CKD Flashcards
what anti-hypertensives are useful in CKD?
ACEi- esp in proteinuric renal disease eg diabetic nephropathy
furosemide esp when eGFR<45/30
what is an acceptable effect on eGFR/creatinine when starting ACEi?
decrease in eGFR up to 25%
or rise in creatinine up to 30% are acceptable
what diet is advised in CKD?
low protein
low phosphate
low sodium
low potassium
to reduce renal strain as many of these products are excreted by the kidneys
why does hypocalcaemia indicate chronic rather than acute kidney disease?
renal failure can result in reduced levels of metabolised vitamin D/1,25(OH)2D
this results in reduced calcium reabsorption in the kidneys
what endocrine disorder can CKD cause?
secondary hyperparathyroidism
what are USS findings of CKD?
bilateral small kidneys
what are other cause of small kidneys?
ADPKD
diabetic nephropathy- initial stages
amyloidosis
HIV-associated nephropathy
what variables are used in formula MDRD to estimate eGFR?
serum creatinine
age
gender
ethnicity
what factors may affect result of serum creatinine?
pregnancy
muscle mass- amputees/body builders
eating red meat 12 hrs prior to sample
what is CKD stage 1?
eGFR>90
some sign of kidney damage on other tests
what is CKD stage 2?
eGFR 60-90
some sign of kidney damage
what is CKD stage 3a?
eGFR 45-59
moderate reduction in kidney funciton
what is CKD stage 3b?
eGFR 30-44
moderate reduction in kidney function
what is CKD stage 4?
eGFR 15-29
severe reduction in kidney function
what is CKD stage 5?
eGFR<15
established kidney failure
dialysis or kidney transplant may be needed
what does normal kidney tests mean?
no CKD
normal U+Es and no proteinuria
what is most likely cause of death in someone with CKD on haemodialysis?
ischaemic heart disease
due to htn, dyslipidaemia, anaemia + systemic inflammation common in CKD patients
what are the common causes of CKD?
diabetic nephropathy
HTN
chronic glomerulonephritis
chronic pyelonephritis
renal artery stenosis
adult polycystic kidney disease
SLE
myeloma + amyloidosis
drugs eg analgesic nephropathy
how many months of poor renal function/kidney damage suggests CKD?
3 months
what investigations are needed in CKD?
bloods
- low hb, U+E, ESR, glucose, low Ca, high Po4, raised ALP/PTH
- immune- ANA, dsANA, ANCA, GBM, C3+4, Ig, hepatitis
film- burr cells
urine
- dip, MCS, PCR, BJP
Imaging
- CXR- cardiomegaly, pleural/pericardial eff, oed
- AXR- calcification from stones
- renal USS- usually small <9cm, large in polycystic or amyloid
- bone X rays- renal osteodystrophy (pseudofractures)
- CT KUB- cortical scarring from pyelonephritis
renal biopsy- if cause unclear + size normal
what are complications of CKD?
CRF HEALS
cardiovascular disease
renal osteodystrophy
fluid/oedema
HTN
electrolyte disturbance- K, H
Anamia
Leg restlessness
sensory neuropathy
