CKD Flashcards
(42 cards)
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