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AC1 > CKD > Flashcards

CKD Flashcards

1
Q

Define CKD

A

Abnormalities of kidney structure or function , present for > 3 months with implications for health

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2
Q

What are the criteria for CKD?

A

For >3 months, either:

1 or more markers of kidney damage:

  • Albuminuria (ACR > or = 30mg/g)
  • Urine sediment abnormalities
  • Electrolyte and other abnormalities due to tubular disorders
  • Abnormalities detected by histology
  • Structural abnormalities detected by imaging
  • History of kidney transplantation

OR decreased GFR <60ml/min/1.73m2

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3
Q

Which investigations can be done to confirm CKD?

What in each test would you be looking for?

A

Urine dip: Proteinuria

U&Es: reduced GFR

Renal USS: structural abnormalities

Urine ACR/PCR: lab confirmed protein or albuminuria

Renal biopsy: histology of renal disease

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4
Q

What is creatinine?

Why is it used as a marker of kidney function?

A

Breakdown product of skeletal muscle

Excreted exclusively by the kidneys

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5
Q

What influences normal creatinine levels?

A

Muscle bulk, which can depend on gender, ethnicity, weight and age

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6
Q

Which information is used to calculate GFR?

A

Serum creatinine

Serum cystatin C

Age

Gender

Race

Weight

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7
Q

List some of the causes of CKD

Which are the biggest causes?

A

Type 2 diabetes

HTN

Type 1 diabetes

Glomerular diseases

Cystic/hereditary

Nephritis

Tumours

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8
Q

What bedside tests can be conducted to investigate the cause of CKD?

What would you be looking for?

A

Urine dip:

  • Protein or blood
    • Nephritis?
    • Nephropathy

Blood pressure:

  • Hypertension?
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9
Q

What bloods can be taken to investigate a cause for CKD?

What would these be looking for?

A

HbA1c: ?diabetes

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10
Q

What imaging can be used to investigate the cause of CKD?

What does it look for?

A

Renal USS: structural abnormalities and tumours

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11
Q

What special tests can be performed to investigate the cause of CKD?

What does this consist of?

A

Renal screen:

  • PSA (prostate issues?)
  • Protein electrophoresis/ serum light chains (myeloma?)
  • ANA and complement (vasculitis?)
  • MPO/PR3
  • Anti GBM
  • Blood borne viruses: Hepatitis and HIV

Renal histology:

  • Biopsy to confirm other investigations
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12
Q

What are the functions of the kidney?

A
  • *A:** Acid-base balance
  • *W:** Water removal
  • *E:** Erythropoietin production
  • *T:** Toxin removal
  • *B:** Blood pressure control
  • *E:** Electrolyte balance
  • *D:** Vitamin D activation
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13
Q

What signs and symptoms of impaired water removal by the kidneys?

What are the approaches to management of this?

A

Signs:

  • Peripheral oedema
  • Pulmonary oedema

Symptoms:

  • Dyspnoea
  • Swelling
  • Nocturia

Management:

  • Fluid restriction
  • Diuretics
  • Renal replacement therapy
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14
Q

What are the signs and symptoms of impaired toxin removal by the kidneys? (Uraemia)

What investigations can be conducted to confirm this?

What are the management strategies?

A

Symptoms:

  • Nausea
  • Vomiting
  • Hiccups
  • Neuropathy
  • Pruritis
  • Malaise

Signs:

  • Encephalopathy
  • Pericarditis
  • Bleeding tendency

Investigations: U&Es

Management:

  • Renal replacement therapy
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15
Q

What are the signs and symptoms of impaired blood pressure control by the kidneys?

What investigations can be conducted?

What are the management strategies?

A

Signs:

  • Hypertensive urgency

Symptoms:

  • Headache
  • Visual disturbance

Investigations: BP monitoring

Management:

  • Antihypertensives
  • Renal replacement therapy
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16
Q

What are the signs and symptoms of impaired acid-base balance by the kidneys?

What investgations can be conducted for this?

What are the management strategies?

A

Signs: N/A

Symptoms:

  • Anorexia
  • Lethargy

Investigations:

  • pH and bicarbonate

Management:

  • PO or IV sodium bicarbonate
  • Renal replacement therapy
17
Q

What are the signs and symptoms of impaired erythropoietin production by the kidneys?

What investigations can be conducted for this?

What are the management strategies?

A

Symptoms:

  • Dyspnoea
  • Chest pain
  • Lethargy

Signs:

  • Pallor

Investigations:

  • FBC

Management:

  • EPO replacement
  • Blood transfusion
18
Q

What are the signs and symptoms of impaired electrolye balance by the kidneys? (Hyperkalaemia)

What investigations can be conducted for this?

What are the management strategies?

A

Signs:

  • Pulse: irregularly irregular

Symptoms:

  • Palpitations

Investigations:

  • ECG
  • U&Es

Management:

  • Low potassium diet
  • Renal replacement therapy
19
Q

What are the signs and symptoms of impaired vitamin D activation by the kidneys?

What investigations can be conducted for this?

What are the management strategies?

A

Signs:

  • Osteomalacia
  • High phosphate
  • Hypocalcaemia

Symptoms:

  • Aches and pains
  • Bone deformities
  • Fractures

Investigations:

  • Calcium
  • Phosphate
  • Vitamin D
  • Parathyroid hormone

Management:

  • Phosphate binders
  • Calcium replacement
  • Vitamin D replacement
  • Calcitonin
20
Q

What are the complications of CKD?

What investigations can be used to confirm each?

A

BP check: Hypertension

Fundoscopy: Hypertensive retinopathy

ECG: arrhythmias

U&Es: GFR severity, uraemia, hyperkalaemia

FBC: anaemia

Clotting: uraemia

Bicarb and pH: acid-base balance

X-ray: fractures/ osteomalacia

21
Q

What foods should be avoided in a low potassium diet?

A
  • Bananas
  • Coffee
  • Apricots
  • Potatoes
  • Kiwis
  • Avocados
22
Q

Name 3 types of renal replacement therapy

A

Haemodialysis

Peritoneal dialysis

Renal transplant

23
Q

What are the advantages and disadvantages of haemodialysis?

A

Advantages:

  • Bridge
  • Quick to set up
  • Routine

Disadvantages:

  • Fistula
  • Invasive
  • Regular appointments
  • Infections
24
Q

What are the advantages and disadvantages of peritoneal dialysis?

A

Advantages:

  • Home
  • Flexible
  • Less invasive
  • Can be done overnight

Disadvantages:

  • Storage
  • Time
  • Dexterity
  • Surgical insertion
  • Infections
25
Q

What are the advantages and disadvantages of renal transplant?

A

Advantages:

  • Independence
  • No dialysis

Disadvantages:

  • Immunosuppression for life
  • Surgery risk
  • May be difficult to find a match
  • Rejection risk
  • Follow up
26
Q

Describe stage 1 of CKD

A

Stage 1:

  • Kidney damage with normal kidney function
  • eGFR >90
  • 90-100% of kidney function intact
27
Q

Describe stage 2 of CKD

A

Kidney damage with mild loss of kidney function

60-89% of renal function intact

eGFR 60-89

28
Q

Describe stage 3a of CKD

A

Mild to moderate loss of kidney function

eGFR 59-45

45-59% of renal function intact

29
Q

Describe stage 3b of CKD

A

Moderate to severe loss of kidney function

eGFR 30-44

30-44% renal function intact

30
Q

Describe stage 4 of CKD

A

Severe loss of kidney function

eGFR 15-29

15-29% of kidney function intact

31
Q

Describe stage 5 of CKD

A

Renal failure

eGFR less than 15

Less than 15% renal function intact

AC1 (32 decks)

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