CKD Flashcards
definition
impaired renal function for >3 months based on abnormal structure or function- GFR < 60 ml/min/1.73m2
how many stages are there on classification and when do symptoms usually occur
5 stages, symptoms after stage 4
what is end stage renal failure defined as
GFR <15ml/min/1.73m2 or need for renal replacement therapy
causes of CKD
diabetes, glomerulonephritis, unknown, hypertension/renovascular disease, pyelonephritis and reflux nephropathy
what is a common inherited cause of CKD
adult polycystic kidney disease
who is screening recommended for
diabetics, hypertension, cardio disease, structural renal disease stones of BPH, recurrent UTIs, multisystem disorders which could affect kidney eg SLE, fhx, opportunistic detection haematuria and proteinuria
what are uraemic symptoms
high urea symptom renal failure- anorexia, vomiting, restless legs, fatigue, weakness, pruritis, bone pain
what would be found on examination
pallor, uraemic tinge to skin (yellowish), purpura, excoriations, incr bp, cardiomegaly, signs fluid overload. can present severe uraemia, hyperkalaemia, encephalopathy, seizures, coma
what tests can be done
blood, urine, imaging, histology
tests- blood
Hb (normochromic, normocytic anaemia), ESR, U&E, glucose, decr Ca2+, incr PO34, incr ALP. incr PTH if stage 3 or more
tests- urine
dipstick, MC&S, ACR, PCR
tests- imaging
USS
examining the patient- periphery
hypertension, arteriovenous fistula, signs prev transplant, skin malignancy
examining the patient- face
pallor of anaemia, yellow tinge of uraemia, gum hypertrophy from ciclosporin, cushingoid appearance from steroids
examining the patient- abdomen
catheter, or sign previous, ballotable polycystic kidneys, liver
signs elsewhere on examination
diabetic neuropathy, retinopathy, cardio, peripheral vascular disease
what is the GFR in stage 1
> 90 ml/min. evidence renal damage (proteinuria, haematuria, abnormal anatomy, systemic disease)
what is the GFR in stage 2
60-89. evidence renal damage(proteinuria, haematuria, abnormal anatomy, systemic disease)
what is the GFR in stage 3
a- 45-59. b- 30-44. without evidence other renal damage (proteinuria, haematuria, abnormal anatomy, systemic disease)
what is the GFR in stage 4
15-29. without evidence renal damage (proteinuria, haematuria, abnormal anatomy, systemic disease)
what is the GFR in stage 5
<15. renal failure
what is a falling GFR an independent risk factor for
cardiovascular disease
when to refer to a nephrologist
stage 4-5; proteinuria, haematuria, rapidly falling GFR, incr BP, genetics, suspected renal artery stenosis
what is management of CKD split into
investigation (identify and treat causes), limiting progression/complications, symptom control and prep for RRT
what is the target bp in CKD pt
70)
what are you at risk with in CKD (renal bone disease)
osteodystrophy, adynamic bone disease- treat raised PTH. PO4^3- rises in CKD thus incr PTH. restrict diet, give binders to decr gut absorption. vit D analogues and ca2+ supplements
how to modify cardio risk
risk from cardio death higher in stage 1 and 2 than ESRF. give statins and aspirin
symptom control
anaemia- replace iron/B12/folate; acidosis- sodium bicarb (caution in hypertension as sodium load can incr bp); oedema- loop diuretics furosemide, restrict fluid and salt; restless legs/cramps- check ferritin, clonazepam or gabapentin may help
contraindications to renal biopsy
abnormal clotting, hypertension, single kidney, CKD with small kidneys, horseshoe kidney, renal neoplasms
