CKD Flashcards
What are the causes of CKD?
Diabetes
Hypertension
Medications
Glomerulonephritis
Polycystic kidney disease
Renal involvement secondary to multisystem disease
What is the classification of CKD?
G stages
G1 - eGFR over 90
G2 - 60-89
G3a - 45-59
G3b - 30-44
G4 - 15-29
G5 - under 15
A stage - based on albumin:creatinine ratio
A1 - under 3mg/mmol
A2 - 3-30 mg/mmol
A3 - above 30 mg/mmol
What is the presentation of CKD?
Most patients asymptomatic
Fatigue
Pallor
Foamy urine
Nausea
Loss of apetite
Pruritis
Oedema
Hypertension
Peripheral neuropathy
What investigations are performed in CKD?
Urine dipstick
MC&S if haematuria
Early morning albumin: creatinine ratio
U&Es
FBC
LFTs
Bone profile
HbA1c
Lipid profile
Clotting screen
When is a renal biopsy indicated for diagnosis of CKD?
If cause of renal impairment is unclear
Rapid progression of CKD
When glomerulonephritis is suspected
What are the complications of CKD?
Anaemia
Renal bone disease
Cardiovascular diease
Peripheral neuropathy
End-stage kidney disease
Dialysis-related complications
What lifestyle advice should be provided to those with CKD?
Smoking cessation
Moderating alcohol intake
Maintaining a healthy weight with regular exercise
Maintaining a health diet
Avoid over the counter nephrotoxics
What is the medical management of CKD?
Treat the underlying cause of CKD
Review medications and reduce/stop nephrotoxic drugs
Treat hypertension with up to 4 hypertensives
Optimise diabetic control
When should patients be referred to a renal specialist?
eGFR < 30
Urine ACR more than 70
Accelerated progression
5 year risk of requiring dialysis over 5%
Uncontrolled hypertension despite four or more antihypertensives
What is the target blood pressure for those with CKD?
140/90 for most patients with CKD
130/80 in patients with an ACR of more than 70
What medications can help slow the progression of CKD?
ACE inhibitors
SGLT-2 inhibitors (specifically dapagliflozin)
Which CKD patients are ACE inhibitors offered to?
Diabetics with a urine ACR of above 3
Hypertension plus a urine ACR of above 30
All patients with an ACR of above 70
How does CKD cause bone disorders?
Reduced phosphate excretion lead to high serum phosphate
Kidneys metabolise vitamin D - without vitamin D, calcium is unable to be absorbed, leading to low serum calcium
Low serum calcium causes PTH secretion, resulting in secondary hyperparathyroidism
PTH stimulates osteoclast activity, increasing calcium absorption from the bone - can result in osteomalacia and osteosclerosis
What is the classical finding on XR of renal bone disease?
Rugger jersey spine - sclerosis of both ends of each vertebral body, and osteomalacia in the centra of the vertebral body
What is the management of renal bone disease?
Low phosphate diet
Phosphate binders
Active forms of vitamin D
Ensuring adequate calcium intake
