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Y3(M) - Renal > CKD > Flashcards

CKD Flashcards

1
Q

What is CKD?

A

Chronic progressive reduction in kidney function sustained over 3 months

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2
Q

Why is CKD non reversible?

A

Functional cells replaced by extracellular matrix (fibrosis)

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3
Q

What are some causes of CKD?

A

Diabetes
Hypertension
Hepatorenal syndrome
PKD
Medications (NSAIDs or lithium)
Chronic pyelonephritis
Chronic glomerulonephritis

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4
Q

What are some signs and symptoms that may be present with a CKD patient that has worsening renal function?

A

Fatigue
Pallor (anemia)
Foamy urine
Nausea
Puritus
Oedema
Hypertension
Peripheral neuropathy

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5
Q

Why may a patient withi CKD have pallor/be anaemic?

A

Loss of production of erythropoietin

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6
Q

What part of the kidney has changes with CKD?

A

Cortex thins

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7
Q

What are the 2 measurements used to classify CKD?

A

eGFR
Albumin:creatinine ratio

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8
Q

What is the G scoring system for CKD classification?

A

G1: eGFR > 90ml/min
G2: eGFR 60 - 89 ml/min
G3a: eGFR 45-59 ml/min
G3b: eGFR 30-44 ml/min
G4: eGFR 15-29 ml/min
G5: eGFR <15 ml/min

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9
Q

What is the albumin:creatinine ratio for an A1 AKI?

A

<3mg/mmol

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10
Q

What is the albumin:creatinine ratio for an A2 AKI?

A

3-30mg/mmol

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11
Q

What is the albumin:creatinine ratio for an A3 AKI?

A

> 30mg/mmol

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12
Q

What are the complications of CKD?

A

Anaemia
Renal bone disease
CVS Disease
Peripheral neuropathy
End stage kidney disease
Dialysis relatedcomplications

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13
Q

How does diabetes Mellitus cause CKD?

A

Hyper-filtration occurs
Lots of glucose reabsorbed across SGLT2 reabsorbing lots of Na+ with it
Low levels of Na+ detected in filtrate
RAAS activates
Leads to high BP in glomerulus leading to damage to glomerulus

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14
Q

Why does renal bone disease occur with CKD?

A

Less active Vitamin D made by kidneys
Vitamin D needed to absorb calcium from GI system and reabsorption in the kidney

Less phosphate removed from body due to low GFR

Parathyroids produce more PTH due to low calcium and high phosphate

PTH stimulates osteoclast activity leading to inc bone resorption to increase serum calcium

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15
Q

When does osteomalacia occur with CKD?

A

PTH leads to inc osteoclast activity so bone resorption

If not adequate calcium supply (diet) osteomalacia occurs

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16
Q

When does osteosclerosis occurs with CKD?

A

Inc level of PTH leads to inc osteoclast activity

Osteoblast activity also increases to try and match osteoclast actiivty

17
Q

What type of hyperparathyroidism occurs with CKD?

A

Secondary hyperparathyroidism

18
Q

What are some investigations that should be done to determine CKD / its causes?

A

Serum creatinine too estimate eGFR
Urine dip (?proteinuria + ?haematuria)
BP (?HTN)
HbA1c (?Diabetic)
Lipid profile (?hypercholesterolaemia)

19
Q

When should a patient be referred to a real specialist?

A

eGFR < 30ml/min
Urine albumin to creatinine ratio >. 70mg/mmol
Accelerated decline in eGFR
5 Year risk of requiring dialysis > 5%
Uncontrolled HTN but on 4 antihypertensives

20
Q

How do you treat CKD?

A

Treat underlying cause:
-optimise diabetic control
-optimise HTN control
-reduce or avoid nephrotoxic drugs
-treat glomerulonephritis when its the cause

21
Q

What are some complications of CKD?

A

Anaemia
Vitamin D deficiency
Secondary hyperparathyroidism
Hypocalcaemia
Renal bone disease
Metabolic acidosis

22
Q

Why does metabolic acidosis occur with CKD?

A

Impaired acid excretion and impaired HCO3- reabsorption

23
Q

How do you manage metabolic acidosis that occurs due to CKD?

A

Give sodium bicarbonate

24
Q

How do you manage anaemia that occurs due to CKD?

A

Give EPO and iron supplements

25
Q

How do you manage renal bone disease that occurs with CKD?

A

Give Vitamin D and give phosphate binders and commence a low phosphate diet

26
Q

What are some medications that can be given to help reduce blood pressure and slow progression of CKD?

A

ACEi like ramipril
SGLT2 inhibitors like Dapagliflozin

27
Q

What medication and lifestyle changes is given to all patients with CKD to reduce risk of cardiovascular disease?

A

Atorvastatin 20mg

Exercise
Maintain healthy weight
Smoking cessation

28
Q

What electrolyte disturbances can ACEi cause?

A

Hyperkalaemia

29
Q

How can you differentiate between CKD and an AKI?

A

CKD likely to have the following features which an AKI patient most likely doesn’t have:
-anaemia
-hypocalcaemia
-secondary hyperparathyroidism
-ATROPHIC KIDNEYS ON ULTRASOUND

Y3(M) - Renal (5 decks)

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