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Renal > CKD > Flashcards

CKD Flashcards

1
Q

What is the definition of CKD?

A

reduced GFR and/or evidence of kidney damage- 2 measurements 3 months apart

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2
Q

How is GFR assessed?

A

estimated by creatinine clearance

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3
Q

Why does creatinine clearance over-estimate GFR

A

creatinine is secreted by tubules

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4
Q

What is creatinine produced?

A

muscle breakdown- muscular people produce more creatinine

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5
Q

How is creatinine adjusted?

A

corrected for women, black race and age by MDRD4 equation

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6
Q

What GFR is accurate for?

A

if GFR is less than 60ml/min

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7
Q

What must serum creatinine be in order for eGFR to be valid?

A

serum creatinine must be stable

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8
Q

How does eGFR affect actual GFR if muscle mass is low?

A

over-estimates

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9
Q

What is stage 1 CKD?

A

GFR >90ml/min with evidence of kidney damage

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10
Q

What is stage 2 CKD?

A

GFR 60-90ml/min with evidence of kidney damage

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11
Q

What must be present for a diagnosis of stage 1 or 2 CKD?

A

evidence of kidney damage

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12
Q

How are stages 3-5 CKD defined?

A

on GFR alone

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13
Q

What is evidence of kidney damage?

A

proteinuria; haematuria (in absence of LUT cause) or abnormal imaging

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14
Q

What is stage 3 CKD?

A

GFR 30-60

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15
Q

What is stage 4 CKD?

A

15-30

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16
Q

What is stage 5 CKD?

A

<15 GFR OR ON RENAL REPLACEMENT THERAPY

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17
Q

What risks does CKD increase?

A

CVS

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18
Q

Which patients are more likely to progress with CKD?

A

those with proteinuria; and younger patients (have longer to progress)

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19
Q

What are the common causes of CKD?

A

DM; HT; vascular disease; chronic glomerulonephritis; reflux nephropathy; polycystic kidneys

20
Q

Why is the cause of CKD not always known?

A

many patients present late with small scarred kidneys which could be caused by lots of things

21
Q

At what GFR do symptoms of decreased GFR appear?

A

<20ml/min

22
Q

What are the symptoms of reduced GFR?

A

tiredness; poor appetite; itc and sleep disturbance

23
Q

What is the most common type of polycystic kidneys?

A

autosomal dominant which presents in adulthood

24
Q

What are the principles of managemnet of CKD?

A

slow progression; reduce CVS risk; treat complications of CKD and prepare for renal replacement therapy

25
Q

What factors increase rate of progression of CKD?

A

proteinuria and BP; poor glycaemic control; smoking

26
Q

What is the treatment used to slow progression?

A

ACEi and ARBs - also spironolactone

27
Q

What do you need to be cautious about with ACEi and spironolactone?

A

cause intial fall in GFR and may cause hyperkalaemia

28
Q

How is CVS risk reduced with CKD?

A

BP and proteinuria; stop smoking and statins

29
Q

What complication should be checked for in patient with CKD?

A

anaemia- iron, B12 and folate

30
Q

What is the treatment for IDA in CKD?

A

IV iron ; then epo by injection every week or fortnight

31
Q

what is the target Hb in CKD?

A

10.5-12.5g/dl

32
Q

Why might you get hyperparathyroidism in CKD?

A

impaired vitamin D hydroxylation leading to reduced clacium absorption and increased serum phosphate

33
Q

What happens if secondary hyperparathyroidism is not treated?

A

the glands undergo hyperplasia and one gland may become autonomous leading to tertiary hyper-PTH

34
Q

What are the consequences of tertiary hyper-PTH?

A

bone disease; vascular calcificaiton and heart valve calcification due to high clacium

35
Q

What is the treatment for hyperparathyroidism?

A

alfacalcidol; reduced dietary phosphate intake and phosphate binders

36
Q

What is alfacalcidol?

A

hydroxylated vitamin D which doesn’t need activated by the kdineys

37
Q

Give examples of phsophate binders?

A

calcium carbonate; calcium acetate and sevelamer

38
Q

What are the options for renal failure?

A

haemodialysis; peritoneal dialysis; transplantation and conservative mx

39
Q

When do patients start receiving information about dialysis?

A

when GFR is about 20ml/min

40
Q

What GFR do most patients begin dialysis?

A

8ml/min

41
Q

What is needed for haemodialysis?

A

arterovenous fistula

42
Q

When should patients be referred to vascular surgeons for AVF?

A

when GFR is around 15

43
Q

How long does AVF need to mature?

A

6 weeks

44
Q

How long does a catheter for peritoneal dialysis take until it can be used?

A

1-2 weeks

45
Q

When can patients be listed for transplant?

A

within 6 months of dialysis

46
Q

What patients tend to choose conservative mx?

A

older patients with mulitple co-morbidities

Renal (33 decks)

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