CKD Flashcards
Definition of CKD
Reduction of kidney function or structural damage for more than 3 months with associated health implications
Causes of CKD - 8
- Conditions associated with kidney damage - HTN, DM, Glomerular disease
- History of AKI
- Nephrotoxic drugs : ACEis, bisphosphonates, caluneurin inhibitors, diuretics, lithium, NSAIDs, aminoglycosides
- Conditions associated with obstructive uropathy e.g. recurrent calculi, BPH, renal tract disease
- Multisystem diseases that can have renal involvement - SLE, vasculitis, myeloma
- FH of CKD or PCKD
- CVS disease
- Gout
Complications of CKD - 7
- CKD
- HTN or dysipidaemia
- CVS disease such as IHD, peripheral arterial disease, HF, stroke
- Renal anaemia
- Malnutrition
- Mineral and bone disorders
- Peripheral neuropathy and myelopathy
When to suspect CKD - 4
- if they have any of the risk factors
- raised serum creatinine or lowered eGFR
- Proteinuria
- Persistant haematuria
Presentation of CKD - 9
- lethargy
- itching
- cramps
- sleep disturbance
- bone pain
- loss of appetite
- weight loss
- taste disturbance
- polyuria, oligouria, nocturia or anuria
Examination findings for CKD - 8
- ammonia smell on breath
- pallor
- cachexia
- cognitive impairment
- tachypnoea
- HTN
- Bilateral flank masses
- peripheral oedema
Investigations of CKD
- Serum creatinine and eGFR
- urine sample to measure albumin : creatinine ratio to test for proteinuria
- Arrange a urine dipstick to test for haematura
- Renal ultrasound - looks at renal size, texure, hydronephrosis and structural kidney disease
What advice should pts be given about serum creatinine blood test and eGFR testing
Do not eat meat for at least 12 hours before
Which markers are used to classify CKD
eGFR (will be decreased)
urinary albumin:creatinine ratio (will be increased)
Classification of CKD - eGFR
Stage G1 - >90
Stage G2 - 60-89
Stage G3a - 45-59
Stage G3b - 30-44
Stage G4 - 15-29
Stage G5 - <15
Classification of CKD - ACR
A1 - <3
A2 - 3-30
A3 - >30
Management of CKD - working to preserve kidney function - 4
- Lifestyle - maintain a healthy weight, no smoking, less alcohol
- Keep blood pressure low
- Review Hba1c in diabetes
- Medication review to discuss nephrotoxic drugs
what is the BP target for CKD pts
For pts with ACR <70 - <140/90
For pts with ACR >70 - <130/80
How are complications of CKD managed?
Proteinurea, anaemia, mineral bone disorder, fluid overload, acid-base imbalence and CVS disease
Proteinurea - ACEis/ARBs
Anaemia - consider IV iron or EPO
Mineral bone disorder - dietary phosphate restriction, phosphate binders and vit D
Fluid - fluid and salt restriction and diuretics
Acid-Base - oral sodium bicarbonate
CVS - consider statins and anti-platelets as prevention
How does CKD lead to Anaemia
Kidney produce EPO, so if kidney function is decreased EPO production is decreased so less RBCs made
