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Renal > CKD > Flashcards

CKD Flashcards

1
Q

What is CKD?

A

Abnormal kidney function and/or structure

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2
Q

What will CKD commonly co-exist with?

A 
CV disease
Diabetes 
AKI
Falls
Fragility
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3
Q

What is the diagnostic criteria for CKD?

A

2 samples of raised creatinine and low eGFR for more than 90 days

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4
Q

What does eGFR take into consideration?

A

Serum creatinine level
Age
Sex
Race

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5
Q

What is stage G1 CKD?

A

eGFR more than 90 ml/min

Normal kidney function but urine findings or structural abnormalities or genetic trait to point to kidney disease

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6
Q

What is stage G2 CKD?

A

eGFR of 60-90 ml/min
Mildly reduced kidney function but urine findings or structural abnormalities or genetic trait to point to kidney disease

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7
Q

What is stage G3a CKD?

A

eGFR of 45-59
Moderately reduced kidney function - risk of endocrine and CV risks increased
Requires follow up

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8
Q

What is stage G3b CKD?

A

30-44

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9
Q

What is stage G4 CKD?

A

eGFR 15-29

Severely reduced kidney functin

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10
Q

What is stage G5 CKS?

A

eGFR <15 ml/min

Established renal failure

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11
Q

What is category A1 ACR (albumin creatinine ratio)?

A

<3 mg/mmol

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12
Q

What is category A2 ACR?

A

3-30 mg/mmol

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13
Q

What is category A3 ACR?

A

> 30 mg/mmol

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14
Q

How long should someone be monitored after an AKI?

A

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

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15
Q

What else should you test for when testing for CKD using eGFR and ACR?

A

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

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16
Q

What is the definition of accelerated progression of CKD?

A

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

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17
Q

What are risk factors for CKD progression?

A 
CV disease
Proteinuria
AKI
Hypertension
Diabetes
Smoking
African, afro-carribean or asian family origin
Chronic use of NSAIDs
Untreated urinary outflow tract obstruction
18
Q

When should people be referred to nephrology?

A

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

19
Q

What is the BP targets in those with CKD?

A

140/90 mmHg

20
Q

What is the BP target in those with CKD and diabetes?

A

130/80`

21
Q

When should the dose of an ACEI/ARB not be modified?

A

GFR decreased from pre-treatment baseline less than 25%

Serum creatinine increase from baseline less than 30%

22
Q

What drug should be offered to everyone with CKD?

A

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

23
Q

What are the 2 commonest causes of CKD?

A

Diabetes mellitus

Hypertension

24
Q

What are the different types of glomerulonephritis?

A

Primary e.g membranous/IgA/ primary focal segmental glomerulosclerosis
Secondary: DM/SLE/FSGS due to HIV/ heroin/ obesity

25
Q

What are the vascular causes of CKD?

A

RAS
Ischaemia/ hypertensive nephrosclerosis
Microangiopathic: HUS/ TTP/ HELLP/ pre-eclampsia
Small cell vasculitis : GPA, MPA, EGPA

26
Q

What are the tubulointerstitial causes of CKD?

A

Acute Interstitial Nephritis (AIN)
Acute tubulointerstitial nephritis (TIN)
Autosomal Dominant Polycystic Kidney Disease (ADPKD)
Reflux nephropathy

27
Q

What are the post renal causes of CKD?

A

Calculi - renal, ureteric, bladder
Prostatic - benign prostatic hyperplasia (BPH), cancer
Bladder - malignancy, bladder wall thickening
Urethral stricture

28
Q

What are the clinical signs of CKD?

A

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

29
Q

What are the symptoms of anaemia related CKS?

A

Fatigue

Muscle pain

30
Q

What pain can be associated with CKD?

A

Bony
Neuropathic
Ischaemic
Visceral

31
Q

What uraemic symptoms are associated with CKD?

A 
N+V
Anorexia
Wt loss
Fatigue
Itch
Altered taste
Restless legs
Muscle twitching
Difficulties concentrating
Confusion
32
Q

What are the renal consequences of CKD?

A

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)

33
Q

What are the extra-renal consequences of CKD?

A

CVD
Mineral and bone disease
Anaemia
Nutrition

34
Q

What are the renal replacement therapies available?

A

Hemodialysis
Peritoneal dialysis
Transplantation
Conservative management

35
Q

What can be done to reduce the risk of CVD in those with CKD?

A 
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
36
Q

What ions and minerals are important in bone health?

A 
Calcium
Phosphate
PTH
Vitamin D
FGF-23 (responsible for vitamin D and phosphate metabolism in the bones)
37
Q

What are consequences of CKD mineral and bone disease?

A 
Secondary/ tertiary HPT
Vascular calcification
Bone pain
Fractures
CV events
Lower quality of life
High morbidity and mortality
38
Q

What dietary advice can be given for management of CKD-MBD?

A 
Phosphate restriction
Salt reduction
Potassium restriction
Fluid restriction to 1-1.5L a day 
Correct metabolic acidosis
39
Q

What medications can be given in CKD-MBD?

A

Alfacalcidol
Phosphate binders
Calcimimetic

40
Q

What is the target Hb in CKD?

A

100-120 g/L

41
Q

What needs to be investigated in anaemia in CKD?

A

Other causes: exclude B12 and folate deficiency

Check ferritin and iron stores aiming for; ferritin > 100

42
Q

How is renal anaemia manged?

A

Iron therapy

Renal (22 decks)

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