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Y4: Nephrology > CKD > Flashcards

CKD Flashcards

1
Q

What is the definition of CKD?

A
  • Irreversible deterioration in renal function
    • Develops over a period of years
  • Manifests as biochemicala abnormality
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2
Q

How can CKD be classified?

A
  • Based on:
    • GFR category
    • Albuminuria
    • Aetiology
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3
Q

What are the problems with using formula to grade renal disease by eGFR?

A
  • Large discrepancies between individuals
  • Can be altered be eating a high protein meal
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4
Q

Why is GFR preferred over serum creatinine for indicating renal impairment?

A

People with low muscle mass (the elderly) can have normal serum creatinine despite a significant drop in GFR

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5
Q

Clinical features of CKD?

A
  • Elevated urea and creatinine
  • Nocturia
  • Fatigue, dyspnoea
  • Pruritis, N/V
  • Kussmaul breathing (from metabolic acidosis)
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6
Q

Describe the classification system for CKD using GFR?

A
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7
Q

Describe the classification system for CKD using albuminuria?

A
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8
Q

Describe the classification system for CKD using the underlying disease?

A
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9
Q

What are the most common causes of CKD in the UK

A
  1. Diabetes
  2. Glomerulonephritis
  3. Hypertension/renovascular disease
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10
Q

What determines the prognosis in someone with CKD?

A
  • Reduced GFR and albuminuria are independently associated with higher risk of:
    • All cause Mortality
    • CV mortality
    • Progressive kidney disease and kidney failure
    • AKI
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11
Q

Importance of trimethoprim in CKD?

A
  • Trimethoprim alters creatinine concentration but not GFR
    • Reversible increases serum creatinine, by inhibiting its renal tubular secretion
    • Without a change in glomerular filtration rate
    • Causes a decrease in calculated creatinine clearance
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12
Q

What are the investigations that can be performed for CKD?

A
  • Blood:
    • U&Es, Hb, glucose, Ca2+, PO43-, PTH, ANA, ANCA, antiphospholipi antibodies
    • Paraprotein, complement, cryoglobulin, anti-GBM
  • Urine:
    • Dipstick, MC&S, A:CR, P:CR, Bence jones protein
  • Imaging:
    • US (small kidney exceptive amyloid & myeloma)
  • Histology
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13
Q

Describe the monitoring which should be performed for someone with CKD?

A
  • GFR & albuminuria annually
    • If high risk, biannually
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14
Q

What are the risk factors for a decline in renal function in CKD?

A
  • DIM(I)N(I)SSH
    • DM
    • Infection
    • Metabolic disturbance
    • (I)
    • NSAIDs
    • (I)
    • Smoking
    • Superimposed AKI
    • Hypertension
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15
Q

What does managment of CKD require?

A
  • Appropriate referral to nephrology
  • Treatment to slow renal disease progression
  • Treatment of renal complications of CKD
  • Treatment of other complications of CKD
  • Preparation for renal replacement therapy
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16
Q

When should a referral to nephrology be considered in someone with CKD?

A
  • Stage G4 and G5 CKD
  • Moderate proteinuria A:CR >70mg/mmol
  • Proteinuria A:CR >30mg/mmol with haematuria
  • Declining eGFR
  • BP poorly controlled w/ >3 antihypertensives
  • Known or suspected rate/genetic cause of CKD
17
Q

Describe treatments to slow renal disease progression in CKD?

A
  • Target BP < 140/90
    • DM BP <130/80
  • ACEi/ARB
    • Do not combine drugs due to hyperkalaemia risk
  • Low salt intake . (2g sodium)
  • Target Hb1AC of around 53 mmol/mol
  • Exercise, healthy weight and smoking cessation advice
18
Q

Name some renal complications of CKD?

A
  • Anaemia
  • Acidosis
  • Oedema
  • Bone-mineral disorders
  • Restless legs/cramps
  • Diet
19
Q

Describe the treatment of anaemia as a complication of CKD?

A
  • Iron, B12 and folate therapy if required
  • Do not miss chronic blood loss
  • If Hb <110g/L
    • Consider erythropoeitin stimulating agent
20
Q

Describe the treatment of acidosis as a complication of CKD?

A
  • If eGFR <30 and serum bicarbonate <20mmol/L
    • Consider sodium bicarbonate supplements
    • Caution in hypertensive and fluid overloaded patients due to sodium component
21
Q

Describe the treatment of oedema as a complication of CKD?

A
  • Restrict fluid and sodium intake
  • High dose loop diuretics may be required
    • +/- thiazide diuretic
22
Q

How does CKD induce bone-mineral disorders?

A
  • Two components:
    • Impaired excretion of phosphate
      • => Phosphate triggers PTH release
    • Impaired ability to convert vitamin D to its active form
      • => Impaired absorption of calcium
23
Q

Describe the treatment of bone-mineral disorders as a complication of CKD?

A
  • Dietary restrictions of phosphate containing foods
    • Milk, cheese, eggs
  • Phosphate binders
    • Calcium carbonate
  • Active vitamin D metabolites if hypocalcaemia occurs
24
Q

Describe the treatment of restless legs/cramps as a complication of CKD?

A
  • Exclude iron deficiency as exacerbating factor
  • Give sleep hygiene advice
  • Gabapentin/pregabalin/dopamine agonists for severe cases
    • SEs: falls cognitive impairment, impulse-control disorder
25
Q

Describe the treatment of diet as a complication of CKD?

A
  • Dietician input
  • Specifically protein intake, K+, phosphate restriction (dairy)
26
Q

Describe the treatment of CVD as a complication of CKD?

A
  • Higher CVD risk due to hypretension, inflammation, oxidative stress etc
    • Antiplatelets: aspirin
    • Atorvastatin 20mg for prevention of CVD
    • End stage renal failure can influence troponin and BNP values
27
Q

Describe the prearations for renal replacement therapy in CKD?

A
  • Prep should begin when risk of renal failure is 10-20% within a year
  • Referral to nephrology should be more than 1 year before RRT is required
  • Suitable patients hsould be listed for a deceased donor transplantation
28
Q

Name some drugs which are excreted renally therefore should have their administrations altered?

A
  • Aminoglycosides
  • Penicillins, cephalosporins
  • Heparin
  • Lithium
  • Opiates
  • Digoxin
  • *Loading doses should not be changed*
29
Q

Where do loop diuretics have their action?

A
  • Inhibit sodium-potassium-chloride cotransporter in the thick ascending limb
  • Transporter normally reabsorbs 25% of the sodium load
    • More effective than thiazide diuretics
30
Q

Where do thiazide diuretics have their action?

A
  • Inhibit the sodium-chloride transporter in the distal tubule
  • Normally reabsorbs 5% of filtered sodium
31
Q

Where do potassium sparing diuretics have their action?

A
  • Antagonize the actions of aldosterone at the distal segment of the distal tubule
    • More sodium to pass into the collecting duct and excreted in urine
32
Q

What is end-stage renal disease (ESRD)?

A
  • When death is likely without RRT
    • CKD stage 5
33
Q

What can be used to manage proteinuria in CKD?

A

ACEi / ARBs

Y4: Nephrology (8 decks)

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