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Renal > CKD > Flashcards

CKD Flashcards

1
Q

what is chronic kidney disease

A

abnormal kidney function and/ or structure

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2
Q

what does CKD often co exist with

A

other conditions inc diabetes and CV disease

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3
Q

risk of what is increased in moderate to severe CKD

A

acute kidney injury, falls, fragility and mortality

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4
Q

how does age affect risk of getting CKD

A

increases with age

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5
Q

what is the aim of treatment in CKD

A

prevent or delay progression
reduce/ prevent complications
reduce risk of CV disease

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6
Q

what is eGFR based upon

A

serum creatinine, age, sex, race

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7
Q

what does a spiked creatinine suggest

A

acute kidney injury

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8
Q

how do you diagnose CKS

A

minimum of two samples at least 90 days apart

eGFR, eGFRcreatinine and ACR

can use eGFRcreatinineC

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9
Q

what is G1 stage of CKD

A

e GFR 90 (normal function but urine findings/ structural abnormalities/ genetic trait point to kidney disease

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10
Q

what is G2 stage of CKD

A

eGFR 60-89

midly reduced renal function

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11
Q

what are G3a and b stages of CKD

A

G3a 45-59
G3b 30-44

Moderately reduced kidney function- risk of endocrine and cardiovascular increases problems

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12
Q

what is G4 stage of CKD

A

eGFR 15-29

severely reduced kidney function

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13
Q

what is G5 stage of CKD

A

eGFR <15

established renal failure

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14
Q

what does albumin in urine suggest

A

glomerular damage

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15
Q

what is ACR

A

albumin creatinine ratio
A1 <3
A2 3-30
A3 >30

shows level of albumin in urine, A1 normal

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16
Q

does having and acute kidney injury increase your risk of getting CKD

A

yes have to monitor every 2-3 years

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17
Q

who should you offer CKD testing to

A

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

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18
Q

who DOESNT have CKD

A

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

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19
Q

what is accelerated progression of CKD

A

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.

20
Q

what are the risk factor with CKD progression

A

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

21
Q

who with CKD should get referred

A

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

22
Q

what are the BP targets in CKD

A

below 140/90

if also have diabetes/ ACR >70 below 130/80

23
Q

what drugs reduce eGFR

A

ACEi/ ARBs (RAAS inhibition)
reduce glomerular flow
don’t be alarmed and reduce dose when glomerular function decreases

24
Q

what is the treatment for CKD-BMD

A 
dietary advise- phosphat, salt, potassium and fluid restriction 
alfacacidol (vit D)
phosphate binders (calcium based/aluminium/ non calcium based)
calcimimetic
25
Q

why is phosphate an issue in CKD

A

as kidneys naturally bad at excreting it anyway

26
Q

what causes CKS

A 
diabetes 
hypertension 
glomerular nephricities 
vasular- renal artery stenosis, nephosclerosis, micro angiopathic (HUS, pre-eclampsia), 
GPA, EGPA, MPA
post renal obstruction 
tubuloinstersistal
27
Q

what are the types of glomerular nephricities

A

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)

28
Q

what are the clinical signs of CKD

A

Anaemia – conjunctival and palmar pallor

weight loss

29
Q

what are the signs of advanced uraemia

A 
Lemon yellow skin 
Uraemic frost (smell on skin)
Twitching
Encephalopathic flap
Confusion
Pericardial rub or effusion
Kussmaul breathing (metabolic acidosis)
30
Q

what are the symptoms of CKD

A 
Uraemic:
N &amp; V
Anorexia 
Wt loss
Fatigue
Itch
Altered taste
Restless legs
Muscle twitching
Difficulties concentrating
Confusion

Anaemia:
fatigue
muscle weakness

Pain:
bony 
neuropathic 
ischaemic 
visceral
31
Q

what are the renal consequences of CKD

A

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

32
Q

what are the extra renal consequences of CKD

A

Cardiovascular disease (CVD)

Mineral & Bone Disease (CKD-MBD)

Anaemia

Nutrition

33
Q

what are the treatment options for end stage kidney disease

A

Renal Replacement Therapies (RRT):
Haemodialysis (HD)
Peritoneal Dialysis (PD)
Transplantation

or
Conservative management

34
Q

what will most patients with CKD die of

A

a cardiovascular incident

35
Q

what increased CVD risk in CKD

A

eGFR < 50 mls/min

microalbuminuria

36
Q

what is there greatly increased risk of in CKD

A

CVD

37
Q

how can you modify CVD risk in CKD

A 
Smoking cessation 
Weight loss 
Aerobic exercise 
Limiting salt intake 
controlling hypertension 
lipid lowering therapy 
consider aspirin
38
Q

what does mineral and bone disease in CKD affect

A

increases morbidity and mortality

comprises homeostatic mechanisms

39
Q

what happens in CKD-BMD (bone mineral disease)

A 
there are different adaptive changes in;
Calcium
Phosphate
PTH
Vit D
FGF-23
40
Q

what are the conseqences of CKD-BMD

A

Secondary/ tertiary HPT (hyperparathryoidism)

Vascular calcification

Bone pain

Fractures

CV events

Lower quality of life

High morbidity and mortality

41
Q

what should be offered to all CKD patients

A

Atorvastatin 20mg for the primary or secondary prevention of CVD

42
Q

who is at risk of anaemia with CKD

A

diabetics

43
Q

what is the target Hb in CKD

A

100-120 g/L

44
Q

what is the treatment for anaemia in CKD

A

exclude other causes (B12/folate deficiency, haematological cause)
iron therapy- ferbinject, venofer (if oral iron fails refer for IVI iron)

45
Q

what defines renal anaemia

A

HB < 100-110 g/dl

despite no iron/ haematinic deficiencies

46
Q

how many CKD patients develop ESRD

A

v small minority

Renal (27 decks)

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