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TCD 22 - CKD > CKD and Complications > Flashcards

CKD and Complications Flashcards

1
Q

What is CKD?

A

Abnormalities of kidney function or structure present >3 months

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2
Q

What are the symptoms of CKD?

A
  • Fatigue
  • Muscle cramps
  • Bone pain
  • Weight loss
  • SOB
  • Urinary symptoms
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3
Q

What makes people more at susceptible to developing a CKD?

A 
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
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4
Q

What are the most common causes of CKD?

A
  1. DM
  2. Glomerulonephritis
  3. HTN
  4. PKD
  5. Renovascular disease
  6. Pyelonephritis
  7. Age-related decline
  8. NSAIDs, PPIs, lithium
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5
Q

When do you offer investigations to assess for CKD?

A

• 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)

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6
Q

What investigation would you do for CKD?

A
  • eGFR
  • Urinalysis
  • ACR
  • Serum creatinine
  • Renal USS
  • BP
  • FBC
  • Ca2+, phosphate, vitamin D and PTH
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7
Q

What are the ACR categories?

A

A1 - normal-mildly increased
<3

A2 - moderately increased
3-30

A3 - severely increased
>30

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8
Q

What are the eGFR categories?

A

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

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9
Q

What causes CKD mineral bone disease?

A

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

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10
Q

What are the features of CKD mineral bone disease?

A

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)

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11
Q

How do you manage high phosphate in CKD mineral bone disease?

A
  • Dietary restriction (dairy)

* Phosphate binders (calichew)

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12
Q

How do you manage low vitamin D in CKD mineral bone disease?

A

• Vitamin D supplements (colecalciferol or ergocalciferol)

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13
Q

How do you manage low vitamin D and an increase in PTH in CKD mineral bone disease?

A

• Activated vitamin D analogue (alphacalcidol or calcitriol)

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14
Q

What causes normochromic, normocytic anaemia?

A
  • 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)
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15
Q

What are the symptoms of normochromic, normocytic anaemia?

A
  • Fatigue
  • Palpitations
  • Dizziness
  • SOB
  • Lethargy
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16
Q

How do you treat normochromic, normocytic anaemia?

A

Erythropoietin and IV iron

17
Q

What are the target ranges for ferritin and Hb for normochromic, normocytic anaemia?

A

Target ferritin >200

Target Hb 100-120g/L

18
Q

What is the management for metabolic acidosis?

A

Sodium bicarbonate

19
Q

How do you manage hyperkalaemia?

A
  • Dietary restriction

- Dose reduction of ACEi/ARBs

20
Q

How do you manage uraemia?

A

RRT/Transplant

21
Q

How do you manage fluid overload?

A

Diuretics

22
Q

Why are CKD patients at increased risk of CVD?

A
  • Increased BP
  • Vascular stiffness
  • Inflammation
  • Oxidative stress
  • Abnormal endothelial function
23
Q

What do you give to CKD patients to manage CVD?

A

Atorvastatin 20mg
• Irrespective of serum lipid levels

Aspirin 75mg
• QRISK3 for people with CKD 3, 4 or 5

24
Q

What causes restless leg syndrome?

A
  • CKD

- Iron deficiency

25
Q

What are the features of restless leg syndrome?

A

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

26
Q

How do you manage restless leg syndrome?

A

exclude iron as a precipitating factor

27
Q

Name the complications of CKD

A
  • CKD-MBD
  • Anaemia (normochromic, normocytic)
  • Metabolic acidosis
  • Hyperkalaemia
  • Uraemia
  • Fluid overload
  • CVD risk increases
  • Restless leg syndrome

TCD 22 - CKD (3 decks)

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