CKD Flashcards
What is CKD?
Chronic kidney disease
Irreversible and progressive loss of renal function over time
What are the stages of CKD?
Stage 1 - GFR >/=90 Stage 2 - 60= GFR < 89 Stage 3 - 30= GFR <59 Stage 4 - 15= GFR <29 Stage 5 GFR<15
What can cause CKD?
Diabetes Hypertension Immunologic - glomerulonephritis Infection - pyelonephritis Genetic - PCKD, Alports
How is CKD investigated?
GFR
Bloods - U+Es, CRP
USS
Kidney biopsy
What are modifiable risk factors for CKD?
Lifestyle
Smoking
Obesity
Lack of exercise
What are common effects of CKD?
Hypertension Hyperkalaemia Acidosis Anaemia Mineral bone disease
How is hypertension managed in CKD?
Anti-hypertensives
Diuretics
Fluid restriction
How is hyperkalaemia managed in CKD?
Stop ACEi / ARB
Avoid drugs that increase K+
What are symptoms of acidosis?
Headache Sleepiness Confusion Shortness of breath Nausea
How is acidosis managed in CKD?
Oral NaHCO3 tablets
What causes anaemia in CKD?
High hepcidin Reduced EPO production Iron deficiency Mineral bone disease Bone marrow suppression by uraemia
How is anaemia managed in CKD?
Check iron stores
- replace iron
Check ESA
How does CKD cause mineral bone disease?
Reduce calcitriol
- reduces intestinal Ca2+ absorption
- increases bon resorption
Reduce PO4 excretion
How is mineral bone disease managed in CKD?
Reduce phosphate intake
Phosphate binder s
1-a-calcidol
What is ESRD?
End stage renal disease
GFR <15mls/min
What are the symptoms of ESRD?
Tiredness Difficulty sleeping Oedema N+V Increased infection risk
What are the options in ESRD?
Haemodialysis
Peritoneal dialysis
Transplant
What are the advantages of HD?
Less responsibility
Time off
What are the disadvantages of HD?
4 hours
Restriction on fluid/food intake
What are contra-indications of HD?
Failed vascular access
Heart failure
Coagulopathy
What are complications of HD?
Infections
Thrombosis
CVS instability
What are advantages of PD?
Independence
Less fluid/food restrictions
Easier travel
What are disadvantages of PD?
Frequent daily changes
Responsibility
What are contra-indications of PD?
Failure of peritoneal membrane
Adhesions
Obesity
What are complications of PD?
Peritonitis
Ultrafiltration failure
Leaks
Hernia development
