CKD Flashcards
What is CKD?
Long standing and progressive impairment in renal function
>3 months evidence of kidney damage (proteinuria, haematuria or anatomical abnormality) and/or impaired GFR
Patients at risk hyperrenisve or diabetic should be screened regularly
What are the causes of CKD?
Congenital and inherited disease: Polycystic kidney disease (adult and infantile forms) Tuberous sclerosis Congenital obstructive uropathy Glomerular disease: Primary glomerulonephritides Secondary glomerular disease- diabetes mellitus, amyloidosis, SLE Vascular disease: Hypertensive nephrosclerosis (common in black Africans) Reno-vascular disease Small and medium-sized vessel vasculitis Tubulointerstitial disease Urinary tract obstruction
What are the symptoms and signs of CKD?
Anaemia- pallor, lethargy
CNS- confusion, coma, fits
Platelet abnormality- epistaxis, bruising
Skin- pigmentation, pruritus
CVS- uraemic pericarditis, hypertension, PVD, heart failure
GI- anorexia, nausea, vomiting, diarrhoea
Renal- nocturne, polyuria, oedema
Endocrine- amenorrhoea, erectile dysfunction, infertility
Mineral and bone disorder- osteoporosis, osteomalacia, hyperparathyroidism, osteosclerosis, dynamic bone disease
Polyneuropathy
What are the complications of CKD?
Polyneuropathy- paraesthesiae and weakness
Autonomic dysfunction- postural hypotension and disturbed GI mobility
CVD- MI and cardiac failure (most common cause of death)
Peptic ulceration, acute pancreatitis, increased incidence of malignancy
How is CKD defined from AKI?
Normochromic anaemia, small kidneys and renal osteodystrophy are in favour of CKD
What are the complications of long term dialysis?
CVD as a result of atheroma
Sepsis- s. aureus infection in peritoneal dialysis (endocarditis)
Amyloidosis- carpal tunnel, joint pains (shoulders)
What is polycystic kidney disease?
Autosomal dominant
Cysts increase in size with age and lead to renal enlargement and destruction of normal tissue
Irregular kidneys, hypertension and hepatomegaly
USS for definitive diagnosis
What are the clinical features of polycystic kidneys disease?
Acute loin pain due to cyst haemorrhage or infection, or urinary tract stone
formation (uric acid calculi occur more commonly)
Abdominal discomfort caused by renal enlargement
Hypertension
Progressive renal impairment. End-stage renal failure develops in about
50% of patients by 50–60 years of age.
Liver cysts (pancreas, spleen, ovary)
Subarachnoid haemorrhages
Mitral valve prolapse in 20%
How does diabetes cause CKD?
Excess glucose attaches to the walls on the efferent arteriole (non-enzymatic glycation)
Stiff and narrow (hyaline arteriosclerosis)
Increased pressure, hyper-filtration
What occurs with calcitriol with CKD?
Produced by hydroxylation of calcidiol in the PCT
People with CKD have reduced hydroxylation capacity - less calcitriol is produced
Leading to hypocalcaemia
What are the features of rhabdomyolysis?
Acute kidney injury with disproportionately raised creatinine
Elevated creatine kinase (CK)
Myoglobinuria
Hypocalcaemia (myoglobin binds calcium)
Elevated phosphate (released from myocytes)
Hyperkalaemia (may develop before renal failure)
metabolic acidosis
How do differentiate an AKI from dehydration?
AKI would present with a proportionally greater rise in creatinine than urea (very high creatinine)
Dehydration rise in urea is proportionally bigger than rise in creatinine
What are the complications of haemodialysis?
Site infection
Endocarditis
If plasma renin is high in uncontrolled hypertension think?
Renal artery stenosis
If it’s normal could be cushing’s/phaeochromocytoma
What are the extra renal manifestations of PKD?
Liver cysts (70% - the commonest extra-renal manifestation): may cause hepatomegaly Berry aneurysms (8%): rupture can cause subarachnoid haemorrhage Cardiovascular system: mitral valve prolapse, mitral/tricuspid incompetence, aortic root dilation, aortic dissection Cysts in other organs: pancreas, spleen; very rarely: thyroid, oesophagus, ovary
