CKD Flashcards
what is chronic kidney disease
abnormal kidney function and/ or structure
what does CKD often co exist with
other conditions inc diabetes and CV disease
risk of what is increased in moderate to severe CKD
acute kidney injury, falls, fragility and mortality
how does age affect risk of getting CKD
increases with age
what is the aim of treatment in CKD
prevent or delay progression
reduce/ prevent complications
reduce risk of CV disease
what is eGFR based upon
serum creatinine, age, sex, race
what does a spiked creatinine suggest
acute kidney injury
how do you diagnose CKS
minimum of two samples at least 90 days apart
eGFR, eGFRcreatinine and ACR
can use eGFRcreatinineC
what is G1 stage of CKD
e GFR 90 (normal function but urine findings/ structural abnormalities/ genetic trait point to kidney disease
what is G2 stage of CKD
eGFR 60-89
midly reduced renal function
what are G3a and b stages of CKD
G3a 45-59
G3b 30-44
Moderately reduced kidney function- risk of endocrine and cardiovascular increases problems
what is G4 stage of CKD
eGFR 15-29
severely reduced kidney function
what is G5 stage of CKD
eGFR <15
established renal failure
what does albumin in urine suggest
glomerular damage
what is ACR
albumin creatinine ratio
A1 <3
A2 3-30
A3 >30
shows level of albumin in urine, A1 normal
does having and acute kidney injury increase your risk of getting CKD
yes have to monitor every 2-3 years
who should you offer CKD testing to
people with:diabetes
hypertension
Acute kidney injury
cardiovascular disease (ischaemic heart disease, chronic heart failure, peripheral vascular disease or cerebral vascular disease)
structural renal tract disease, recurrent renal calculi or prostatic hypertrophy
multisystem diseases with potential kidney involvement – for example, systemic lupus erythematosus
family history of end-stage kidney disease (GFR category G5) or hereditary kidney disease
opportunistic detection of haematuria
who DOESNT have CKD
an eGFRcreatinine of 45–59 ml/min/1.73m2 and
an eGFRcystatinC of more than 60 ml/min/1.73m2 and
no other marker of kidney disease
what is accelerated progression of CKD
a sustained decrease in GFR of 25% or more and a change in GFR category within 12 months
or
a sustained decrease in GFR of 15 ml/min/1.73m2 per year.
what are the risk factor with CKD progression
Cardiovascular disease
Proteinuria
Acute kidney injury
Hypertension
Diabetes
Smoking- accelerated risk of atherosclerosis
African, African-Caribbean or Asian family origin
Chronic use of NSAIDs
Untreated urinary outflow tract obstruction
who with CKD should get referred
GFR less than 30 ml/min/1.73m2 (GFR category G4 or G5)
ACR 70 mg/mmol or more, unless known to be caused by diabetes and already appropriately treated
ACR 30 mg/mmol or more (ACR category A3), together with haematuria
accelerated progression
poorly controlled hypertension despite using 4 drugs
genetic causes of CKD
suspected renal artery stenosis
what are the BP targets in CKD
below 140/90
if also have diabetes/ ACR >70 below 130/80
what drugs reduce eGFR
ACEi/ ARBs (RAAS inhibition)
reduce glomerular flow
don’t be alarmed and reduce dose when glomerular function decreases
what is the treatment for CKD-BMD
dietary advise- phosphat, salt, potassium and fluid restriction alfacacidol (vit D) phosphate binders (calcium based/aluminium/ non calcium based) calcimimetic
why is phosphate an issue in CKD
as kidneys naturally bad at excreting it anyway
what causes CKS
diabetes hypertension glomerular nephricities vasular- renal artery stenosis, nephosclerosis, micro angiopathic (HUS, pre-eclampsia), GPA, EGPA, MPA post renal obstruction tubuloinstersistal
what are the types of glomerular nephricities
primary eg Membranous/ IgA/ 1ry FSGS
secondary e.g embranous/ DM/ lupus/ FSGS due to HIV/ Heroin/ obesity etc (associated with malignancy)
(anything that damages the capillaries of the kidneys)
what are the clinical signs of CKD
Anaemia – conjunctival and palmar pallor
weight loss
what are the signs of advanced uraemia
Lemon yellow skin Uraemic frost (smell on skin) Twitching Encephalopathic flap Confusion Pericardial rub or effusion Kussmaul breathing (metabolic acidosis)
what are the symptoms of CKD
Uraemic: N & V Anorexia Wt loss Fatigue Itch Altered taste Restless legs Muscle twitching Difficulties concentrating Confusion
Anaemia:
fatigue
muscle weakness
Pain: bony neuropathic ischaemic visceral
what are the renal consequences of CKD
Local – pain/stones/ haemorrhage/ infection
Urinary – haematuria/ proteinuria/nocturia/oligouria
Impaired salt and water handling- odema/ dehydration
Hypertension
Electrolyte abnormalities- Na/K/Mg/Ca
Acid-base disturbance- metabolic acidosis
→ ESRD
what are the extra renal consequences of CKD
Cardiovascular disease (CVD)
Mineral & Bone Disease (CKD-MBD)
Anaemia
Nutrition
what are the treatment options for end stage kidney disease
Renal Replacement Therapies (RRT):
Haemodialysis (HD)
Peritoneal Dialysis (PD)
Transplantation
or
Conservative management
what will most patients with CKD die of
a cardiovascular incident
what increased CVD risk in CKD
eGFR < 50 mls/min
microalbuminuria
what is there greatly increased risk of in CKD
CVD
how can you modify CVD risk in CKD
Smoking cessation Weight loss Aerobic exercise Limiting salt intake controlling hypertension lipid lowering therapy consider aspirin
what does mineral and bone disease in CKD affect
increases morbidity and mortality
comprises homeostatic mechanisms
what happens in CKD-BMD (bone mineral disease)
there are different adaptive changes in; Calcium Phosphate PTH Vit D FGF-23
what are the conseqences of CKD-BMD
Secondary/ tertiary HPT (hyperparathryoidism)
Vascular calcification
Bone pain
Fractures
CV events
Lower quality of life
High morbidity and mortality
what should be offered to all CKD patients
Atorvastatin 20mg for the primary or secondary prevention of CVD
who is at risk of anaemia with CKD
diabetics
what is the target Hb in CKD
100-120 g/L
what is the treatment for anaemia in CKD
exclude other causes (B12/folate deficiency, haematological cause)
iron therapy- ferbinject, venofer (if oral iron fails refer for IVI iron)
what defines renal anaemia
HB < 100-110 g/dl
despite no iron/ haematinic deficiencies
how many CKD patients develop ESRD
v small minority
