CKD and Complications Flashcards
What is CKD?
Abnormalities of kidney function or structure present >3 months
What are the symptoms of CKD?
- Fatigue
- Muscle cramps
- Bone pain
- Weight loss
- SOB
- Urinary symptoms
What makes people more at susceptible to developing a CKD?
o More common in women o Men more likely to progress to ESRD o Increasing age o Family Hx o Reduced kidney mass o Low birth weight o Ethnic minorities o Low income
What are the most common causes of CKD?
- DM
- Glomerulonephritis
- HTN
- PKD
- Renovascular disease
- Pyelonephritis
- Age-related decline
- NSAIDs, PPIs, lithium
When do you offer investigations to assess for CKD?
• Risk factors for CKD
An incidental finding of:
o eGFR <60
o Proteinuria = ACR ≥3mg/mmol
o Persistent haematuria (2/3 urine dipsticks)
o Urine sediment abnormalities (RBCs, WBCs or granular casts and renal tubular epithelial cells)
What investigation would you do for CKD?
- eGFR
- Urinalysis
- ACR
- Serum creatinine
- Renal USS
- BP
- FBC
- Ca2+, phosphate, vitamin D and PTH
What are the ACR categories?
A1 - normal-mildly increased
<3
A2 - moderately increased
3-30
A3 - severely increased
>30
What are the eGFR categories?
G1 - normal/high
≥90
G2 - mildly decreased
60-89
G3a - mildly-moderately decreased
45-59
G3b - moderately-severely decreased
30-44
G4 - severely decreased
15-29
G5 - kidney failure
<15
What causes CKD mineral bone disease?
High phosphate (>1.5mmol/L) due to reduced renal excretion
Low active vitamin D (<25nmol/L) as kidneys cannot convert it to its active form
Secondary hyperparathyroidism as parathyroid glands reacts to hypocalcaemia
What are the features of CKD mineral bone disease?
Osteomalacia (bone softening)
• Bone discomfort or pain in lower back, pelvis and extremities
• Impaired physical function
• Muscle aches and weakness (Quadriceps and glutei)
• Symmetric lower back pain
Osteoporosis (brittle bones)
Osteosclerosis (hardening of bones)
Extra-skeletal calcifications (blood vessels or skin)
How do you manage high phosphate in CKD mineral bone disease?
- Dietary restriction (dairy)
* Phosphate binders (calichew)
How do you manage low vitamin D in CKD mineral bone disease?
• Vitamin D supplements (colecalciferol or ergocalciferol)
How do you manage low vitamin D and an increase in PTH in CKD mineral bone disease?
• Activated vitamin D analogue (alphacalcidol or calcitriol)
What causes normochromic, normocytic anaemia?
- Reduced EPO
- Reduced erythropoiesis due to toxic effects of uraemia on bone marrow
- Reduced absorption of iron
- Anorexia/nausea due to uraemia
- Reduced RBC survival (HD)
What are the symptoms of normochromic, normocytic anaemia?
- Fatigue
- Palpitations
- Dizziness
- SOB
- Lethargy
How do you treat normochromic, normocytic anaemia?
Erythropoietin and IV iron
What are the target ranges for ferritin and Hb for normochromic, normocytic anaemia?
Target ferritin >200
Target Hb 100-120g/L
What is the management for metabolic acidosis?
Sodium bicarbonate
How do you manage hyperkalaemia?
- Dietary restriction
- Dose reduction of ACEi/ARBs
How do you manage uraemia?
RRT/Transplant
How do you manage fluid overload?
Diuretics
Why are CKD patients at increased risk of CVD?
- Increased BP
- Vascular stiffness
- Inflammation
- Oxidative stress
- Abnormal endothelial function
What do you give to CKD patients to manage CVD?
Atorvastatin 20mg
• Irrespective of serum lipid levels
Aspirin 75mg
• QRISK3 for people with CKD 3, 4 or 5
What causes restless leg syndrome?
- CKD
- Iron deficiency
What are the features of restless leg syndrome?
Urge to move the legs which may be accompanied by:
• Tingling/burning/throbbing
• Itching
• “Creepy crawly” sensations
Symptoms worsen with:
• Periods of inactivity (worse in the night)
• Partially/totally relieved by movement
How do you manage restless leg syndrome?
exclude iron as a precipitating factor
Name the complications of CKD
- CKD-MBD
- Anaemia (normochromic, normocytic)
- Metabolic acidosis
- Hyperkalaemia
- Uraemia
- Fluid overload
- CVD risk increases
- Restless leg syndrome
