CKD Flashcards
What is Chronic Kidney Disease (CKD)?
CKD is a chronic reduction in kidney function sustained over three months. It tends to be permanent and progressive.
What factors can speed up the decline of kidney function and cause CKD?
- Diabetes
- Hypertension
- Medications (e.g., NSAIDs, lithium)
- Glomerulonephritis
- Polycystic kidney disease
What are the common signs and symptoms of Chronic Kidney Disease (CKD)?
- Fatigue
- Pallor (due to anaemia)
- Foamy urine (proteinuria)
- Nausea
- Loss of appetite
- Pruritus (itching)
- Oedema
- Hypertension
- Peripheral neuropathy
What investigations are used to diagnose Chronic Kidney Disease (CKD)?
- eGFR: Estimates kidney function based on serum creatinine, age, and gender.
- Urine albumin:creatinine ratio (ACR): Quantifies proteinuria.
- Haematuria: Assessed by urine dipstick or microscopy.
- Renal ultrasound: Identifies obstructions and polycystic kidney disease.
- Other risk factor tests: Blood pressure, HbA1c, and lipid profile.
What is the diagnostic criteria for Chronic Kidney Disease (CKD)?
CKD is diagnosed when either:
* eGFR is sustained below 60 mL/min/1.73 m² for three months.
* Urine ACR is sustained above 3 mg/mmol for three months.
How is Chronic Kidney Disease (CKD) classified?
- G Stage (eGFR):
- G1: Over 90
- G2: 60-89
- G3a: 45-59
- G3b: 30-44
- G4: 15-29
- G5: Under 15
- A Stage (ACR):
- A1: Under 3 mg/mmol
- A2: 3-30 mg/mmol
- A3: Above 30 mg/mmol
What is accelerated progression in CKD?
Accelerated progression refers to a sustained decline in eGFR within one year by either 25% or 15 mL/min/1.73 m².
What are the complications of Chronic Kidney Disease (CKD)?
- Anaemia
- Renal bone disease
- Cardiovascular disease
- Peripheral neuropathy
- End-stage kidney disease
- Dialysis-related complications
When should a CKD patient be referred to a renal specialist?
Referral is needed for:
* eGFR less than 30 mL/min/1.73 m²
* Urine ACR more than 70 mg/mmol
* Accelerated progression
* 5-year risk of dialysis >5%
* Uncontrolled hypertension despite 4+ antihypertensives
What are key treatment strategies for Chronic Kidney Disease (CKD)?
- Optimising diabetic and hypertension control
- Reducing or avoiding nephrotoxic drugs
- Treating glomerulonephritis if present
- Blood pressure target: <130/80 for CKD patients with ACR >70 mg/mmol
Which medications are used to slow progression in Chronic Kidney Disease (CKD)?
- ACE inhibitors (or angiotensin II receptor blockers)
- SGLT-2 inhibitors (specifically dapagliflozin)
What lifestyle changes help reduce complications in CKD?
- Exercise
- Maintain a healthy weight
- Avoid smoking
- Atorvastatin 20mg for primary prevention of cardiovascular disease
How are complications of CKD managed?
- Metabolic acidosis: Oral sodium bicarbonate
- Anaemia: Iron and erythropoietin
- Renal bone disease: Vitamin D, phosphate binders, and a low phosphate diet
What is the management of end-stage renal disease (ESRD)?
- Special dietary advice
- Dialysis
- Renal transplant
When should ACE inhibitors be used in CKD patients?
ACE inhibitors should be used in:
* Diabetes with urine ACR above 3 mg/mmol
* Hypertension with urine ACR above 30 mg/mmol
* All patients with ACR above 70 mg/mmol
What is the monitoring requirement for patients on ACE inhibitors?
Serum potassium needs to be monitored closely, as both CKD and ACE inhibitors can cause hyperkalaemia.
What role do SGLT-2 inhibitors play in CKD management?
Dapagliflozin, an SGLT-2 inhibitor, is used in:
* Diabetes with ACR above 30 mg/mmol
* Non-diabetics with ACR of 22.6 mg/mmol or above
How is anaemia treated in Chronic Kidney Disease (CKD)?
Anaemia in CKD is treated with:
* Erythropoiesis-stimulating agents (e.g., recombinant human erythropoietin)
* Iron deficiency is treated first with intravenous iron (especially in dialysis patients)
What is renal bone disease (CKD-MBD)?
Renal bone disease involves high serum phosphate, low vitamin D activity, and low serum calcium, leading to bone complications like osteomalacia and osteosclerosis.
How is renal bone disease treated in CKD?
Treatment includes:
* Low phosphate diet
* Phosphate binders
* Active vitamin D (alfacalcidol, calcitriol)
* Ensuring adequate calcium intake
* Bisphosphonates for osteoporosis alongside renal bone disease
