CKD Flashcards
what investigative results suggest CKD?
a glomerular filtration rate less than 60 mL/minute/1.73 m²,
the presence of one or more of the following markers of kidney damage: albuminuria/proteinuria,
urine sediment abnormalities (e.g., haematuria),
electrolyte abnormalities due to tubular disorders
abnormalities detected by histology
structural abnormalities detected by imaging
history of kidney transplantation
how long does reduce kidney function need to be present to be classified as CKD?
Diagnosis is determined only by laboratory studies: proteinuria or haematuria, and/or a reduction in
the glomerular filtration rate, for more than 3 months’ duration.
what are the most common causes of CKD?
diabetes mellitus (minimise risk with glycemic control)
hypertension
when is CKD usually detected?
usually in the later stages
what is the epidemiology of CKD?
The incidence is rising and is thought to be due to an
ageing population; a higher incidence of diseases such as diabetes and hypertension, which are the most
common causes in the adult population; and an increased incidence of glomerular disorders such as focal
segmental glomerulosclerosis.
Black people, Hispanic people, and those with a family member who has a diagnosis of kidney disease have a higher prevalence than the general population.
Additionally, individuals with an episode of acute kidney injury are most likely to be at risk for chronic kidney injury and end-stage kidney disease in the future.[
whats the pathophysiology of CKD?
In response to renal injury, there is thought to be an increase in intra-glomerular pressure with
glomerular hypertrophy, as the kidney attempts to adapt to nephron loss to maintain constant
glomerular filtration.
increase in glomerular permeability to macro-molecules such as transforming growth factor-beta
(TGF-beta), fatty acids, pro-inflammatory markers of oxidant stress, and protein may result in toxicity
to the mesangial matrix, causing mesangial cell expansion, inflammation, fibrosis, and glomerular
scarring.
Additionally, renal injury results in an increase in angiotensin II production, causing an upregulation of
TGF-beta, contributing to collagen synthesis and renal scarring within the glomerulus.
Both the structural alterations and accompanying biochemical, cellular, and molecular changes seem
to account for progressive renal scarring and loss of kidney function.
All forms of CKD are also associated with tubulo-interstitial disease; the exact mechanism of injury is
not known, but is thought to be secondary to a reduction in blood supply in addition to an infiltration of
lymphocytes and inflammatory mediators that result in interstitial fibrosis and tubular atrophy.
how is CKD classfied?
G1 GFR ≥90: normal or high
• G2 GFR 60 to 89: mildly decreased
• G3a GFR 45 to 59: mildly to moderately decreased
• G3b GFR 30 to 44: moderately to severely decreased
• G4 GFR 15 to 29: severely decreased
• G5 GFR <15: kidney failure.
who is screened for CKD?
recommendations to screen those considered high-risk and include all individuals with diabetes and hypertension aged <50 years, and all of those aged >50 years, with an annual urinalysis and serum creatinine.
Other high-risk populations, such as those with a family history of kidney disease, should also be considered in the screening programme
what symptoms/history factors can indicate CKD?
- fatigue
- oedema
- nausea with/without vomitting
- pruritis
- restless leg
- anorexia
- arthralgia
- enlarged prostate gland
- foamy urine
- coca cola urine
what are your differentials?
- nephrotic syndrome
- glomerulonephritis
- diabetic kidney disease
how is CKD treated?
G1 - G4 categories
1st line = ACE inhibitors/ Ang II antagonist
2nd line = non dihydropyridine CCB
modify CV risk factors
education
Treatment of anaemia with the use of erythropoietin-stimulating agents is recommended for patients with
CKD after other causes of anaemia such as iron, vitamin B12, folate, or blood loss have been excluded.
Patients with CKD frequently have iron deficiency, and iron replacement should be considered as a goal
of treatment.
catergory 4, consider RRT and edcuate
category 5, initiate RRT
