CKD Flashcards
What is CKD?
Abnormal kidney function and/or structure
What will CKD commonly co-exist with?
CV disease Diabetes AKI Falls Fragility
What is the diagnostic criteria for CKD?
2 samples of raised creatinine and low eGFR for more than 90 days
What does eGFR take into consideration?
Serum creatinine level
Age
Sex
Race
What is stage G1 CKD?
eGFR more than 90 ml/min
Normal kidney function but urine findings or structural abnormalities or genetic trait to point to kidney disease
What is stage G2 CKD?
eGFR of 60-90 ml/min
Mildly reduced kidney function but urine findings or structural abnormalities or genetic trait to point to kidney disease
What is stage G3a CKD?
eGFR of 45-59
Moderately reduced kidney function - risk of endocrine and CV risks increased
Requires follow up
What is stage G3b CKD?
30-44
What is stage G4 CKD?
eGFR 15-29
Severely reduced kidney functin
What is stage G5 CKS?
eGFR <15 ml/min
Established renal failure
What is category A1 ACR (albumin creatinine ratio)?
<3 mg/mmol
What is category A2 ACR?
3-30 mg/mmol
What is category A3 ACR?
> 30 mg/mmol
How long should someone be monitored after an AKI?
2-3 years after AKI even if serum creatinine has returned to baseline
Advise people who have had an AKI that they are at increased risk of CKD
What else should you test for when testing for CKD using eGFR and ACR?
Diabetes
Hypertension
CV disease
Structural renal disease, recurrent renal calculi or prostatic hypertrophy
Multisystem disease with potential kidney involvement = SLE
Family history of end-stage renal kidney disease
Opportunistic detection of haematuria
What is the definition of accelerated progression of CKD?
Sustained decreased in eGFR of 25% or more and a change in GFR category within 12 months
OR
sustained decrease in GFR of 15 ml/min/1.73m2 per year
What are risk factors for CKD progression?
CV disease Proteinuria AKI Hypertension Diabetes Smoking African, afro-carribean or asian family origin Chronic use of NSAIDs Untreated urinary outflow tract obstruction
When should people be referred to nephrology?
eGFR of less than 30 ml/min/1,72 m2 (G4 or 5) with or without diabetes
ACR 70 mg/mmol
ACR 30 mg/mol with haematuria
Sustained decreased in eGFR 25% or more
Poorly controlled hypertension despite the use of 4 antihypertensive drugs
Known of suspected rare or genetic causes of CKD
RAS
What is the BP targets in those with CKD?
140/90 mmHg
What is the BP target in those with CKD and diabetes?
130/80`
When should the dose of an ACEI/ARB not be modified?
GFR decreased from pre-treatment baseline less than 25%
Serum creatinine increase from baseline less than 30%
What drug should be offered to everyone with CKD?
Atorvastatin 20mg as primary or secondary prevention of CVD
Increase dose if a greater than 40% reduction in non-HDL cholesterol is not achieved and eGFR is 30 ml/min/1.73m2
What are the 2 commonest causes of CKD?
Diabetes mellitus
Hypertension
What are the different types of glomerulonephritis?
Primary e.g membranous/IgA/ primary focal segmental glomerulosclerosis
Secondary: DM/SLE/FSGS due to HIV/ heroin/ obesity
What are the vascular causes of CKD?
RAS
Ischaemia/ hypertensive nephrosclerosis
Microangiopathic: HUS/ TTP/ HELLP/ pre-eclampsia
Small cell vasculitis : GPA, MPA, EGPA
What are the tubulointerstitial causes of CKD?
Acute Interstitial Nephritis (AIN)
Acute tubulointerstitial nephritis (TIN)
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Reflux nephropathy
What are the post renal causes of CKD?
Calculi - renal, ureteric, bladder
Prostatic - benign prostatic hyperplasia (BPH), cancer
Bladder - malignancy, bladder wall thickening
Urethral stricture
What are the clinical signs of CKD?
Anaemia - conjunctival and palmer pallor
Signs of weight loss
Early morning nausea and vomiting
Advanced uraemia: lemon yellow, uraemic frost, twitching, encephalopathic flap, confusion, pericardial rub or effusion, jussmal breathing
What are the symptoms of anaemia related CKS?
Fatigue
Muscle pain
What pain can be associated with CKD?
Bony
Neuropathic
Ischaemic
Visceral
What uraemic symptoms are associated with CKD?
N+V Anorexia Wt loss Fatigue Itch Altered taste Restless legs Muscle twitching Difficulties concentrating Confusion
What are the renal consequences of CKD?
Local - pain/ haemorrhage/ infection/ stones
Urinary - haematuria/ proteinuria (frothy urine)/ nocturia/ oliguria
Impaired salt and water handling - oedema, dehydration
Hypertension
Electrolyte abnormalities
Acid-base disturbance
End stage renal disease (ESRD)
What are the extra-renal consequences of CKD?
CVD
Mineral and bone disease
Anaemia
Nutrition
What are the renal replacement therapies available?
Hemodialysis
Peritoneal dialysis
Transplantation
Conservative management
What can be done to reduce the risk of CVD in those with CKD?
Smoking cessation Weight loss Aerobic exercise Limiting salt intake Control of hypertension Lipid lowering therapy Aspirin for secondary prevention - can increase risk of GI bleed
What ions and minerals are important in bone health?
Calcium Phosphate PTH Vitamin D FGF-23 (responsible for vitamin D and phosphate metabolism in the bones)
What are consequences of CKD mineral and bone disease?
Secondary/ tertiary HPT Vascular calcification Bone pain Fractures CV events Lower quality of life High morbidity and mortality
What dietary advice can be given for management of CKD-MBD?
Phosphate restriction Salt reduction Potassium restriction Fluid restriction to 1-1.5L a day Correct metabolic acidosis
What medications can be given in CKD-MBD?
Alfacalcidol
Phosphate binders
Calcimimetic
What is the target Hb in CKD?
100-120 g/L
What needs to be investigated in anaemia in CKD?
Other causes: exclude B12 and folate deficiency
Check ferritin and iron stores aiming for; ferritin > 100
How is renal anaemia manged?
Iron therapy
