CKD / diabetes Flashcards
How should CKD be diagnosed?
-Serum creatinine and eGFR must be measured
–Repeat eGFR in 2 weeks if <60
–If persists, with no evidence of AKI, repeat in 3 months
-Early morning urine sample for ACR
–If <3, no action needed
–If 3-70, repeat in 3 months (no repeat needed if >70)
-Urine dip to check for haematuria
–Arrange MSU to exclude UTI if blood present
-If eGFR and ACR tests have been repeated:
–Diagnose CKD if there is a persistent reduction in renal function lasting for at least 3 months (ie eGFR <60, ACR >3)
How should CKD be managed in the long term?
-Monitor renal function to identify accelerated progression (25% decrease in eGFR every 12 months)
-Stop nephrotoxic drugs if at risk of AKI
-FBC to exclude renal anaemia in advanced stages
-Screen for metabolic / bone disorders in advances stages
-Commence ACEi / ARB gradually and monitor renal function / potassium
-Commence statin and anti platelet for CVD prevention
What is considered first-line management for T2DM?
-Lifestyle management and group education programme
-Metformin (reduces liver production of glucose and increases tissue sensitivity to insulin, causes diarrhoea)
-Dual therapy required if HbA1c >58 on metformin (and triple therapy if persists)
What are the 2nd line drugs used in diabetes?
-Sulfonylureas eg gliclazide, glimepiride
–encourage beta cell production, risk of hypoglycaemia
-DPP-IV inhibitors eg sitagliptin and linagliptin
–increase insulin secretion, decrease glucagon secretion
-Thiazolidineodiones eg pioglitazone
–preserve beta cell function and reduce insulin resistance
-SGLT-2 inhibitors eg empagliflozin, dapagliflozin
–inhibit reabsorption of glucose, sugar excreted in urine
How should diabetes be monitored?
-Measure HbA1c every 6 months
-Annual retinopathy screening
-Annual foot problem / neuropathy screening
-Annual nephropathy screening (ACR and eGFR)
-Annual CVD risk screening
How should cardiovascular risks be mitigated in diabetic patients?
-Atorvastatin 20mg if no established disease
-Atorvastatin 80mg in established disease / secondary prevention
-BP review and monitor annually
-If taking insulin / severe hypo in past 12 months must inform DVLA
