CKD + Chronic liver failure Flashcards
Mechanism of chronic liver failure
Commonly due to cirrhosis
Progressive destruction + regeneration of liver parenchyma leads to fibrosis + cirrhosis
Causes of liver failure
Hepatitis
Alcoholic liver disease
Methotrexate, amiodarone, nitrofurantoin
Fatty liver disease
Wilsons disease
Biliary cirrhosis
Sclerosing cholangitis
Right HF
RF of liver failure
Alcohol
Obesity
Metabolic syndrome
IVDUs
Unprotected sex with multiple partners
S+S liver failure
Ascites
Haematemesis
Itching
Gallstones
Jaundice
Loss of appetite
Easy bruising
Diarrhoea
Fatigue
Palmar erythema
Dupytrens contracture
Management of liver failure
Corticosteroids, interferons, antivirals, bile acids
Supportive: diuretics, albumin, vit K, abx
What is the definition of CKD?
Abnormality of kidney structure or function, present for >3 months, with implications for health
What is the definition of AKI?
Sudden deterioration of function in absence of prior abnormality
Causes of CKD
Diabetic nephropathy
Glomerulonephritis
HTN
Systemic disease (SLE, vasculitis, myeloma)
Renal artery stenosis
Polycystic kidney disease
Pyelonephritis
Urinary tract obstruction (inc prostatic disease)
HF
NSAIDs
How does CKD present?
HTN
Incidental findings on bloods
Symptoms usually late stage
Indications for screening pts at risk of developing CKD
Diabetes
HTN
CV disease
Nephrotoxic drugs (NSAIDs, lithium)
Structural renal disease
What causes a high serum urea?
Catabolic state
High protein intake
GI bleed
Dehydration
CV failure
Reduced renal function
What causes a low serum urea?
Liver failure
What causes a high serum creatinine?
Reduced renal function
Large muscle mass (young, male, muscular)
What causes a low serum creatinine?
Low muscle mass (elderly, wasting, females)
How do you calculate eGFR?
Calculated from blood results + demographic data (age, gender, race)
How is proteinuria measured + why is it important?
Measured in urine sample as protein: creatinine ratio (PCR) or albumin: creatinine ratio (ACR)
Guides management
How would you investigate the cause of CKD?
Haematology/ biochem
Urine dip + MC+S
Immunology screen
Renal USS +- biopsy
What is the normal function of the kidneys?
Excrete substances
Homeostasis - fluid balance, BP, acid-base
Endocrine - erythropoietin, bone metabolism
Metabolic complications of CKD
Anaemia
Bone mineral disorder (low Ca, high PO4, high PTH
Metabolic acidosis (low bicarb)
Hyperkalaemia
Clinical features of CKD
Renal: fluid retention, polyuria, polydipsia
CV: HTN, pulmonary oedema, vascular disease, dyslipidaemia
GI: anorexia, N+V, peptic ulcers
Neuro: neuropathy
Derm: pruritis, pigmentation
Endocrine: amenorrhoea, reduced fertility
MSK: bone pain, fractures
When to refer pt to renal care
eGFR <30
Progression
Uncertain cause
Possible hereditary disease
Significant proteinuria
Haematuria + proteinuria
Management of CKD
BP control
CVS risk reduction - statins
Diet
Vit D, folic acid, iron, phosphate control
Bicarbonate supplements
Dialysis
What are the RF for progression?
Lower eGFR
BP control
Proteinuria
Smoking
Hyperglycaemia
Obesity
Nephrotoxic drugs
What diet is recommended with CKD?
Restrict salt
Restrict calories
Restrict phosphate + potassium
