CKD Flashcards
What is CKD?
Reduction in GFR <60ml/min/1.73m^2 >3m
Kidney damage = haematuria/ proteinuria, abnormalities on imaging
What can cause CKD?
DM** HTN** GN PKD Obstructive uropathy AKI
What are the causes of obstructive uropathy?
Myeloma
Renal tumour
BPH
Stones
Who should be offered (annual) CKD testing?
DM, HTN, AKI, CVD, obstructive uropathy, structural renal tract disease, multi-system disease involving kidney (SLE), FH of ESRF/PKD, opportunistic detection of haematuria
What are the stages of of CKD?
Stage 1:
- Kidney damage GFR >90
Stage 2:
- Kidney damage GFR 60-89
Stage 3a:
- GFR 45-59
Stage 3b:
- GFR 30-44
Stage 4:
- GFR 15-29
Stage 5: ESRF
- GFR <15
- Needs RRT
Which is the most common CKD stage?
Is stage 5 common?
Stage 3
No, stage 5 is not common
If U&E is normal and there is no proteinuria in stages 1 and 2, is this considered CKD?
No
Which factors affect the eGFR result?
Why?
- Pregnancy
- Body builders, amputees
- Eating red meat 12h prior to sample being taken
Creatinine is higher?
How does it present?
Early stages are ASX
When SX, which SX are present?
Malaise Loss of appetite Insomnia Fatigue, pallor - anaemia ( lack of EPO) Oedema (salt + water retention) Uraemia SX - nausea, pruritus, anorexia Nocturia, polyuria Oliguria - Advanced CKD, indicative of ESRF
What signs might a pt have?
Increased skin pigmentation Excoriation Pallor HTN Postural hypoTN Peripheral oedema Pleural effusion Peripheral neuropathy
What is uraemia?
Raised level of urea in blood
What are the SX of uraemia?
Metallic taste Anorexia N/V Pruritus Confusion
What are the signs of uraemia?
Uraemic tinge - grey/yellow
Pericarditis - pericardial friction rub
Seizures
Bleeding
What IX are needed?
Creatinine - high eGFR ACR - >= 3mg/mmol = proteinuria Urine dip - haematuria +1, glycosuria, casts Renal USS - small kid,
Other:
FBC - anaemia, normochromic normocytic
U&E - raised urea, low Na, high K
Blood glucose - DM
Serology - AAB
ECG - underlying CV abnormalities, hyperK
Bone profile - hypoCa, hyperPi, hyperPTH, high ALP
What ACR values indicate proteinuria and when should you repeat?
3 - 70 mg/mmol
- repeat next early morning
If >70, no need for a repeat
What are the complications of CKD?
Anaemia Renal osteodystrophy CVD Protein malnutrition Metabolic acidosis HyperK Pulmonary oedema
How is CKD MX?
STOP nephrotoxic drugs RX underlying cause RX HTN RX DM Statins, stop smoking, wt loss - CV risk Epoeitin alfa + oral ferrous sulfate Renal replacement therapy
How is anaemia caused and how can it present?
Caused by iron deficiency/ EPO deficiency
Signs and SX
- Tachycardia
- Fatigue
- Pallor
- Aortic flow murmur - soft ejection systolic murmur that doesn’t radiate
