CKD Flashcards
what is CKD
long standing progressive impairment in renal function
defined on the basis of persistent (>3mo) evidence of kidney damage (proteinuria, haematuria) and or impaired GFR
what pts are at inc risk of CKD
diabetes mellitus hypertension atherosclerotic renal vascular disease schistosomiasis in middle east they should be regularly screened
clinical features CKD
early = asymptomatic A declining GFR, rise in serum urea and creatinine conc Anaemia Bone disease Neurological Cardiovascular
Investigations
Same as AKI
Why is anaemia a feature of CKD
due to decrease in erythropoietin production by the diseased kidney
erythropoietin = a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues.
Why is bone disease a feature of CKD
renal phosphate retention and impaired production of 1,25-dihydroxyvitamin D lead to falls in calcium concentration and inc in PTH. Sustained inc in PTH = skeletal decalcification = osteomalacia and osteoporosis
What are the neurological features in CKD
polyneuropathy manifests as paraesthesiae & weakness
autonomic dysfunction presents as postural hypertension and disturbed GI motility
advanced uraemia = depressed cerebral func
median N compression in carpal tunnel common
why CVD in CKD
MI, cardiac failure, sudden cardiac death and stroke due to HTN, dyslipidaemia & vascular calcification
differentiate CKD from AKI
hx, duration of symptoms and previous urinalysis of serum creatinine
normocytic anaemia, small kidneys on USS and presence of renal osteodystrophy = chronic
management CKD
- treat underlying cause eg immunosuppressants for vasculitis
- slow deterioration of renal function (renoprotection) = maintain norm BP and urinary protein w ACEi, diuretic and CCB
- reduce CV risk - BP control, reduce proteinuria, statins, stop smoking
- treat complications eg anaemia
- appropriate dose adjustment of drugs
