CKD Flashcards

1
Q

CKD = increased risk of

A

Peptic ulcers

Cardiovascular problems

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2
Q

Extra-renal manifestations

A
Gouty tophi
Splinter haemorrhages (haematuria, proteinuria)
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3
Q

Asymptomatic range of proteinuria

A

less than 1g

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4
Q

Heavy proteinuria range

A

1-3g/day

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5
Q

Nephrotic proteinuria range

A

over 3g/day

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6
Q

Isomorphic RBCs

A

LUT

Round

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7
Q

Dysmorphic RBCs

A

UUT

Squished, escaping

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8
Q

Hyaline casts

A

Benign

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9
Q

Red cell casts

A

Always pathological
Nephritic syndrome
Dysmorphic red cells
Bleeding through glomerulus into tubule

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10
Q

Leukocyte casts

A

Infection or inflammation

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11
Q

Granular casts

A

CKD

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12
Q

Severe renal impairment ECG

A

Tall r waves, depressed ST segment, inverted T waves

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13
Q

CKD stages

A
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
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14
Q

Define CKD

A

Reduced GFR and kidney damage

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15
Q

How to assess CKD

A
Urinalysis - proteinuria, haematuria
Nuclear medicine (radioactive label)
Creatinine clearance (eGFR)
Serum creatinine
ACR
UandEs
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16
Q

What is creatinine?

A

Breakdown of protein

17
Q

When is eGFR less accurate?

A

greater than 60ml/min

18
Q

As creatinine increases, GFR _____________

A

decreases

19
Q

Who is more likely to progress?

A

Younger

Proteinuria

20
Q

Causes of CKD

A
Diabetes
HT
Vascular disease
Chronic GN
Reflux nephropathy
PCKD
21
Q

Symptoms of CKD

A

Don’t occur til less than 20 GFR

Fatigue, poor appetite, itch, sleep disturbance, uraemia (rub), nocturia

22
Q

How to slow progression

A
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
23
Q

Caution with intial use of ACEI/ARB

A

Initial fall in GFR

Indirectly reduce aldosterone = hyperkalaemia

24
Q

Complications of CKD

A

Anaemia
Bone disease
Hyperparathyroidism

25
Q

Where is erythropoietin produced?

A

Kidneys = reduced in CKD = anaemia

26
Q

How to treat anaemia

A

Check iron status, B12 and folate
IV iron
Erythropoietin (epo) injection - IV iron top ups

27
Q

Where is Vit D hydroxylated?

A

Liver and kidney = impaired in CKD = reduced Ca absorption = secondary hyperparathyroidism = tertiary after a while

28
Q

Phosphate in CKD

A

Less phosphate excreted in CKD = serum phosphate rises = stimulates PTH

29
Q

What does high Ca and phosphate cause?

A

Vessel calcification = vascular disease, valve problems

30
Q

Treatment for hypocalcaemia and hyperphosphataemia

A
Alfacalcidol (hydroxylated Vit D)
Phosphate (diet)
Phosphate binders (take with every meal)
31
Q

How often should serum creatinine be measured?

A
Every year (patients with stage I and II CKD, HT, diabetes)
Every 6 months (patients with stage III-V)
32
Q

When are ACEIs contraindicated?

A

Bilateral renal artery stenosis (may lead to hypoperfusion)