CKD Flashcards
Definition?
Kidney damage or GFR<60 for longer than 3 months
RF?
AKI HTN DM Smoking NSAID CVS disease
Decreased GFR - ^^urea in blood which can cause:
o nausea and appetite loss,
o CNS (encephalopathy – asterixis which is a tremor of hand)
o Pericarditis
o uremic frost (crystals in skin)
Kidney helps to activate Vitamin D to allow calcium absorption from the diet. CKD – less activated Vit D – hypocalcaemia leading to ?
Leading to osteomalacia and osteoporosis. Give Vit D supplements.
Kidneys also respond to low fluid by releasing renin to act on RAAS system to increase blood pressure. what happens in CKD when you have a falling GFR?
increase renin release - HTN
Kidney also release erythropoietin, which stimulates production of RBC from bone marrow. In CKD, this is reduced – leads to ?
anaemia (normochromic normocytic anaemia). Anaemia in CKD predisposes to development of LV hypertrophy – 3x risk of mortality in renal patients,
Ix?
on bloods with renal failure - how will you know they have CKD?
what will you find on imaging\?
high PTH to compensate for low active Vit D to try and increase calcium release
Imaging - USS to check size (usually small <9cm),
Mx of CKD:
limit progression:
- for BP control?
- for bone disease?
- CVS complications?
manage complications:
- fluid balance?
- anaemia
Limit progression/complications
BP control – ACEi
Bone disease – Calcium carbonate + Vit D
CV – Statins ± antiplatelet
Manage complications
Fluid balance – Diuretics, fluid restriction
Anaemia –Iron/folate/B12, EPO in severe cases or fit and young
when do you refer to nephrology ?
o Stage G4/5 CKD
o Moderate proteinuria >70
o Proteinuria >30 with haematuria.
o Declining eGFR
what is the problem with ACE-i for BP control in CKD?
reduces filtration pressure - get a fall in GFR and rise in creatinine
NICE recommend that fall in GFR by 25% and rise of creatinine by 30% is accepted.
