CKD Flashcards
What is chronic kidney diseas
Chronic kidney disease (CKD) is defined as an abnormality of kidney structure or function that persists for > 3 months.
what is the cause of CKD
diabetes mellitus, hypertension, and glomerulonephritis
what are patients with CKD at risk of developing?
atherosclerotic cardiovascular disease (ASCVD)
what is the treatment goal for CKD
slow CKD progression and prevent and manage complications
how is asvd managed in CKD
using statin therapy and adequate treatment of diabetes mellitus
what are the symptoms of CKD
fluid overload (e.g., peripheral edema) and/or uremia (e.g., fatigue, pruritus)
WHAT ARE RISK FACTORS OF CKD
Diabetes
Hypertension
Obesity
Advanced age (> 60 years of age)
Substance use (smoking, alcohol, recreational drugs)
Acute kidney injury
what is the egfr for CKD
eGFR < 60 mL/min/1.73 m2
what would you find in a urine dipstick for CKD
proteinuria
what happens to the egfr with CKD
egfr decreases
what happens to the creatinine in CKD
it increases
what is the nutritional management for CKD
Sodium restriction
Potassium intake adjustment
Phosphorus intake adjustment
what is the first line therapy for BP control
ACEI OR ARB
what monitoring should be done in CKD
serum potassium, calcium, and phosphate levels is essential.
what is egfr
A blood test which provides us with an estimate as to how well the kidneys are filtering (ml/min)
As eGFR drops – so does the ability of the kidney to function
what is albuminuria
Albuminuria is a marker of kidney damage
↑ albuminuria =↑ risk of CKD progression & cardiovascular events
what are the measurements of proteinuria
uPCR
uACR
what are the management aims of CKD
Treat underlying condition
Reduce risk of CKD progression
Reduce cardiovascular risk
What is the leading cause of end-stage renal disease
Diabetes is the leading cause
why are acei or arbs used?
RAASi are renoprotective
why slgt-2 inhibitors (flozins)
Inhibit sodium-glucose cotransporter 2 (SGLT-2) in the PCT of the kidney
↓glucose reabsorption leading to↑glycosuria = reduced blood glucose levels
how is cvd risk reduced in ckd patients
Offer statin to all patients with CKD regardless of cholesterol levels
NICE Guidance – atorvastatin 20mg OD
how is gastrointestinal symptoms treated
treat with conventional antiemetics and laxatives
how is muscle cramp symptoms treated
treat with oral quinine preparations
how is fluid retention treated
Restricting fluid intake to 1 – 3 litres per day
Reducing dietary sodium intake and avoid sodium-containing medicines where possible
Loop diuretics. Higher doses are needed in patients with advanced CKD (eGFR < 30ml/min) due to diminished tubular secretion
how is metabolic acidosis treated
Managed with oral sodium bicarbonate 1 – 6g daily
what are complications of ckd
Cardiovascular disease
Anaemia of chronic disease (renal anaemia)
Mineral and bone disorder
why does ckd cause anaemia
IRON DEFICIENCY
REDUCTION IN ERYTHROPOIESIS
how is renal anaemia treated
Synthetic version of erythropoietin – stimulates bone marrow to make red blood cells
Must have sufficient iron stores therefore IV iron may be given
Given IV (HD patients) or SC (CKD or PD)
Epoetin Alfa (Eprex) – starting 2000-3000 units 2-3 a week
Darbopoetin Alfa (Aranesp) – starting 20micrograms weekly (can be fortnightly)
Oral agent- Roxadustat (HIF-PHI)
Titrate to achieve Hb 100-120g/L
Monitor blood pressure! If too high may need to pause ESA treatment
what is mineral and bone disorder
Disorder in CKD caused by mineral imbalance = skeletaland vascular problems
how is mineral and bone disorder treatment
Bind to dietary phosphate preventing it being absorbed
MUSTbe taken with meals (immediately before/during/straight after)
what are types of phosphate binders are there
calcium and non calcium based
when is dialysis started
Dialysis usually started in CKD stage 5 with eGFR< 15and symptoms ofuraemia
