CKD Flashcards
What is CKD stage 1?
GFR 90+ but other long-term evidence of kidney disease e.g.
proteinurea/haematuria
Genetic diagnosis
Structural abnormality
What is CKD stage 2?
GFR 60-89 + other long-term evidence of kidney disease e.g.
proteinurea/haematuria
Genetic diagnosis
Structural abnormality
What are the stages of CKD 3+?
3: GFR 30-59
4: 15-29
5: <15
What re the investigations for CKD?
Bloods: FBC, U&Es, LFTs, calcium, phosphate, PTH levels, glucose
Urinalysis & MCS - quantify proteinurea, exclude infection, look for casts
24h urinary protein/creatinine clearance - assess severity/nephrotic syndrome
CXR if pulmonary oedema suspected
Renal USS is obstructive causes suspected
DTPA scan - investigate vascular supply
Renal biopsy if cause unknown
Bone imaging - renal bone disease
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)
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 causes of anaemia in CKD?
Normochromic normocytic anaemia
Reduced erythropoietin levels
Reduced absorption of iron
Anorexia/nausea due to uraemia
Reduced red blood cell survival
Stress ulceration leading to chronic blood loss
blood loss due to capillary fragility and poor platelet function
What indicated whether the kidney disease is chronic or acute?
Hypocalcaemia is seen in chronic disease
Renal failure results in reduced levels of metabolised Vit D
Which chronic conditions present with normal/enlarged kidneys?
autosomal dominant polycystic kidney disease
diabetic nephropathy
amyloidosis
HIV-associated nephropathy
