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year 3 endocrionology > CKD > Flashcards

CKD Flashcards

1
Q

What is chronic kidney diseas

A

Chronic kidney disease (CKD) is defined as an abnormality of kidney structure or function that persists for > 3 months.

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2
Q

what is the cause of CKD

A

diabetes mellitus, hypertension, and glomerulonephritis

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3
Q

what are patients with CKD at risk of developing?

A

atherosclerotic cardiovascular disease (ASCVD)

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4
Q

what is the treatment goal for CKD

A

slow CKD progression and prevent and manage complications

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5
Q

how is asvd managed in CKD

A

using statin therapy and adequate treatment of diabetes mellitus

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6
Q

what are the symptoms of CKD

A

fluid overload (e.g., peripheral edema) and/or uremia (e.g., fatigue, pruritus)

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7
Q

WHAT ARE RISK FACTORS OF CKD

A

Diabetes
Hypertension
Obesity
Advanced age (> 60 years of age)
Substance use (smoking, alcohol, recreational drugs)
Acute kidney injury

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8
Q

what is the egfr for CKD

A

eGFR < 60 mL/min/1.73 m2

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9
Q

what would you find in a urine dipstick for CKD

A

proteinuria

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10
Q

what happens to the egfr with CKD

A

egfr decreases

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11
Q

what happens to the creatinine in CKD

A

it increases

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12
Q

what is the nutritional management for CKD

A

Sodium restriction
Potassium intake adjustment
Phosphorus intake adjustment

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13
Q

what is the first line therapy for BP control

A

ACEI OR ARB

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14
Q

what monitoring should be done in CKD

A

serum potassium, calcium, and phosphate levels is essential.

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15
Q

what is egfr

A

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

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16
Q

what is albuminuria

A

Albuminuria is a marker of kidney damage

↑ albuminuria =↑ risk of CKD progression & cardiovascular events

17
Q

what are the measurements of proteinuria

A

uPCR
uACR

18
Q

what are the management aims of CKD

A

Treat underlying condition

Reduce risk of CKD progression

Reduce cardiovascular risk

19
Q

What is the leading cause of end-stage renal disease

A

Diabetes is the leading cause

20
Q

why are acei or arbs used?

A

RAASi are renoprotective

21
Q

why slgt-2 inhibitors (flozins)

A

Inhibit sodium-glucose cotransporter 2 (SGLT-2) in the PCT of the kidney

↓glucose reabsorption leading to↑glycosuria = reduced blood glucose levels

22
Q

how is cvd risk reduced in ckd patients

A

Offer statin to all patients with CKD regardless of cholesterol levels

NICE Guidance – atorvastatin 20mg OD

23
Q

how is gastrointestinal symptoms treated

A

treat with conventional antiemetics and laxatives

24
Q

how is muscle cramp symptoms treated

A

treat with oral quinine preparations

25
Q

how is fluid retention treated

A

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

26
Q

how is metabolic acidosis treated

A

Managed with oral sodium bicarbonate 1 – 6g daily

27
Q

what are complications of ckd

A

Cardiovascular disease
Anaemia of chronic disease (renal anaemia)
Mineral and bone disorder

28
Q

why does ckd cause anaemia

A

IRON DEFICIENCY

REDUCTION IN ERYTHROPOIESIS

29
Q

how is renal anaemia treated

A

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

30
Q

what is mineral and bone disorder

A

Disorder in CKD caused by mineral imbalance = skeletaland vascular problems

31
Q

how is mineral and bone disorder treatment

A

Bind to dietary phosphate preventing it being absorbed
MUSTbe taken with meals (immediately before/during/straight after)

32
Q

what are types of phosphate binders are there

A

calcium and non calcium based

33
Q

when is dialysis started

A

Dialysis usually started in CKD stage 5 with eGFR< 15and symptoms ofuraemia

34
Q
A

year 3 endocrionology (19 decks)

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