CKD Flashcards
Important causes of CKD are
1 2 3 4 5
diabetes mellitus (35%), glomerulonephritis (25%), hypertension (13%) polycystic kidney disease (8%), reflux nephropathy (8%) and
The commonest cause of ESKF in Australia is
_______
diabetes mellitus
The commonest cause of nephritis leading to
kidney failure in Australia is _____
IgA nephropathy.
T or F
Warmer climates, poorer living conditions and
certain genetic predispositions are associated with
a higher prevalence of kidney failure
T
Uraemic symptoms are non-specific and usually are
not recognised until the creatinine clearance is less
than ______
20% of normal
______ is characterised by the accumulation of
uraemic toxins and a deficiency of kidney
hormones that cause dysfunction of organs other
than kidneys
CKF
CKF
Age is an issue—we lose _____
1% of renal function
per year
is defined as a sudden (days to weeks) decrease in kidney function (azotaemia) with or without oliguria
Acute kidney failure (AKF
Classification of AKI
• prerenal (e.g. acute circulatory failure → kidney
hypoperfusion)
• postrenal (e.g. obstruction)
• kidney (intrinsic) (e.g. acute glomerulonephritis)
an estimated or measured glomerular filtration
rate (GFR) 1 <60 mL/min/1.73m 2 that is present
for ≥ 3 months with or without evidence of
kidney damage
Chronic kidney disease and failure
CKD can also be defined as
evidence of kidney damage with or without
decreased GFR that is present for ≥ 3 months as
evidenced by the following, irrespective of the
underlying cause:
1
2
3
4
— albuminuria
— haematuria after exclusion of urological
causes
— structural abnormalities (e.g. on kidney
imaging tests)
— pathological abnormalities (e.g. renal biopsy)
Chronic kidney (or renal) failure (CKF) is defined as
a severe reduction in nephron mass over an extended
period of time, resulting in_____
uraemia
Not modifiable risk factors for HPN
Age >60
Family history
Aboriginal or Torres Strait
Islander origin
Symptoms from CKF are
rare unless the creatinine clearance is less than ______
of normal and only become common when less than
______ of normal.
20%
10%
The common early presenting symptoms of CKD are
generally non-specific and referable to the GIT,
presumably due to the formation of _______in the
upper GIT.
ammonia
If a patient presents with symptoms and
has a________ appearance due to a
combination of anaemia and brownish pigmentation,
then CKF should be highly suspected
sallow ‘lemon’ tinge
In CKF
Urinalysis should test .
glucose, blood and protein
Proteinuria should be confirmed with a 24-hour
urine protein estimation or (preferably) an ______
albumin creatinine ratio (ACR).
Microalbuminuria
Men: ______
Women:______
- 5–25 mg/mmol
3. 5–35 mg/mmol
Macroalbuminuria
Men:_______
Women: _____
> 25 mg/mmol
> 35 mg/mmol
The traditional test in identifying and monitoring CKD
is the ________. The normal range is about
40–120 μ mol/L (0.04–0.12 mmol/L)
serum creatinine level
T or F,
creatinine is a reliable and insensitive
marker of CKD
F
unreliable
Although common in older people, an eGFR ______
is associated with increased risks of adverse clinical
outcomes, especially renal and cardiovascular
<60
eGFR = _______
140 – age
Drugs that can damage the kidneys include:
• classic nephrotoxic drugs e.g. _____
NSAIDs, COX-2 inhibitors
• ACE inhibitors and AIIR blockers (ARBs)
• aminoglycosides
gentamicin, vancomycin
Beware of the ‘triple whammy’
1
2
3
- NSAIDs/COX-2 inhibitors
- ACE inhibitors
- diuretics
Increased risk of adverse reaction
• ________:
— vasculitis
— liver dysfunction
• _________
— liver dysfunction
— myopathy
— rhabdomyolysis
• _______: rhabdomyolysis
Allopurinol
Statins:
Gemfibrozil
Do not use ____ and _______ together.
statins and gemfibrozil
• \_\_\_\_\_\_\_: interstitial nephritis • \_\_\_\_\_\_: bleeding • \_\_\_\_\_: GIT bleeding • Omeprazole and related agents: interstitial nephritis
Beta lactams
LMW heparin
Aspirin/NSAID
What drug?
Confusion, encephalopathy
Aciclovir
What drug?
Steven Johnson syndrome
Cotrimoxazole
Peripheral neuropathy
Flagyl (long term)
Seizures
Penicillin (high dose IV)
Quinalones:
• ciprofloxacin
• norfloxacin
Prolonged hypoglycaemia
Sulfonylureas
Nausea, bradycardia
Digoxin
Ventricular tachycardia (Mg required before conversion
Sotalol
Confusion, acute brain syndrome
Codeine
Liver dysfunction
Bone marrow depression
Methotrexate
Tremor—confusion
Thyroid dysfunction
Lithium
none of the antihypertensive
agents is specifically contraindicated but those
eliminated mainly by the kidney ________ should be given in lower dosage.
e.g. ACE
inhibitors, atenolol, sotalol)
ACE inhibitors should not be
used in the presence of __________;
________ are effective in
larger doses.
kidney artery stenosis
loop diuretics (e.g. frusemide)
The first-line agents are ACEIs or
ARBs, which should not be used together. They
should be ceased if the creatinine levels exceed
_______above baseline or if the serum K exceeds
________ (despite dose reduction
30%
6 mmol/L
Diuretics have a vital role in the patient with _____
diastolic
heart failure
Mx of Anemia in CKF
Anaemia
• Exclude _____ and _______
• Give iron for iron deficiency and also
_____especially for Hb <100 g/L
initiated in a renal unit.
• Avoid transfusions where possible
chronic infection and iron deficiency.
erythropoietin
Hyperphosphataemia control in CKF
• Balanced nutrition to reduce dietary phosphate
______ restriction
• __________tablets (to bind phosphate
• Protein
Calcium carbonate
Hot to Tx Hyper K
• Low potassium diet • Cease ACEI/ARB/spironolactone (if applicable) 1 2 3 4 5
- Nebulised salbutamol
- IV insulin and dextrose
- IV calcium gluconate
- Oral resonium A
- Then dialysis
About
two-thirds of patients receive haemodialysis and
about_________ are on continuous ambulatory peritoneal
dialysis and automated overnight peritoneal dialysis
(nocturnal dialysis).
22%
In HD
The preferred access is via an _______ usually
between the radial artery and a cephalic vein.
AV fistula
_______ is the treatment of choice for
kidney failure except where contraindicated, such as
with active malignancy or tuberculosis and perhaps
the elderly.
Transplantation
Rejection and infection are
problems, occurring especially in the first 6 months.
As a rule, never stop the_____
immunosuppressants
The commonest causes of CKF in children include 1 2 3
chronic glomerulonephritis, obstructive
nephropathy and reflux nephropathy.
Dialysis and transplantation are normally considered
for children over _______ of age with end-stage CKF
2 years
