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Long-term Conditions > CKD > Flashcards

CKD Flashcards

1
Q

What is CKD?

A

Reduction in kidney function or structural damage present for more than 3 months
Associated with health implications

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2
Q

What is GFR?

A

Glomerular filtration rate

Rate at which blood is filtered in the kidneys

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3
Q

What is a normal GFR?

A

100-200 ml/minut/1.73m squared

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4
Q

What are the two excretory functions of the kidney

Effects of CKD?

A 
Inorganic substances (e.g. potassium & phosphate)
Organic (urea, creatinine)

CKD: hyperkalaemia, N&V

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5
Q

What are the homeostatic functions of the kidneys?

Effects of CKD?

A

Normal: fluid balance
CKD: fluid retention/ polyuria/ nocturia

Normal: BP
CKD: HTN, pulmonary oedema

Normal: acid-base balance
CKD: metabolic acidosis

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6
Q

What are the endocrine functions of the kidneys?

Effects of CKD?

A

Erythropoietin production
CKD: anaemia

Bone metabolism
CKD: bone minderal disorders, low serum calcium, bone pain

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7
Q

What are the 3 main functions of the kidneys?

A

Excretory
Homeostasis
Endocrine

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8
Q

When should you suspect CKD?

think creatinine & eGFR

A

Incidental finding of raised serum creatinine

Or eGFR <60

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9
Q

Normal eGFR

A

> 90

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10
Q

eGFR: Mild reduction (or not young adult)

A

60-89

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11
Q

What is mild-mod CKD?

What stage?

A

45-59

Stage 3a

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12
Q

What is mod-severe CKD?

What stage?

A

30-44

Stage 3b

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13
Q

What is severe reduction of eGFR?

What stage?

A

15-29

Stage 4

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14
Q

What eGFR means renal failure?

A

<15 (stage 5)

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15
Q

What are possible findings on urine dip?

A

Proteinuria
Persistent haematuria
Urine sediment abnormalities

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16
Q

What defines persistent haematuria?

A

2 of 3 urine dipsticks positive for blood

17
Q

Give some general symptoms you should ask about

A

Lethargy, itch, breathlessness, cramps, bone pain, anorexia, vomiting

18
Q

Give 7 nephrotoxic drugs

AA B C D LN

A 
aminoglycosides
ACEi
Bisphosphonates
Ciclosporins
Diuretics
Lithium
NSAIDs
19
Q

How may someone present if they are uraemic?

A

Weakness, fatigue, muscle atrophy, tremors, abnormal mental function, metabolic acidosis

20
Q

If CKD is suspected, what blood tests should be arranged?

What should people not do before the blood test?

A

Serum creatinine & eGFR

Advise not to eat meat for 12 hours before

21
Q

If initial eGFR is <60 what should be done?

A

Repeat the test in 2 weeks

If <60 on repeat (with no evidence of AKI) repeat in 3 months

22
Q

What test is used to calculate ACR?

A

ACR (albumin: creatinine ratio)

Early morning urine sample

23
Q

How and when should CKD be diagnosed?

A

Persistent reduction in renal function (eGFR <60) and/ or proteinuria (urinary ACR >3)
FOR >3 MONTHS

24
Q

What is the most common cause of CKD

A

Diabetes

25
Q

How does diabetes cause CKD?

A

Glycation of the efferent arteriole. Increased pressure leads to hyperfiltration. This causes glomerulosclerosis

26
Q

How does HTN cause CKD?

A

Narrow arterial lumen means less blood & oxygen to the kidney. Leads to ischaemic glomerular injury & glomerulosclerosis

27
Q

Give 3 other causes of CKD

A 
Systemic disease (e.g. lupus/ RA)
Infection (HIV)
Medication (e.g. long term NSAID use)
28
Q

What is defined accelerated progress of CKD?

A

Sustained decrease in eGFF of 25% or more from the baseline

29
Q

When should a patient with CKD be referred to a renal specialist? (4)

A

eGFR <30
Significant progression
Significant proteinuria
Complications

30
Q

When is dialysis usually needed?

A

When eGFR is <10

31
Q

What is dialysis?

A

Replaces the role of the kidneys: Diffusion of solutes between blood & dialysis fluid, removal of excess salt & water.

32
Q

What are the two kinds of dialysis?

A

Haemodialysis

Peritoneal dialysis

33
Q

How does haemodialysis work?

A

Access via fistula

4 hours 3 times a week as an outpatient or in hospital

34
Q

How does peritoneal dialysis work?

A

Home therapy

Diffusion of solutes between blood in peritoneal capillaries & dialysis fluid in peritoneal cavity

35
Q

What are the two kinds of peritoneal dialysis?

A

CAPD (continuous ambulatory peritoneal dialysis) 4 x 2-3 litre exchanges per day

APD (automated PD) several exchanges by machine whilst asleep at night

36
Q

What are 3 options for end stage renal failure?

A

Conservative care
Dialysis
Renal translpant

37
Q

Why are most patients not suitable for transplantation?

A

Co-morbidities

38
Q

What do patients require life-long after transplantation?

A

Life long immunosuppression

Long-term Conditions (21 decks)

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