CKD Flashcards
CKD = increased risk of
Peptic ulcers
Cardiovascular problems
Extra-renal manifestations
Gouty tophi Splinter haemorrhages (haematuria, proteinuria)
Asymptomatic range of proteinuria
less than 1g
Heavy proteinuria range
1-3g/day
Nephrotic proteinuria range
over 3g/day
Isomorphic RBCs
LUT
Round
Dysmorphic RBCs
UUT
Squished, escaping
Hyaline casts
Benign
Red cell casts
Always pathological
Nephritic syndrome
Dysmorphic red cells
Bleeding through glomerulus into tubule
Leukocyte casts
Infection or inflammation
Granular casts
CKD
Severe renal impairment ECG
Tall r waves, depressed ST segment, inverted T waves
CKD stages
Stage 1: over 90 with kidney damage (proteinuria or abnormality on scanning) Stage 2: 60-90 with kidney damage Stage 3: 30-60 Stage 4: 15-30 Stage 5: less than 15
Define CKD
Reduced GFR and kidney damage
How to assess CKD
Urinalysis - proteinuria, haematuria Nuclear medicine (radioactive label) Creatinine clearance (eGFR) Serum creatinine ACR UandEs
What is creatinine?
Breakdown of protein
When is eGFR less accurate?
greater than 60ml/min
As creatinine increases, GFR _____________
decreases
Who is more likely to progress?
Younger
Proteinuria
Causes of CKD
Diabetes HT Vascular disease Chronic GN Reflux nephropathy PCKD
Symptoms of CKD
Don’t occur til less than 20 GFR
Fatigue, poor appetite, itch, sleep disturbance, uraemia (rub), nocturia
How to slow progression
Reduce proteinuria Control HT and CV risk factors (smoking, exercise, statin in stage 4) ACEI/ARB - reduce BP and proteinuria Spironolactone Glycaemic control in diabetics
Caution with intial use of ACEI/ARB
Initial fall in GFR
Indirectly reduce aldosterone = hyperkalaemia
Complications of CKD
Anaemia
Bone disease
Hyperparathyroidism
Where is erythropoietin produced?
Kidneys = reduced in CKD = anaemia
How to treat anaemia
Check iron status, B12 and folate
IV iron
Erythropoietin (epo) injection - IV iron top ups
Where is Vit D hydroxylated?
Liver and kidney = impaired in CKD = reduced Ca absorption = secondary hyperparathyroidism = tertiary after a while
Phosphate in CKD
Less phosphate excreted in CKD = serum phosphate rises = stimulates PTH
What does high Ca and phosphate cause?
Vessel calcification = vascular disease, valve problems
Treatment for hypocalcaemia and hyperphosphataemia
Alfacalcidol (hydroxylated Vit D) Phosphate (diet) Phosphate binders (take with every meal)
How often should serum creatinine be measured?
Every year (patients with stage I and II CKD, HT, diabetes) Every 6 months (patients with stage III-V)
When are ACEIs contraindicated?
Bilateral renal artery stenosis (may lead to hypoperfusion)
