CKD Flashcards
What is CKD
Chronic Kidney Disease - chronic reduction in kidney function which tends to be permanent and progressive over a period of three months .
What are the TWO MAIN causes of CKD
Diabetes
Hypertension
What is the link between diabetes and CKD
1- excess glucose in blood sticks to proteins ( NON- ENZYMATIC GLYCATION)
2- efferent arterioles become stiff and narrow- HYALINE ARTERIOSCLEROSIS
3- increased pressure in glomeruli
4- hyperfiltration
5- Response to high pressure state - supportive mesangial cells secrete structural matrix expanding size of glomerulus
6- Over years this dimishes nephron ability to filter blood leading to CKD
What can a decreased infiltration rate lead in relation to urea
Ureamia -urea in blood
What can ureamia cause
-N/V
- Encephalopathy
- Pericarditis
- Bleeding
-Uremic frost
Role of kidneys in regulation of Calcium
- Normally kidneys activate vit d which helps to increase absorption of Ca from diet
- In CKD this is disrupted leading to hypocalcaemia
- can lead to secondary hyperparathyroidism
Risk factors for CKD
Older age
Hypertension
Afro-carribean
Diabetes
Smoking
Use of medications that affect the kidneys
Pathophysiology of HT and CKD
- Walls of arteries begin to thicken in order to withstand pressure- but causes a narrow lumen
- less o2 delivery, ischemic injury in nephron glomerulus
- macrophages and fat laden macrophages called foam cells slip into the damaged glomerulus
- growth factors are secreted TGF-B1
- Cause mesangial cells to regress back to mesangioblasts
- these secrete extracellular structural matrix - leads to glomerulosclerosis + diminshes nephrons ability to filter blood
Signs of CKD
- HT
-Fluid Overload - Uraemic sallow
- Pallor - anaemia due to decreased EPO
Failing GFR lead to what?
Renin secretion by kidneys > HT
Symptoms of CKD
- aSYMPTOMATIC early on
- Lethargy
- Pruritus
- Muscle Cramps
-Nausea - Frothy Urine
- diabetic nephropathy
Investigations for CKD
Urine Dip/ urinalysis- proteinuria + haematuria + glycosuria
ACR
FBC- normocytic anaemia secondary to reduced EPO
Bone profile and PTH
Renal US
ECG
Describe the G score system
G1 = eGFR >90
G2 = eGFR 60-89
G3a = eGFR 45-59
G3b = eGFR 30-44
G4 = eGFR 15-29
G5 = eGFR <15 (known as “end-stage renal failure”)
Describe the A score system
The A score is based on the albumin:creatinine ratio:
A1 = < 3mg/mmol
A2 = 3 – 30mg/mmol
A3 = > 30mg/mmol
What would give you a definitive diagnosis of CKD
eGFR of < 60 or proteinuria
eGFR < 90ml/min/1.73m2 + signs of renal damage
Albuminuria > 30mg/24hrs
When would you refer to a specialist
-eGFR < 30
-ACR ≥ 70 mg/mmol
-Accelerated progression defined as a decrease in eGFR of 15 or 25% or 15 ml/min in 1 year
-Uncontrolled hypertension despite ≥ 4 antihypertensives
What would slow the progression of the disease
Optimise diabetic control
Optimise hypertensive control
Treat glomerulonephritis
What would reduce the risk of complications in CKD
Exercise, maintain a healthy weight and stop smoking
Special dietary advice about phosphate, sodium, potassium and water intake
Offer atorvastatin 20mg for primary prevention of cardiovascular disease
How would you treat complications in CKD
Oral sodium bicarbonate to treat metabolic acidosis
Iron supplementation and erythropoietin to treat anaemia
Vitamin D to treat renal bone disease
Dialysis in end stage renal failure
Renal transplant in end stage renal failure
Complications of CKD
Cardio
- CVD
- HT
-Hypercholestrolaemia
MSK
- CKD- metabolic bone disease
Endo
- secondary hyperparathyroidism
- diabetes
Oedema
What type of anaemia does chronic kidney disease most commonly cause?
Normocytic
What type of anaemia does chronic kidney disease most commonly cause?
Diffuse proliferation glomerulonephritis
A patient with a history of chronic kidney disease dies following a myocardial infarction. What does his renal biopsy demonstrate?
Diabetic nephropathy
A patient with a history of rheumatoid arthritis develops chronic kidney disease. A renal biopsy is taken:
Amyloidosis
