CKD Flashcards
definition
kidney structure/function abnorm
> 3 months
with health implications
What are ckd pts most likely to die of ?
Heart disease
who should be tested for CKD
People with risk factors
Incidental proteinuria
Persistent haematuria (not UTI)
eGFR <60
How do you test for CKD
- measure serum Cr to calculate eGFR
2. Take early morning urine to measure urinary ACR and dip for haematuria
Why is urine taken in the early morning?
To stop the false positive of orthostatic proteinuria
Persistent haematuria in the absence of UTI makes you suspect what?
Uro cancer
How do you act on the eGFR result?
<90 but serum cr has increased by >20% indicates a decline in renal function
<60- repeat in 2w (exclude AKI), if still <60 repeat within 3mths. If it is then <60 then = CKD, if it is 45-59 and no proteinuria then confirm the diagonsis with eGFR cystatin C test
How do you act on the ACR result
> 70- refer straight to nephrologist
3-70- repeat in 3 months. If still >3 then = CKD
Does the diagnosis of CKD require both ACR and eGFR?
No is and/or
How could you consider confirming the diagnosis
eGFR cystatin C test
When is eGFR cystatin C test inaccurate
Uncontrolled thyroid disease
What do you need to be mindful of in the eGFR test?
Don’t eat meat for 12h before
Interpret with caution in extremes of muscle mass, pregnancy, oedema, malnourished, asian/chinese (less well validated)
What rate of eGFR is considered normal for a young adult?
125 ml/min/1.73m2
An eGFR of <60 is associated with what
Higher risk for complications of CKD
How is CKD staged?
Uses eGFR and ACR in a grid so e.g. G4A2
Is an older person more or less likely to progress to end stage renal disease than a young person?
Less likely
CKD can only be diagnosed on at least __ eGFR tests at least _____ apart
2
3mths
How is ‘progressive’ CKD defined
Sustained fall in eGFR of >25% AND change in category in <12m
OR
Sustained fall in eGFR of 15 in <12m
What extra investigations should you do in CKD if their eGFR is <45
Hb
What extra investigations should you do in CKD if their eGFR is <30
Hb
calcium
phosphate
PTH
Vit D
Renal USS
What extra investigations should you do in CKD if their ACR >=3
Dip for haematuria
If macroscopic or persistent (+1 on at least 2/3 occasions) then renal USS and r/o cancer if >50yo
Also need annual f/u of eGFR, ACR, BP, urine dip
What extra investigations should you do in CKD if their ACR is >30 with haematuria or >70
Consider referral
In what circumstances do you consider referral?
ACR is >30 with haematuria or >70
BP v poor control
Progressive
Outflow obstruction
Genetic or rare cause susp
What is general CKD management?
Usual lifestyle advice
BP control- aim for 140/90 (but diabetics with ACR >70 aim for 130/80).
If ACR >70 alone/ACR >30 + HTN/ACR >3 + diabetes –> ACEi/ARB
Statin- atorvostatin 20mg
+manage anaemia, bone and metabolic disorders in severe disease
Should you use Qrisk?
No
What effect can CKD have on clotting?
Can = bleeding and thrombotic tendencies
How should CKD be monitored?
Depends on pt and severity and stability of eGFR and ACR. There is a table in nice to guide (1-4 times per year)
Bear in mind that CKD is not progressive in many people
What would you include in a CKD review?
Any symptoms (nb usually none)
Lifestyle advice
Compliance with HTN and statin meds
Test eGFR, ACR, BP and urine dip
if eGFR, ACR have decreased to certain thresholds then do the extra tests/consider referral etc.
