CKD Flashcards
what is CKD
worsening, progressive and irreversible loss of kidney function
what are the causes of CKD
AKI with irreversible intrinsic damage
hypertension - vessel thickening reduces blood flow
diabetes - nephropathy
glomerulopathies
vasculitis
polycystic kidney disease
what are the 6 complications associated with CKD
water, electrolyte and acid/base balance
hypertension
muscle dysfunction
renal bone disease
uraemia
renal anaemia
what is electrolyte/water and acid/base balance in CKD and how is it caused
in early stages it is caused by the inability to dilate urine
in late stages, it causes fluid build up - hyperkalaemia and acidosis
what is acidosis
inability of kidneys to remove H+ ions from the urine
how is electrolyte/water balance in CKD treated
turn off tap - fluid and sodium restriction
pull the plug - loop diuretics then metolazone
- stop at dialysis
how is acid/base balance in CKD treated
potassium - 4-6mmol/L target - calcium resonium
acidosis - sodium bicarbonate 500mg TDS
what does calcium resonium do
binds to potassium in the GIT and releases calcium ions - constipation
what causes hypertension in CKD
circulatory volume increase due to sodium and water retention - can cause artery stenosis, renin release and kidney decline and proteinuria
how is hypertension in CKD treated
lifestyle and meds
- if ACR <30 - as per NICE
- if ACR >30 - ACEi/ARB, other anti-hypertensives can be added as needed
monitoring requirements in ACEi/ARB in CKD
potassium prior and 1-2 weeks post
creatinine
C/I IN RENAL ARTERY STENOSIS
how is muscle dysfunction caused in CKD
nutritional deficiencies and electrolyte disturbances
how is muscle dysfunction in CKD treated
lifestyle - iron, caffeine, alcohol, diet
medicines - efficacy is debated - quinine and ropinerole
which stages of CKD are renal bone disease the most prevalent
4 and 5
what causes renal bone disease in CKD
hyperphosphatemia
low vit D
hypocalcaemia
increased PTH release from parathyroid
what causes hyperphosphatemia in CKD
high phosphate as it is not being excreted by kidneys - can cause pruritis
what is low vitamin D caused by in CKD
less vit d activation as it is not happening in the kidney - causes bone softening
what causes hypocalcaemia in CKD
less vit d = less absorption of calcium from GI tract, increase of phosphate also leads to more sequestering of calcium in bones
what causes increased PTH release in CKD
low calcium, PTH is released to release calcium from bones
what is the effect of high PTH in CKD
weakened bone structure
osteopenia and osteoporosis
increased fracture risk
bone hardening
- can lead to secondary hyperparathyroidism
how is hyperphosphatemia treated in CKD
diet
phosphate binders - calcium acetate or sevlamer
how is hypocalcaemia and low vit d treated in CKD
vit d3 analogue that is activated in the liver - alfacalcidol
how is hyperparathyroidism treated in CKD
effective management of causes of renal bone disease
cinacalet - lowers PTH by increasing sensitivity of calcium receptors
paricalcitol - iv vit d
what are the symptoms of uraemia
anorexia
N&V
constipation
foul taste
pruritis
skin discolouration
how is uraemia treated in CKD
- dialysis
- off label - antihistamines, SSRIs, gaba
what causes renal anaemia in CKD
low levels of iron and erythropoietin - hormone synthesised in kidneys that stimulate RBC proliferation
how is renal anaemia treated in CKD
recomb erythropoietin IV/SC
PO or IV ferritin
what are the side effects of erythropoietin
hypertension, pre red cell aplasia
target ferritin range
200-500mcg/L
why would SGLT2 inhibitors be used in CKD
dapa only - renal protective effect
what warnings are associated with dapagliflozin
sick day - stop
DKA can have normal BM
Fournier’s gangrene
what vitamin replacement is used in CKD
renavit - all water soluble vitamins needed
which vaccinations do all CKD patients with blood manipulation need
Hep B 5 yearly
