Smoking Use of medications that affect the kidney
How might someone with CKD present?
Pruritis Loss of appetite Nausea Oedema Muscle cramps Peripheral neuropathy Pallor Hypertension
Usually asymptomatic and is diagnosed due to routine testing
What investigations would be done in someone with CKD?
FBC
-look to see if anaemic due to decreased EPO production
Calcium + PTH
-decreased production of activated vit D can lead to decreased calcium and consequently rise in PTH
U+E
-used to calculate eGFR
Urine dip
-check for haematuria
Urinary ACR (albumin:creatinine ratio) -used to check proteinuria
Renal ultrasound
-used when there is accelerated CKD, haematuria and FH of polycystic kidney disease
How many stages of CKD are there?
How is each stage defined?
5 stages (with 2x stage 3)
Stage 1
-eGFR >90
Stage 2
-eGFR 60-89
Stage 3a
-eGFR 45-59
Stage 3b
-eGFR 30-44
Stage 4
-eGFR 15-29
Stage 5 (end-stage renal failure) -eGFR <15
What complications can occur with CKD?
Anaemia
-renal anaemia due to decreased production of EPO
Renal bone disease (osteomalacia/fractures/brown tumour)
-occurs due to vitamin D deficiency leading to secondary hyperparathyroidism leading to increased calcium being drawn from bones because low vit D means there is reduced calcium being absorbed from gut
CVD
Peripheral neuropathy
Hyperkalaemia
Dialysis related problems
When is someone with CKD referred to a specialist
eGFR < 30
ACR> 70mg/mmol
Accelerated progression i.e. decrease in eGFR of 15
Uncontrolled hypertension despite >4 antihypertensives
What are the main aims of management?
Slow the progression of disease
- optimise diabetic control
- optimise hypertensive control
- treat glomerulonephritis
Reduce the risk of CVD
Reudce the risk of complications
- exercise
- maintain healthy weight
- smoking cessation
- dietary advice regarding sodium, potassium and water intake
- offer atorvastatin 20mg for primary prevention of CVD
Treat the complications
- sodium bicarb for metabolic acidosis
- iron supplementation + synthetic EPO for anaemia
- vitamin D for bone disease
- dialysis for end-stage
- renal transplant
What is the 1st line treatment for hypertension in CKD?
What needs to be monitored along side?
ACEi
Serum potassium
-due to CKD and ACEi possibling causing hyperkalaemia
What are the 3 features of renal bone disease and why does each occur?
What Xray changes would you expect to see?
Osteomalacia (softening of bones)
-increased bone turnover without adequate calcium supply
Osteoporosis (brittle bones)
-can occur along side due to age and steroids acting as risk factors
Osteosclerosis (hardening of bones)
-increased osteoblast activity to try and match osteoclasts but low calcium levels means the new bone not properly mineralised leading to sclerosis
Spine xray:
- sclerosis of both ends of vertebrae= appears denser white
- osteomalaxia in centre= less white
I.e. “rugger jersey” spine = looks like the stripes of rugby shirt
What is the pathophysiology underlying renal bone disease?
High serum phosphate due to reduce excretion
Low active vit D due to decrease metabolism of vit D
-vitamin D important for calcium absorption in intestine and kidneys and regulating bone turnover
Induces secondary hyperparathyroidsm due to low serum calcium and high serum phosphate being detected by the parathyroids and stimulating increased excretion of PTH
How is renal bone disease managed?
Alfacalidol and calcitriol i.e. active forms of vitamin D
Low phosphate diet
Bisphosphonates for osteoporosis
