CKD teaching Dr Pickering Flashcards
How common is CKD?
10% population
Why do most people not end up on HD?
- Not suitable
- Other co-morbidities
- Most don’t end up in ESRF - do not progress through the stages
How does creatinine relate to renal function?
Goes up exponentially - not linear
Stages of CKD numbers
- More than 90 + signs kidney damage
- 60-90 + signs kidney damage
- a 45-59
- b 30-45
- 15-29
- Less than 15
When is eGFR not valid?
- Pregnancy
- Age under 18
- Extremes BMI - too low or high
What are the other signs of kidney damage used to stage CKD 1 and 2?
- Proteinuria
- Haematuria
- Structurally abnormal kidneys
- Biopsy result
When can you say someone ahs CKD? on first blood test?
No - need multiple over few months usually
If first one have to treat as AKI if could be
Management of CKD stage 5 steps
- Treat underlying cause
- Control BP
- Control proteinuria
- Avoid nephrotoxic medications
- Address complications
- Prepare for RRT
How is proteinuria and BP controlled in CKD?
ACEi
Main nephrotoxic drug to avoid in CKD
NSAIDs inc topical
Which complications do we need to address in CKD stage 5?
- Anaemia
- Renal metabolic bone disease
How do we treat anaemia CKD?
- IV iron if deficienct
- Erythropoeitin replacement
Textbook results for renal metabolic bone disease
- Ca2+ low
- Phosphate high
- PTH high
More often Ca2+ is normal
Phosphate is normal/high
PTH is high
How does the body initially respond to the increased phosphate in CKD?
- Phosphate increases
- Stimulates PTH
- Works for a bit
- Then eGFR reduces more
- Phosphate rises
- Stimulates PTH
= cycles for a while until eventually cannot compensate
When PTH is high, calcium then becomes higher
What happens when calcium and phosphate are both high?
Can get calcium phosphate depositis
These can occur in coronary arteries
Treatment for renal metabolic bone disease
- Calcimimetic
- 1 alpha hydroxylated Vitamin D - ACTIVE vitamin D
= supression of PTH
Reasons for not having HD
- Frailty
- Chronic co-morbidities
- Not long added to life
What happens if have HD trial then decide to stop?
Only really have 9-14 days left before you will die
Some people are better of not having HD ever if they think they will want to stop - may still have months/years without
Investigations for CKD stages 1+2+3+4 first presentation
- Urine dip
- Culture - haematuria
- Send off for ACR - microalbuminuria
- BP
- Volume status - becomes more important at later stages
- USS - how many kidneys, size, obstruction?
Treatment for stages 1,2,3 and 4
- Control BP
- Address proteinuria - ACEi
Specific treatment for stage 4
- K+ might start becoming a problem when eGFR hits 25
- Hyperuricaemia - gout?
- Anaemia and MBD may begin
Specific treatment for stage 3b and why
- CVD risk reduction eg statins + ezetimibe maybe?
- CVD risk by stage 3b is 3x that of normal
- Also antiplatelet therapy eg aspirin may be considered
