CKD Flashcards
How can kidney damage be assessed?
urine output
- oliguria (reduced), anuria (none)
haematuria
proteinuria - protein creatinine ratio (PCR) = >50mg/mmol is elevated
albuminuria - albumin creatinine ratio (ACR)
What are the signs and symptoms of CKD?
weight loss
nausea
insomnia
nocturia
muscle cramps
dyspnoea
edema
itchy skin
erectile dysfunction
hyperkalaemia
uraemia
anaemia
impaired vitamin D metabolism causing
- hypocalcaemia, hyperphosphataemia, hyperparathyroidism
What are the complication of CKD?
cardiovascular disease
anaemia
mineral and bone disorder
How can CVD be treated?
glycaemic control
BP control
cholesterol control
lifestyle advice
What is the level of haemoglobin in anaemia? What are the symptoms of anaemia?
Hb <130g/L = men and postmenopausal women
Hb < 120g/L = premenopausal women
fatigue, depression, weakness, dizziness
How is anaemia treated? What are the side effects associated?
erythropoiesis stimulating agents (i.v and s.c)
- epoetin alfa
side effects
- increased risk of stroke and VTE, hypertension, seizures, allergic reaction
roxadustat (oral)
iron supplements
What is renal mineral and bone disorder? What are the causes? What are the symptoms?
mineral and bone disorder = renal osteodystrophy
disruption to the regulation of phosphate, calcium, vitamin D and parathyroid hormone
bone disease, reduced physical activity, decreased muscle mass, postural hypotension, increased risk of falls and fractures
What is the role of vitamin D? What is the active form?
promotes GI absorption of calcium
promotes renal reabsorption of calcium
aids mineralisation of bone
calcitriol - active form
cholecalciferol - must be activated in the liver and kidney
What are the symptoms of vitamin D deficiency?
fatigue
insomnia
bone pain/ache
hair loss
muscle weakness
depression
loss of appetite
What does vitamin deficiency cause?
reduced calcium absorption
increased bone turnover
reduced bone mineral density increased parathyroid hormone
Why is parathyroid hormone elevated?
PTH is elevated in response to low calcium, low vitamin D and high phosphate
How can hyperphosphataemia be treated?
dialysis
dietary management
- avoid milk, cheese, yoghurt, eggs
phosphate binders
- sevelamer = carbonate
- sucroferric oxyhydroxide
- lanthanum
- calcium acetate
- calcium carbonate = only if hypocalcaemic
can interact with levothyroxine, doxycycline, ciprofloxacin
must take with food
side effects
- GI = vomiting, diarrhoea, cramps
How can hyperparathyroidism be treated?
vitamin D supplements
- must be given in the active form (kidney cannot activate it)
= calcitriol, alfacalcidol
calcimimetics
- cinacalcet = mimics calciums action on calcium receptor on PT gland
- etelcalcetide
What drug class can be used to slow the progression of CKD?
SGLT-2 inhibitors
- dapagliflozin, canagliflozin
= alleviate kidney damage by reducing pressure and inflammation in the kidneys
= helps to stop protein from leaking into the urine
= reduces blood pressure and body weight
