CKD Flashcards
What are the stages of CKD? with GFR value and diagnosis
Stage 1= GFR>90— normal
Stage 2= GFR 60-89 —- Mild CKD
Stage 3A= GFR 45-59 —- Mild to moderate CKD
stage 3B= GFR 30-44—- Moderate to severe CKD
Stage 4= GFR 15-29—- Severe CKD
Stage 5= GFR <15 or on dialysis—- Kidney failure
According to stage of CKD
Clinical presentation: asymptomatic in which stages!?
Stage 1
Stage 2
Stage 3A
Signs of Stage 3B
Anaemia in some patients
non progressive or progress very slowly
When 1st symptoms appear on stage 4?
often at GFR <20
Electrolytes problem in which stage?
Stage 4
Significant signs and symptoms at which stage?
Stage 5
Dialysis require in which stage?
at which level?
Stage 5
GFR <10
Upto what level of GFR a patient with CKD can be asymptomatic?
GFR Upto 45
What is CKD
What metabolic abnormalities appear in first
What is ESRD?
Irreversible deterioration of renal function usually develops over a years
biochemical abnormality
when death is likely without the RRT then it is called ESRD
What are the common causes of CKD?
DM:20-45%
interstitial disease: reflux nephropathy, drug induced
Glomerular disease: IgA nephropathy
Hypertension
Systemic inflammatory disease: SLE, Vasculits
Reno vascular disease: mostly atheromatous
Congenital and inherited: PCKD, Alport syndrome
Unknown: 5-10%
Sign and symptoms of CKD
Asymptomatic (incidental findings)
early symptom: Nocturia (non-specific)
tiredness
breathlessness
pruritis
anorexia
weight loss
nausea
vomitting
hiccups
Signs of CKD
Head: yellow complexion, pallor
Neck: raised JVP
Chest: dialysis catheter, pericardial friction rub
Abdomen: transplanted kidney scar, dialysis, tecknocoff catheter for peritoneal dialysis
Limb: pulsus paradoxus, AV fistula, brown line pigmentation
Skin: Excoriation of skin, bruising easily, pitting oedema
Peripheral neuropthy
Absent reflexs, reduced sensation, paraesthesia, restless legs
Whar are the initial test of CKD?
Creatinine, eGFR
Urinanalysis
Electrolytes
Calcium, phosphate, 1,25,vit D, PTH
Albumin
FBC (Fe, Ferritin, folate, vit B12)
Lipid glucose, HBa1C
Renal US,
Hepatitis, HIV serology
Other:
What is kassmaul breathing?
Deep breathing due to metabolic acidosis
Sign of advanced renal disease
Critaria for referral of CKD patient to a nephrologist
- eGFR <30ml/min/1.73m2
- Rapid deterioration of renal function >25% from previous or >15 ml/min/1.73m2/ year
- significant proteinuria (PCR >100 or ACR >70)
- ACR >30 with non visible haeamturia
- Hypertension that is poorly controlled despite at least 4 anti hypertensive medications
- suspicion of renal involvement in multi system disease.