Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Renal / Urology > CKD > Flashcards

CKD Flashcards

1
Q

What is CKD

A

Irreversible and significant loss of renal function
Kidney damage or reduced function eGFR <60
Evidence of damage / structure
- Blood / protein loss
- Imaging / biopsy
- Hx transplant
>3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is stage 1 and how is ACR also used for classification

A

GFR >90
Requires some evidence of damage to kidney

ACR = early and sensitive marker
A1 <3 i.e. no protein loss
A2 3-30
A3 >30 = significant protein / albumin loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is stage 2

A

GFR 60-89

Required evidence of damage as relatively normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What do stage 1+2 require

A

Condition or cause i.e. abnormal U+E or proteinuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is stage 3a + 3b

A 
A = GFR 45-60 
B = GFR 30-45
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is stage 4

A

GFR 15-29

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is stage 5

A

End stage renal disease
Requires RRT
GFR <15

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How do you differentiate CKD from AKI

A

CKD wil have bilateral small kidney due to long standing damage
CKD will have hypocalcaemia due to lack of vitamin D
CKD tends to have slow decrease in eGFR where as AKI = acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are exceptions

A

PCKD
DM
Amyloid
HIV neuropathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the main causes of CKD in adult and in children

A

DM
HTN
Glomerular disease
Stenosis from atherosclerosis / ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are other causes of CKD

A

Pre-renal

  • HF / liver failure as decrease perfusion
  • AKI accelerating as 85% pre-renal

Renal

  • Renal vascular due to HTN
  • Glomerular systemic - DM / amyloid / sarcoid
  • Primary glomerular disease (GN)
  • Interstitial renal disease - reflux in children / PCKD / chronic pyelonephritis / myeloma / chronic exposure to drugs e.g. NSAID / Alpot syndrome

Post

  • Prostatic
  • Malignancy
  • Retroperitoneal fibrosis = rare cause
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the commonest cause of CKD in children

A

Congenital renal / fibromuscular dysplasia = most common
- Present with HTN and declining renal function
Reflux
PCKD
Obstructive stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are symptoms of CKD

A 
Early stages = asymptomatic 
Fatigue
Pallor due to anaemia  
Insomina
Nausea
Headache  
Decreased appetite / anorexia
Taste disturbance 
Pain if capsule stretched  
Weakness / bone pain due to renal bone disease
Muscle cramps
Abdo cramp
Pruritus 
Fluid overload 
Peripheral + pulmonary oedema 
SOB 
Cognition 
Sexual dysfunction / impotence 
Amenorrhoea 
HTN  
Peripheral neuropathy 
Pleural effusion 
Calciflaxis 
Polyuria / oliguria
Haematuria
Proteinuria 
Electrolyte disturbance 
Uraemia - pruritus, N+V, cognition, bleeding as alters platelet, GI bleed, pericarditis due to irritating heart 
Electrolyte disturbance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What causes pruritus

A

Uraemia
High phophate
Low iron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What puts you at high risk of decline

A 
Age 
High BP
DM
Metabolic disturbance
Volume depletion
Infection
NSAID
Smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens to insulin requirements in CKD

A

Drop as insulin metabolised by kidney so require less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do you investigate CKD in GP practice and what would you expect

A 
Same as AKI
FBC
U+E
Urinanalysis 
ACR 
Renal USS

Used to determine need for further investigation e.g. biopsy
If no blood / protein and Hx of HTN likely that

Possible anaemia 
Hyperkalaemia 
Hypoalbumin as leaking out 
Proteinuria 
Increased urea + creatinine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

History and exam?

A 
Previous renal disease
FH
Systemic disease
Drugs
Uraemic / anaemia Sx
Vital signs- BP = very important 
General 
- Cachexia 
- Long term catheter
- Signs of overload/. SOB 
- Bruising / scratch marks - urea alters platelet so bleed more 
- Pallor of anaemia 
Volume status
Access
- Fistula / tunnelled line / catheter
CVS
-Murmur 
- Pericardial rub of pericaditis
- Scars suggesting IHD
Abdo 
- Scar from transplant - RIF
- Enlarged kidney 
- Tenderness suggest co-existing infection
- Renal bruit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What bloods / bedside tests should be done in hospital

A

Bedside

  • Obs inc BP always
  • Urine dip
  • Spot ACR
  • Can do 24 hours
  • Blood glucose
FBC - look for anaemia 
U+E- Dx and define CKD 
CRP - to see if infection worsening 
LFT 
Bicarb - low 
Glucose
Bone profile - Ca + phosphate + PTH 
- HypoCa
- Hyperphosphate and PTH = indicates chronic 
Clotting

Urinanalysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What bloods / other tests to determine cause

A 
CK 
ANA / ANCA / Auto Ab
C3 for GN and SLE
Anti-GBM
Hepatitis
Myeloma screen 
- Protein electrophoresis 
- Bence Jones Protein - urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What tests in the urine

A

Urinanalysis
ACR
24 hour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What other tests / imaging for complications

A 
Renal USS
- Good to look for obstruction and size
- Can do doppler to see thrombosis 
CT KUB non-contrast
- If suspect stone
MR angiography 
- Better to look for stenos 
ECHO / ECG
- See how heart
Vascular access
- If planning RRT
Biopsy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are general measures / conservative in CKD

What are aims of Rx

  • General measures
  • Slow progression / renal protection with ACEI
  • Reduce risk of CVS disease
  • Manage complications
A 
Control BP
Control DM 
Exercise
Stop smoking
Weight loss 
Statin 20mg for primary prevention

Specific Rx of complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What should you aim for DM HbA1c to be

A

<53

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Who is more likely to need prompt dialysis

A

Anuric as can’t excrete

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

How d you monitor CKD

A

eGFR and ACR annual

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

When would you consider dialysis distinct from AKI

A 
Advanced uraemia 
- GFR<10
- Encephalopathy
- Percaridit s
Refractory evere acidosis
Refractory hyperkalaemia
Refractory pulmonary oeema
Certain drug overdose
Fluid and salt uncontrolled
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

When do you prepare and how for RRT

A

<1 year before needed

PD, haemo or transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What are complications of CKD

A 
Acidosis
Anaemia
Bone disease
CV risk
Electrolyte disturbance
Fluid overload
Other 
Gout 
Peripheral neuropathy 
Hypertension
Intoxincation
Dialysis 
Death
Poor growth in children due to CKD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What causes gout

A

Build up of urate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

How do you treat

A

Allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What indicates a higher mortality

A

GFR

Albuminuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What do patients with CKD die of

A

CVD > RRT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What type of acidosis does CKD cause

A

High anion gap due to urate that kidney can’t excrete
Also can’t excrete H ions
Lose bicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What are the affects of acidosis

A 
Worsens hyperkalaemia - anything that causes acidosis = hyperkalaemia
If improve acidosis will improve K 
Exacerbates renal bone disease
Increases muscle metabolism = cachexia
Poor resp reserve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What are the causes of metabolic acidosis

A 
MUDPILES
Methanol
Uraemia acid (CKD) 
DKA 
Paracetamol 
Infection / sepsis
Lactate - metforin
Ethyne glyol
Salicylates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How do you treat acidosis

A

Diet restriction
Sodium bicarb replacement
Potassium citrate
Dialysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

When should you be careful with sodium bicarb

A

Fluid overload due to Na
Hypertension
CI in saline as can worsen acidosis

39
Q

When can you not give potassium citrate

A

Hyperkalaemia

40
Q

What causes anaemia in CKD

A

Reduced EPO production in CKD as stimulate erythrocytes
- Usually around 3b

Can get other causes
Iron deficiency
Increased blood loss
Reduced RBC
Chronic disease 
Infections
41
Q

What type of anaemia

A

Usually normochromic normocitic if due to EPO

42
Q

What should you o first

A

Look for more common causes
Ferritin levels - will be low if iron deficient
Transferrin sat - do if normal as ferritin can rise in CKD due to inflammation

43
Q

How do you treat anaemia

A

Iron

EPO - if definitely due to this, EPO won’t work if iron levels aren’t normal

44
Q

What do you want iron to be

A

Higher than normal <500

Correct iron before add EPO

45
Q

What do you want Hb to be

A

Don’t normal

Target 100-120 as CVD with any value greater

46
Q

Complications of anaemia

A

LVH

47
Q

What causes CVD disease in CKD

A 
Calcifciation of vessels 
Hypertension
Vascular stiffness
Hyperlipidaemia
DM
Proteinura
Endothelial dysfunction
Uraemic pericarditis
Smoking
48
Q

Preventative measures of CVD in CKD

A 
Anti-platelet - unless bleeding risk
Statin
Smoking cessation
BP control 
Exercise
49
Q

What is importance of knowing CKD in CVD

A

Can influence troponin levels
Look at GFR
Should not interfere with HF but monitor K and eGFR

50
Q

What causes fluid overload

A

Na and water retention

51
Q

What does this lead to

A

Oedema
Hypertension
SOB
CVS disease

52
Q

How do you assess fluid balance if on dialysis or poor renal

A

Oedema - peripheral and pulmonary
Listen to lungs
RR, HR, BP
BCM - body composition monitor

53
Q

How do you treat fluid overload

A 
Na and fluid restriction
Diuretic if overload
Loop = 1st line
Thiazide
Monitor
54
Q

How do you treat hypertension associated with fluid overload

A

ACEI - renoprotective

Furosemide

55
Q

What BP should you aim for if no proteinuria and if porteinuia

A

140 / 90 if no proteinuria

130 / 90 if proteinuria

56
Q

What is proteinuria associated with

A

Higher mortality

CVD risk

57
Q

What should you not combine

A

ACEI and ARB as risk of hyperkalameia and AKI

Monitor eGFR and U+E

58
Q

What are uraemia symptoms

A 
Fatigue
Headache
N+V
Cramps
Anorexia
Altered mental
Pruritus
Easily bruising 
Unexplained GI bleed
Pericardiits
Encephalopathy
59
Q

If patient presents with restless legs

A

Exclude iron / uraemia
Sleep hygiene
Gabapentin / dopamine agonist if severe

60
Q

How does renal affect bone overview in CKD

A

Due to disturbance in calcium and phosphate
Less vit D as can’t be activated by the kidney
Less Ca - as no vit D
Increased phosphate - not excreted
Increased PTH - no inhibition / and low Ca

61
Q

Vitamin D role

A

Becomes activated in kidney calcitriol
Inhibits PTH
Increases Ca reabsorption in bowel and kidney
Excretes phosphate

62
Q

In renal bone

A

Less vitamin D as kidney not working to produce
Decreased Ca
Lose inhibition on PTH

63
Q

What does this result in

A

Secondary PTH due to low Ca and high phosphate

64
Q

Calcium role

A

Inhibits PTH

65
Q

Calcium in renal bone

A

No vitamin D to increase
Lose inhibition on PTH
Low Ca in CKD as no vitamin D
Hyper more common in AKI due to high PTH

66
Q

What does high calcium cause

A

Vascular calcification

67
Q

Phosphate

A

Stimulates PTH so increases Ca

68
Q

Phosphate in renal

A

Can’t excrete so increased levels
Leads to increased mortality
Drags calcium from bone causing osteomalacia

69
Q

PTH

Issue with treatment

A

Increases calcium by increasing bone turnover so if PTH is high chronic = problem
Fractures
Osteomalacia due to demineralisation
CVD risk

Other issue
- If suppress PTH too much with treatment then decrease bone turnover which also increases fracture risk

70
Q

What is primary PTH due to

A

Malignancy

71
Q

What is secondary PTH due to

A

Low Ca in renal

72
Q

What is tertiary PTH due to

A

PTH can’t be lowered with medical Rx
Occurs when PTH gland becomes autonomic after chronic activation e.g CKD and secretes without sensing calcium
Often if on dialysis
Require surgery

73
Q

How do you reduce phosphate and PTH and how do you increase calcium

A

Diet restriction - low phosphate
Non calcium based Phosphate binder - sevelamer
Calcium based phosphate binder but risk of hypercalcaemia - calcium acetate

Calcium diet
Vit D supplement -

74
Q

If PTH persists

A

Calcitriol - active vit D that doesn’t need kidney to activate
Calcitonin - not usually needed as CKD causes hypocalcaemia
Calcium minmeic to suppress PTH
Parathyroidetomy if all else fails

75
Q

What is calcitriol

A

1-25 dihydro

Vitamin D

76
Q

If calchiew taken with food

A

Phosphate binder

77
Q

If taken outwit food

A

Calcium supplement as absorbed by blood

78
Q

Complications of renal bone disease

A

Osteoporosis due to age / use of steroid
Osteomalacia due to increased bone turnover without Ca
Osteosclerosis as osteoblast try to produce new bone without Ca to mineralise

79
Q

Calcium acetate

A

Phosphate binder

Cause hypercalcaeima and vascular calcification

80
Q

What can be used to treat and prevent osteoporosis

A

Biphosphonates - Aledronic acid

81
Q

Symptoms of hypercalcaemia

A

Bone
Stone
Groans
Psychic moans

82
Q

When is selevamere CI

A

Bowel obstruction

83
Q

When do you refer to a specialist

A

Stage 4/5 / eGFR <30
ACR >70
Accelerated progression - >25% or >15 in 1 year
Uncontrolled hypertension despite >4 antihypertensives
Uncertain Dx
Suspect glomerulus disease - blood / urine
COmplications

84
Q

What is CKD an independent RF for

A

Cardiovascular disease

85
Q

What is essential in any renal pathology

A

Urine dip

86
Q

When do you biopsy

A 
Protein >1g / day
Unexplained proteinuria >1g/ day 
Unexplained haematuria
Decreased renal function / AKI but unknown cause 
Suspected RPGN / glomerular
Suspected multi-system disease e.g. RA
87
Q

What are absolute CI

A

Clotting
Unctrolled HTN >180 due to bleeding risk
Skin site infection or any active infection

88
Q

What are relative CI

A

Small kindey
SOlitary kidney
Anatomical abnormality

89
Q

What is renal protection

A

Slowing progression by lowering BP

90
Q

What are BP aims in CKD

A

<140 / 90

<130/90 if DM or high protein ACR >70

91
Q

What are indications for ACEI. / ARB independent of BP

A

HTN + ACR >30
DM and ACR >3
ACR >70

92
Q

What do you do if put on ACEI

A

Monitor regularly
Stop in intercurrent illness / AKI
Stop if develop hyperkalaemia

93
Q

If patient end stage renal and asking help what do you want to tell

A 
Aetiology of CKD 
Modality or plan - are the on dialysis / waiting for transplnat
Access available
Freuqnecy and last session of dialysis 
Unit being treated in
94
Q

SE of EPO

A

Flu like
Rash
Bone aches
Accelerated HTN - can cause encephalopathy / seizure
Pure red cell aplasia
Iron deficiency 2 to increased RBC formation

Renal / Urology (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions