Clinical Topic 2: Chronic Kidney Disease Flashcards
What is the most likely cause of death of CKD patients on Haemodialysis?
Ischaemic Heart Disease
What is the appearance of kidneys in Chronic Kidney Disease?
Bilateral shrunken kidneys
What is the appreance of kidneys in diabetic nephropathy?
Bilateral enlarged / normal kidneys
What is Stage 1, 2, 3a, 3b, 4, 5 Chronic Kidney Disease?
Stage 1: >90 Stage 2: 60 - 89 Stage 3a: 45 - 59 Stage 3b: 30 - 44 Stage 4: 15 - 29 Stage 5: < 15
What factors may inappropriately skew eGFR estimation?
- Pregnancy
- Increased muscle mass
- Red meat consumption 12 hours before sample
What are the four features of Diabetic-related Chronic Kidney Disease?
- Mesangial expansion
- Basement membrane thickening
- Glomerular schlerosis
- Podocyte damage
How does Chronic Kidney Disease affect Na+ / H2O balance?
↓ in GFR leads to an increase in Na+ / H2O retention, causing ↑ in BP, and ↑ Peripheral Oedema
How does Chronic Kidney Disease affect K+ balance?
↓ in GFR leads to an increase in K+ retention, causing hyperkalaemia. Hyperkalaemia can cause muscle weakness → ECG changes, i.e. Tall tented T-waves
How does Chronic Kidney Disease affect acid-base balance?
Diminished capacity to excrete H+ to generate bicarbonate, hence metabolic acidosis
How does Chronic Kidney Disease affect Calcium levels and bone health?
Loss of nephrons, leads to a ↓reduction in Calcitriol production (active form of Vitamin D). This causes a ↓ in calcium reabsorption from the GIT / kidney, causing Hypocalcaemia. This stimulates the parathyroid glands causing secondary hyperparathyroidism, causing Osteodystrophy / Osteoporosis via bone breakdown
How does Chronic Kidney Disease cause anaemia? What kind of anaemia is it?
Normocytic, normochromic anaemia
Decreased EPO production (main cause)
How can you manage hypocalaemia and deteriorating bone health in patients with Chronic Kidney Disease?
Vitamin D supplements: Alfacalcidol
Phosphate binders: Calcium carbonate
Calcimimetics
How can you manage anaemia in patients with Chronic Kidney Disease?
IV iron
Erythropoetin
Darbepoetin
What is the most common electrolyte abnormality in patients with Chronic Kidney Disease?
Hypocalcaemia
What are the effects of advanced uraemia in patients with CKD?
- Uraemia induced platelet dysfunction (bruising, bleeding)
- Uraemic pericarditis (chest pain, friction rub)
- Uraemic neuropathy (distal sensorimotor polyneuropathy)
- Uraemic encephalopathy (headache, confusion, coma, seizures)
What are the four indications for renal replacement therapy?
- Symptoms of uraemia
- Fluid overload
- Resistant hyperkalaemia
- eGFR < 10
Due to the theoretical risk of BBV within haemodialysis units, what serology testing is performed and when? What must they also be vaccinated against?
Hepatitis B, C and HIV serology every 6-12 months
Must be vaccinated against Hepatitis B
What are the three main forms of Renal replacement therapy for CKD patients?
Haemodialysis
Peritoneal dialysis
Renal transplantation
What is the Renal replacement therapy for AKI patients?
Haemofiltration
What are some of the complications of Haemodialysis?
Loss of venous access
Bacteraemia from line contamination
How is access obtained in Haemodialysis?
Arteriovenous fistula
Arteriovenous graft
Central catheter
What are some of the complications of Peritoneal Dialysis?
Bacterial peritonitis
Hyglycaemia (dialysis fluid has high glucose intake)
What are some organisms which commonly cause bacterial peritonitis in Peritoneal Dialysis?
Staphylococcus epidermis (most common) Staph aureus
Acute rejection of a renal transplant occurs at what time from transplantation? How is it acutely treated?
Within 6 months
Corticosteroids
Patients who have received an organ transplant are at risk of what cancer? Why
Skin cancer (particularly squamous cell carcinoma) due to long-term use of immunosuppressants
Chronic rejection of a renal transplant occurs at what time from transplantation?
> 6 months post transplantation
Define: Xenograft, Isograft, Autograft, Allograft
Xenograft - transplant between different species
Isograft - transplant between twins
Autograft - transplant within same person
Allograft - transplant within same species
What are the main antigens which give rise to transplant rejection?
ABO blood group
HLA
MHC
Hyperacute organ rejection is mediated by what?
ABO antigens
Acute organ rejection is mediated by what?
T-cells
What is the normal range for anion gap?
10 - 18 mmol/L
What speeds up the progression of chronic kidney disease?
Diabetes
Hypertension
Polycystic kidney disease
Drugs - NSAIDs, lithium
Glomerulonephritis
What is eGFR calculated based off of?
Serum creatinine
Age
Gender
How does Chronic Kidney Disease cause bone disease?
Kidneys activate vitamin D
Vitamin D helps absorb calcium from bones, food etc into the blood and regulating bone turnover
Therefore CKD causes low active vitamin D -> hypocalcaemia
Parathyroid glands react by stimulating more PTH -> increase osteoclasts activity to release calcium from bone -> renal bone disease
When to refer patients with CKD to a renal specialist?
When eGFR consistently below 30
Two most common causes of CKD in adults
Hypertension (26%)
Diabetes (44%)
