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Phase 2 Metabolic > CKD > Flashcards

CKD Flashcards

1
Q

Define Chronic Kidney Disease

A

abnormal kidney structure and/or function which is present for >3 months

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2
Q

Name 3 congenital causes of CKD

A
  1. polycystic kidney disease
  2. medullary cystic disease
  3. congenital obstructive uropathy
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3
Q

Name glomerular causes of CKD

A

primary glomerular disease - FSGS

secondary glomerular disease - lupus, amyloidosis, accelerated HTN, haemolytic uraemic syndrome, sickle cell disease, diabetic glomerulosclerosis

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4
Q

Name 3 vascular causes of CKD

A
  • hypertensive nephrosclerosis
  • renovascular disease
  • diabetic nephropathy
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5
Q

Which are the 2 most common causes of CKD?

A
  1. Diabetes

2. Hypertension

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6
Q

in which ethnic group is CKD more common?

A

Afro-caribbeans

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7
Q

Describe the stages of CKD

A
  1. kidney damage with normal/increased GFR (≥90)
  2. GFR 89-60
    3a. GFR 59-45
    3b. GFR 44-30
  3. GFR 29-15

5 - GFR ≤15

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8
Q

What is end stage kidney disease defined by (symptoms or GFR)?

A

Symptoms!

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9
Q

When do symptoms in CKD typically appear?

A

when there is significant uraemia (>40mmol/L)

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10
Q

Describe symptoms of uraemia

A
  • malaise
  • characteristic metallic taste
  • anorexia and weight loss
  • mild cognitive decline > confusion > myoclonic jerks > seizure > coma
  • insomnia
  • impaired concentrating ability > polyuria and nocturia
  • pruritis
  • parasthesia
  • bone pain
  • salt and water retention
  • hypertension
  • anaemia
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11
Q

Describe clinical signs indicative of uraemia

A
  1. short stature (if hx of CKD in childhood)
  2. pallor
  3. increased photosensitive pigmentation
  4. signs of fluid overload
  5. glove and stocking sensity loss
  6. encephalopathic flap
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12
Q

Which tests are useful in the investigation of CKD

A
  1. urinalysis
  2. urine microscopy
  3. urine biochemistry (urine osmilarity; electrophoresis (paraprotein)
  4. serum biochemistry (U&E, eGFR, creatinine, blood glucose and HbA1c)
  5. imaging
    • USS to establish renal size and exclude hydronephrosis
    • CT for investigation of calculi and obstruction
    • MR - vascular disease
  6. Renal biopsy
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13
Q

Name complications of CKD

A
  1. Anaemia
  2. CKD bone disorder
  3. Cardiovascular disease
  4. Pruritis
  5. Gout
  6. Hyperparathyroidism
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14
Q

Why does anaemia occur in CKD?

A
  • EPO deficiency
  • retention of Bone Marrow toxins
  • red cells have a shortened lifespan in uraemia
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15
Q

Describe the pathophysiology of CKD bone disorder

A
  • impaired production of active Vitamin D > reduced absorption of calcium from GI tract and kidney filtrate
  • phosphate accumulation due to impaired renal excretion
  • PTH released in order to increase serum calcium - increased osteoclast activation
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16
Q

Why is the risk of CVD raised in CKD?

A
  • Hypertension
  • Diabetes (commonest cause of CKD)
  • uraemia can lead to dyslipidaemia
  • raised serum Ca and phosphate + uraemia increases risk of coronary artery calcification
17
Q

Describe how CKD can cause secondary and tertiary hyperparathyroisism

A
  • Lack of vitamin D conversion and inadequate phosphate excretion leads to increased PTH secretion to promote renal excretion of phosphate (but has no effect)
  • raised PTH unable to increase phosphate excretion, but it stimulates osteoclasts, raising Ca and phosphate further - positive feedback leading to more PTH secretion
  • Eventually, secondary hyperparathyroidism can lead to tertiary hyperparathyroidism
18
Q

What are the general measures used to manage CKD

A
  1. address any underlying modifiable cause
  2. address CV risk factors
  3. avoid nephrotoxic drugs
  4. reduce dose of any renally excreted drugs
  5. salt restriction
  6. Exogenous EPO and calcium suppliments
  7. restrict dietary phosphate and give phosphate binder
  8. calcium receptor analogue - ciacalet
  9. sodium bicarbonate
  10. restrict dietary potassium
19
Q

What is used as renoprotection for CKD

A
  • maintain BP <120/80
  • achieve proteinuria <0.3
  • ACEi/ARBs
    • must monitor K+
  • loop/thiazide diuretic
  • statins
  • good diabetic control
20
Q

What factors should warrant consideration for starting dialysis

A
  • eGFR 5-7
  • inability to control volume status leading to fluid overload
  • inability to control BP
  • acid-base/electrolyte abnormalities
  • cognitive impairment/impact of symptoms of uraemia on daily living
21
Q

Which nephrotoxic drugs should be avoided in CKD?

A
  • tetracyclines
  • gentamycin
  • NSAIDs
  • potassium sparing agents

Phase 2 Metabolic (12 decks)

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