CKD Flashcards
what is CKD classed as?
CKD 1 >90ml/min
CKD 2 60-90ml/min
CKD 3 <60ml/min
Aims of CKD treatments
prevent disease progression
manage abnormalities
maintain quality of life
reduce cardiovascular morbidity and mortality
IF a patient has a high creatinine should we re-check this?
yes when they have faster (high protein meals will lead to creatinine production as exogenous protein breaks down and an artificially low eGFR
whats should be measured in diabetics and non-diabetics with eGFR <60ml/min
albumin/creatinine ratio
> 3 is considered significant
30 is severely increased
patients that lose >25% eGFR in a year are at risk of progression to end stage renal function
when dialysis is necessary to maintain life
NICE criteria for patients to be referred to a nephrologist
An ACR >70mg/mmol
An ACR >30mg/ml and >25% reduction of eGFR in the past year
eGFR <30mmol/L or struggling to control BP
Target BP in CKD
normal 140/90
When should patients be prescribed an ACE/ARB
In diabetics when ACR>3mg/mmol (even if not hypertensive
In any CKD patient with ACR >30mg/mmol
In any patient with ACR >70mg/mmol whether or not they have hypertension, diabetes or even CKD.
What symptoms can patients get if they have CKD 4 or 5?
- oedema
- HTN (fluid overload & RAAS)
- hyperkalaemia
- hyperphosphataemia
- hypocalcaemia (failure to activate vit D)
- hyperparathyroidism
- acidosis
- uraemia ( failure to excrete nitrogenous toxins)
- anaemia ) failure to excrete erythropoietin)
what is the advantage of using darbepoetin over opoetin|?
IT can be given IV without loss of efficacy
This makes it less painful (rather than IM)
What preparation of iron do we use in renal anaemia when oral supplementation fails?
Not intramuscular iron sorbitol
calcium carbonate is primary administered to increase serum what?
vitamin D
anaemia can be caused by many things in CKD but one thing is
erythropoietin deficiency
Do we aim for normal reference ranges for Hb in anaemic patients with CKD
no
100-120
Higher levels increase the risk of stroke and CVD
do all really cleared drugs need a dose reduction?
No it depends on the therapeutic window
