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Renal & Urology > CKD > Flashcards

CKD Flashcards

1
Q

What is chronic kidney disease?

A

Defined as
- reduction in kidney function or structural damage (or both) present for > 3 months with associated health implications

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2
Q

How is CKD classified?

A

Classification based on :
- the underlying cause
- GFR
- proteinuria category

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3
Q

What is accelerated progression of CKD defined as?

A

Persistent decrease in eGFR of 25% or more

AND

A change in CKD category within 12 months OR a persistent decrease in eGFR of 15mL/min/1.73m^2 within 12 months

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4
Q

What are the causes and risk factors for CKD?

A

Conditions associated with intrinsic kidney damage

Current or previous Hx of AKI

Potentially nephrotoxic drugs

Conditions associated with obstructive neuropathy

Multisystem disease with potential renal involvement e.g., SLE, vasculitis, myeloma

FHx of CKD stage 5 or hereditary kidney disease e.g., autosomal dominant polycystic kidney disease, Alport’s syndrome and familial glomerulonephritis

Cardiovascular disease

Obesity with metabolic syndrome

Gout

People with incidental finding of haematuria or proteinuria

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5
Q

What should people with risk factors for CKD be offered?

A

Testing for CKD

Using eGFR:creatinine and ACR

Monitor at least annually for people on potentially nephrotoxic drugs

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6
Q

List the conditions associated with intrinsic kidney damage

A

HTN

DM

Glomerular disease e.g., acute glomerulonephritis (typically if CKD follows a Strep URTI; may also follow hep B, C or HIV infection)

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7
Q

List the potentially nephrotoxic drugs

A

Aminoglycosides (e.g. gentamicin, neomycin, streptomycin)

NSAIDs

ACEis

Angiotensin 2 receptor blockers

Calcineurin inhibitors (e.g., ciclosporin or tacrolimus)

Diuretics

Lithium

Mesalazine

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8
Q

List the conditions associated with obstructive neuropathy

A

Structural renal tract disease

Bladder voiding problems e.g., neurogenic bladder, BPH

Urinary diversion surgery

Recurrent urinary tract calculi

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9
Q

What are the different types of renal calculi?

A

Calcium - Ca2+ oxalate/Ca2+ phosphate

Uric acid

Struvite

Cystine

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10
Q

Sources

A

https://cks.nice.org.uk/topics/chronic-kidney-disease/

https://cks.nice.org.uk/topics/renal-or-ureteric-colic-acute/background-information/causes/

https://www.nhs.uk/conditions/kidney-disease/

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11
Q

What are the complications of CKD?

A

AKI

HTN and dyslipidaemia

Cardiovascular disease e.g., ischaemic heart disease, peripheral artery disease, HF and stroke disease

Renal anaemia (Hb < 11g/dL)

Renal mineral and bone disorder - can present with bone pain, increased bone fragility, extra-skeletal calcification e.g., in skin or blood vessels

Peripheral neuropathy and myopathy

Malnutrition - may be seen in ESRD due to poor dietary intake and hypoalbuminaemia

Malignancy

ESRD

All-cause mortality - increases with progressive CKD

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12
Q

People in which stages of CKD may need renal replacement therapy (RRT)?

A

Stages 4-5

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13
Q

What is the classification of CKD?

A

Stage 1 = > 90ml/min/1.73 m2
Stage 2 = 60-89 ml/min/1.73 m2
Stage 3a = 45-59 ml/min/1.73 m2
Stage 3b = 30-44 ml/min/1.73 m2
Stage 4 = 15-29 ml/min/1.73 m2
Stage 5 = <15 ml/min/1.73 m2

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14
Q

In the Hx which general symptoms should you ask about for someone with suspected CKD?

A

General symptoms:
- lethargy
- itch
- breathlessness
- cramps (often worse at night)
- sleep disturbance
- bone pain
- loss of appetite
- vomiting
- weight loss
- taste disturbance (often present with ESRD)

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15
Q

In the Hx which urine output symptoms should you ask about for someone with suspected CKD?

A

Polyuria (tubular concentrating ability is impaired)

Oligouria

Nocturia (due to impaired solute diuresis or oedema)

Anuria (due to possible AKI, obstructive uropathy causing urine retention or ESRD)

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16
Q

What else should you ask in the Hx for someone with suspected CKD?

A

DHx - for potential nephrotoxic drugs

Any associated co-morbidities or complications of CKS

Any FHx e.g., autosomal dominant PKD

Any associated clinical features of anxiety or depression

17
Q

What signs should you examine for in a patient with suspected CKD?

A

Uraemic odour (ammonia-like breath smell - may be present in advanced disease)

Pallor (due to renal anaemia)

Cachexia and signs of malnutrition

Cognitive impairment (language, orientation and attention may be affected)

Dehydration or hypovolaemia (risk of AKI)

Tachypnoea (may be due to fluid overload, anaemia, or co-morbid ischaemic heart disease)

HTN (may be primary or secondary to CKD)

Palpable bilateral flank masses with possible hepatomegaly (suggests PKD with possible liver cysts)

Palpable distended bladder (obstructive neuropathy)

Peripheral oedema (may be due to renal sodium retention, hypoalbuminaemia, or co-morbid HF)

Peripheral neuropathy (may present with paraesthesia, sleep disturbance, and restless leg syndrome) or myopathy

Frothy urine (proteinuria)

18
Q

What blood tests should be arranged? What should you advice the patient before the test?

A

Serum creatinine and eGFR
- advise patient not to eat meat for at least 12 hours before the test

Early morning urine sample to measure urinary albumin:creatinine ratio (ACR)

Urine dipstick to check for haematuria

Nutritional status, BMI, BP and serum HbA1c and lipid profile

19
Q

If the eGFR is less than 60 mL/min/1.73 m2 after the blood test what should you do?

A

Repeat the test within 2 weeks (unless the eGFR is stable)

20
Q

If the eGFR remains less than 60 mL/min/1.73 m2 after the repeat, with no evidence of sudden drop in renal function suggesting AKI, what should you do?

A

Repeat the eGFR within 3 months

21
Q

In which groups of patients should you interpret the eGFR with caution?

A

People with a lot of muscle

Pregnant women

People of Asian or Chinese origin

Has oedema

Malnourished

Uses protein supplements

22
Q

You should arrange an early morning urine sample to measure the urinary albumin:creatinine ratio (ACR). What should you do if the result is < 3mg/mmol (no proteinuria)?

A

No action is needed

23
Q

You should arrange an early morning urine sample to measure the urinary albumin:creatinine ratio (ACR). What should you do if the result is between 3 and 70 mg/mmol?

A

Repeat the test within 3 months

24
Q

You should arrange an early morning urine sample to measure the urinary albumin:creatinine ratio (ACR). What should you do if the result is > 70 mg/mmol?

A

Repeat test not needed

As this shows significant proteinuria

Also protein:creatinine ratio (PCR) can be used as an alternative measure

25
Q

When should you arrange a MSU to exclude a UTI?

A

If there is 1+ or more of blood on dipstick

26
Q

If there is isolated persistent haematuria (two out of three urine dipstick tests show 1+ or more of blood after exclusion of a UTI), with no decrease in eGFR and no proteinuria, what should you be suspicious of?

A

Urological cancer

27
Q

When should you make a diagnosis of CKD?

A

If there is persistent reduction in renal function (eGFR < 60 mL/min/1.73m^2)

AND/OR

Proteinuria (urinary ACR > 3mg/mmol)

Lasting for at least 3 months

28
Q

When can a Dx of CKD be excluded?

A

eGFR is persistently greater than 60 mL/min/1.73 m2

AND/OR

the urinary ACR is persistently less than 3 mg/mmol, and there are no other markers of kidney damage

29
Q

What imaging should be considered?

A

Renal tract USS if indicated

e.g., person has suspected urinary tract stones or obstruction, or a FHx of PKD and is aged > 20 years

30
Q

TO DO

A

Look up PassMed Mx of the different complications of CKD

Renal & Urology (7 decks)

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