CKD Flashcards
What is CKD?
Chronic kidney disease
Presence of kidney damage for more than 3 months (eGFR<60)
What is evidence for CKD?
Albuminuria Proteinuria Haematuria Structural kidney abnormalities Glomerulonephritis
What can cause CKD?
Diabetes Hypertension Glomerulonephritis Polycystic kidney disease Chronic pyelonephritis Obstructive nephropathy
What is stage 1 CKD?
eGFR >90 with evidence of kidney damage
What is stage 2 CKD?
eGFR 60-89 with evidence of kidney damage
What is stage 3a CKD?
eGFR 45-59
What is stage 3b CKD?
eGFR 30-44
What is stage 4 CKD?
eGFR 15-29
What is stage 5 CKD?
eGFR <15
What is PKD?
Polycystic kidney disease
- genetic disease characterised by multiple cysts on the kidneys
What is the inheritance of PKD?
Autosomal dominant
How can CKD present?
Early CKD has no symptoms
Later
- anorexia
- nausea
- vomiting
- pruritus
- oedema
How do you investigate suspected CKD?
Urine ACR
Bloods
- FBC
- U+Es
- phosphate
- calcium
- immunoassay (complement, ANCA, anti GBM)
USS KUB
How do you manage CKD?
Treat underlying cause
BP control
Treat electrolyte abnormalities
Renal replacement therapy
What are the complications of CKD?
Anaemia of CKD
Mineral + bone disease
Secondary/tertiary hyperparathyroidism
Hypertension
What type of anaemia is associated with CKD?
Normocytic - anaemia of chronic disease
What can cause anaemia in CKD?
Reduced erythropoietin production
Iron deficiency
How do you manage anaemia in CKD?
Measure
- B12
- folate
- ferritin
- iron
Replace anything that is deficient
Aim for Hb of 100-120
How can CKD cause mineral bone disease?
Increased ALP + PTH
Increased phosphate
Decreased serum calcium
How is CKD-mineral bone disease diagnosed?
1 or more of
- abnormality of calcium, phosphate, ALP, PTH or vit D metabolism
- vascular or soft tissue mineralisation
- abnormality in bone turnover, metabolism, volume or strength
What are risk factors for CKD?
Increasing age HTN DM Smoking Nephrotoxic medications
What are features of CKD?
Pruritus Anorexia Nausea Oedema HTN
How is CKD staged?
GFR
Urine ACR
What is an ACR stage one score?
ACR <3mg/mmol
What is an ACR stage two score?
ACR 3-70mg/mmol
What is an ACR stage three score?
ACR >70mg/mmol
When should a patient with CKD be referred to a specialist?
4 variable kidney risk assessment >5% ACR > 70mg/mmol ACR >30mg/mmol + haematuria GFR decreases by >25% or >15 in a year Persisting hypertension despite 4 antihypertensives
What is the BP aim in a patient with ACR >70mg/mmol?
<130 systolic
<80 diastolic
What is the BP aim in a patient with ACR <70mg/mmol?
<140 systolic
<90 diastolic
How is BP controlled in CKD patients?
RAAS antagonists
- ARBs
- ACEi
How is high phosphate managed in CKD patients?
Phosphate binders
- calcium acetate (not if calcium is high)
- sevelamer acetate
