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CKD Flashcards

1
Q

What is the definition of CKD?

A

Abnormal kidney structure or function, present for > 3 months, with implications for health

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2
Q

What is stage 1 CKD classed as in terms of GFR?

A

>/= 90 ml/min/1.73m2​

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3
Q

What is stage 2 CKD classed as in terms of GFR?

A

80-89 ml/min/1.73m2

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4
Q

What is stage 3 CKD classed as in terms of GFR?

A

30-59 ml/min/1.73m2​

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5
Q

What is stage 4 CKD classed as in terms of GFR?

A

15-29 ml/min/1.73m2

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6
Q

What is stage 5 CKD classed as in terms of GFR?

A

<15 ml/min/1.73m2

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7
Q

What does A1 mean in terms of persistent albuminuria?

A

<30 mg/g

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8
Q

What does A2 mean in terms of persistent albuminuria?

A

30-300 mg/g

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9
Q

What does A3 mean in terms of persistent albuminuria?

A

>300 mg/g

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10
Q

What is Stage 3a CKD defined as in erms of GFR?

A

45-59 ml/min/1.73m2

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11
Q

What is Stage 3b CKD defined as in erms of GFR?

A

30-44 ml/min/1.73m2

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12
Q

What are congenital causes of CKD?

A
  • Polycystic kidney disease
  • Tuberous sclerosis
  • Medullary cystic disease
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13
Q

What vascular problems can cause CKD?

A
  • Hyperensive nephrosclerosis
  • Renovascular disease
  • Small/medium vessel vasculitis
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14
Q

What secondary glomerular diseases can cause CKD?

A
  • SLE
  • Polyangiitis
  • Wegener’s
  • Amyloidosis
  • Diabetic nephropathy
  • HUS
  • TTP
  • Systemic sclerosis
  • Sickle cell disease
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15
Q

What tubulointerstitial diseases can cause CKD?

A
  • Tubulointerstitial nephritis
  • Reflux nephropathy
  • TB
  • Schistosomiasis
  • Nephrocalcinosis
  • Multiple myeloma
  • Renal papillary necrosis
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16
Q

What causes of urinary tract obstruction can lead to CKD?

A
  • Calculi
  • Prostatic disease
  • Pelvic Tumours
  • Retroperitoneal fibrosis
  • Schistosomiasis
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17
Q

What are symptoms which can occur in CKD?

A

Most are asymptomatic, but in more severe disease - symptoms of uraemia and kidney dysfunction:

  • Malaise
  • Loss of appetite/anorexia
  • Insomnia
  • Itching
  • Nausea/vomiting/diarrhoea
  • Paraesthesiae/Tetany
  • Bone pain
  • Symptoms of anaemia
  • Oedema
  • Amenorrhoea
  • Erectile dysfunction
  • Severe dysfunction - Mental slowing, seizures, Myoclonic twitching
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18
Q

What are peripheral signs of CKD?

A
  • Peripheral oedema
  • Signs of PVD
  • Vasculitic rash
  • Gouty tophi
  • Signs of immunosuppression - bruising easily, skin malignancy
  • Asterixis
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19
Q

What signs might you see in the face in someone with CKD?

A
  • Anaemia
  • Xanthelasma
  • Uraemic (yellow) tinge
  • Jaundice - HRS
  • Gum hypertrophy
  • Cushingoid appearence
  • Periorbital oedema - nephrotic syndrome
  • Telangiectasia - scleroderma
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20
Q

What signs might you see in the neck in someone with CKD?

A
  • Increased JVP
  • Lymphadenopathy
  • Scar from parathyroidectomy
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21
Q

What cardiovascular signs might you see in someone with CKD?

A
  • HTN
  • Sternotomy scar
  • Cardiomegaly
  • Stigmata of endocarditis
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22
Q

What respiratory signs might you see someone with CKD?

A

Pulmonary oedema/effusion

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23
Q

What signs might you see on the abdomen in someone with CKD?

A
  • PD catheter
  • Signs of previous transplant
  • Ballotable polycystic kidney +/- palpable liver
24
Q

What investigations might you do in someone who you suspected had CKD in an attempt to identify a cause?

A
  • Bedside - BP, Urine dipstick
  • Bloods - U+E’s, FBC, Ca2+, PO43-, PTH, LFT, ESR, Glucose, CK
  • Imaging - Renal USS
  • Other - Renal biopsy, Urine MC+S, Urine PCR, blood film
25
Q

Why might you do a blood glucose in someone who is suspected to have CKD?

A

Look for diabetes as a cause of renal failure

26
Q

What blood tests might show that someone with CKD is developing renal osteodystrophy?

A
  • Decreased Ca2+
  • Increased PO43-
  • Increased PTH
27
Q

What bloods test would you consider doing to look for signs of intrinsic renal disease?

A
  • ANA
  • ANCA
  • Antiphospholipid antibodies
  • Paraprotein
  • Complement
  • Anti-GBM
  • Hepatitis serology
  • Cryoglobin
28
Q

What might you see on urine dipstick in someone with CKD?

A
  • Haematuria - GN
  • Proteinura
  • Glycosuria
  • White cells
29
Q

What might you see on Urine electrophoresis in someone with CKD?

A

Bence-Jones Proteins

30
Q

What might you see when measuring urine osmolality in someone with CKD?

A

Low urine osmolality - inability of kidneys to concentrate urine

31
Q

What is renal osteodystrophy?

A

Bone mineral disorder

Embraces the various forms of bone disease that may develop alone or in combination in CKD – hyperparathyroid bone disease, osteomalacia, osteoporosis, osteosclerosis and adynamic bone disease

32
Q

How would you monitor renal function in CKD?

A

Annual measurements of:

  • GFR
  • Albuminuria
33
Q

What are risk factors for decline in renal function?

A
  • Hypertension
  • DM
  • Metabolic disturbance
  • Volume depletion
  • Infection
  • NSAIDs
  • SMoking
34
Q

What might a markedly raised ESR indicate as the cause of CKD?

A

Myeloma or vasculitis as a cuase of CKD

35
Q

What might fragmented RBCs +/- thrombocytopenia on blood film in someone with CKD indicate as the potential cause of CKD?

A

Haemolytic causes

  • HUS
  • TTP
  • Accelerated hypertension
36
Q

What might an elevated CK indicate as the cause of CKD?

A

Rhabdomyolysis

37
Q

What are the main aspects of CKD management?

A
  • Slow disease progression
  • Treat complications - renal and other
  • Consider preparation for RRT
38
Q

How would you treat someone with CKD to slow disease progression?

A
  • BP management
  • Tight glycaemic control
  • Exercise
  • Weight loss
  • Smoking cessation
  • Reduce salt intake
39
Q

What is the general target BP aimed for when trying to control BP in someone with CKD?

A

<140/90 mmHg

40
Q

If someone had DM with CKD, what BP would you aim for when trying to control BP as management of CKD?

41
Q

When would you consider using ACEi/ARBs in managing CKD?

A
  • DM and A:CR ratio > 3mg/mmol
  • Hypertension and A:CR ratio > 30mg/mmol
  • Any CKD with A:CR ratio >70 mg/mmol
42
Q

What is the risk of use ACEi/ARBs in someone with CKD?

A

Hyperkalaemia

43
Q

In those with DM and CKD, what is the target HbA1c aimed for?

A

<53 mmol/mol

44
Q

What factors contribute to anaemia in CKD?

A
  • Erythropoeitin deficiency
  • Bone marrow toxins
  • Bone marrow fibrosis 2o to HPTH
  • Haematinic deficiency
  • Increased haemolysis
  • Increased blood loss - GI, blood sampling, HD
  • ACEi use
45
Q

How would you manage anaemia in someone with CKD?

A
  • Treat deficiencies - Iron, B12, folate
  • Look for signs of blood loss
  • EPO - if Hb < 110 g/l
46
Q

What are complications of CKD?

A
  • Hyperkalaemia
  • Anaemia
  • Metabolic Acidosis
  • Renal bone mineral disease
  • Pruritis
  • Gout
  • Nephrogenic systemic fibrosis
  • Endocrine abnormalities
  • Severe uraemia
  • Restless legs/cramps
  • Calciphylaxis
  • Pericarditis
  • CVS disease
47
Q

How would you manage acidosis in someone with CKD?

A

Consider sodium bicarbonate supplements with eGFR < 30 and bicarb < 20 mmol/L

48
Q

How would you manage oedema in someone with CKD?

A
  • Restrict fluid intake
  • Restrict sodium intake
  • Consider High doses loop + thiazide diuretics
49
Q

Why does vitamin D synthesis reduce with increasing kidney dysfunction?

A

Kidney loses its ability to hydroxylate Vit D in the kidney

50
Q

How would you manage CKD related bone-mineral disorders?

A
  • Dietary phosphate restriction and phosphate binders
  • VIt D supplements
51
Q

Why do those with CKD develop secondary hyperparathyroidism?

A
  • Decreased renal production of the 1α-hydroxylase enzyme -> reduced conversion of 25-(OH)2D3 to 1,25-(OH)2D3.
  • Reduced activation of vitamin D receptors (VDR) in the parathyroid glands -> increased release of PTH
  • Calcium sensing receptors (CaR), expressed in the parathyroid glands, react rapidly to acute changes in extracellular calcium -> a low calcium leads to increased release of PTH.
52
Q

What dietary advice would you want to give someone with CKD?

A
  • Potassium restriction if hyperkalaemic
  • Phosphate restriction if hyperphosphataemic
53
Q

How would you manage cardiovascular risk in someone with CKD?

A
  • Antiplatelets
  • Atorvastatin
  • Consider ACEi in hypertension
  • Lifestyle advice - smoking, diet, alcohol, exercise
54
Q

What drugs are particularly important to check before prescribing in CKD?

A
  • Aminoglycosides
  • Penicillins
  • Cephalosporins
  • Heparin
  • Lithium
  • Opiates
  • Digoxin
55
Q

What mnemonic could you use to remember the features of CKD?

A

RESIN + 8 P’s

  • Retinopathy
  • Excoriations (scratch marks)
  • Skin is yellow
  • Increased blood pressure
  • Nails are brown
  • Pallor
  • Purpura and bruises
  • Pericarditis and cardiomegaly
  • Pleural effusions
  • Pulmonary oedema
  • Peripheral oedema
  • Proximal myopathy
  • Peripheral neuropathy

Renal (19 decks)

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