CKD updated Flashcards
What is CKD?
A progressive condition where the kidneys have been damaged over time
What 2 conditions increase the risk of CKD?
- Diabetes
- Hypertension
What 3 types of diseases are patients with CKD more at risk of?
- Cardiovascular disease
- Anaemia
- Bone disease
What are the 5 most common causes of kidney diease?
- Diabetic nephropathy
- Chronic glomerulonephritis
- Chronic pyelonephritis
- Hypertension
- Adult polycystic kidney disease
What are 4 early clinical manifestations of chronic kidney disease?
- Fatigue
- Polyuria/ Nocturia
- Hypertension
- Puffiness or swelling
Why is fatigue an early symptom of CKD?
This is due to the build-up of toxins that the kidneys are unable to filter out, as well as anaemia, a common feature in CKD resulting from reduced erythropoietin production by the kidneys.
Why is hypertension an early symptom of CKD?
High blood pressure can be both a cause and an early consequence of CKD due to dysregulation of fluid volume and the renin-angiotensin system.
What can happen to urine output in later stages of CKD?
Decreased urine output
What symptoms are experienced at a later stage of Kidney disease in reference to fluid overload?
- breathlessness
-Peripheral oedema
-hypertension
What symptoms can a patient experience due to high levels of urea in the blood?
- nausea
-vomiting
-anorexia
-metallic taste in mouth
-hiccups
-puritius - seizures and coma (uraemic encephalopathy)
How does CKD affect the bones?
Bone and Mineral Disease: CKD can disrupt calcium and phosphate balance, leading to bone pain, fractures, and other symptoms of renal osteodystrophy.
What symptoms can be experienced due to metabolic acidosis?
Patients may present with symptoms of metabolic acidosis, such as rapid breathing, confusion, and lethargy.
What two readings are needed to confirm a diagnosis of CKD?
- eGFR
- Albumin to creatine ratio
How is proteinuria assessed?
Proteinuria (protein in the urine) is quantified with a urine albumin:creatinine ratio (ACR).
What is microscopic haematuria?
Microscopic haematuria is when blood is identified on testing but not visible on inspection.
What is macroscopic haematuria?
Macroscopic haematuria refers to visible blood in the urine. Haematuria can indicate infection, malignancy (e.g., bladder cancer), glomerulonephritis or kidney stones.
What is the classification for CKD?
- Estimated glomerular filtration rate (eGFR) is sustained below 60 mL/min/1.73 m2
- albumin:creatinine ratio (ACR) is sustained above 3 mg/mmol
What other investigations can be requested when investigating CKD?
Blood pressure (for hypertension)
HbA1c (for diabetes)
Lipid profile (for hypercholesterolaemia)
What is defined as accelerated progression?
Accelerated progression is a sustained decline in the eGFR within one year of either 25% or 15 mL/min/1.73 m2.
What are 6 complications of CKD?
- Anaemia
- Renal bone disease
- Cardiovascular disease
- Peripheral neuropathy
- End stage kidney disease
- Dialysis related complications
When should you refer to a renal specialist?
eGFR less than 30 mL/min/1.73 m2
Urine ACR more than 70 mg/mmol
Accelerated progression (a decrease in eGFR of 25% or 15 mL/min/1.73 m2 within 12 months)
5-year risk of requiring dialysis over 5%
Uncontrolled hypertension despite four or more antihypertensives
What 3 medications are often given to CKD patients?
- ACE inhibitors
- SGLT-2 inhibitors (specifically dapagliflozin)
- Statin (Atorvastatin 20mg)
What is used to treat metabolic acidosis?
Oral sodium bicarbonate
What is used to treat renal bone disease?
Vitamin D, low phosphate diet and phosphate binders
