Complications of renal disease Flashcards
Give 6 complications of CKD
Anaemia Mineral bone disease progression of CKD to ESRD Cardiovascular complications Anorexia and Malnutrition Haematologic complications Skin complications Neurologic complications Abnormal secretion of Sodium, Potassium, Phosphate
define CKD
<3 month of unstoppable destruction of nephron number and function due to multiple aetiologies, resulting and frequently leading to end state renal failure
describe the complications relevant to each stage of CKD
stage 1: no complications
stage 2: increased CVD
stage 3: increased CVD, bone disease- raised PTH
stage 4: CVD, anaemia, bone disease- low Ca, high PO4
stage 5: CVD, anaemia, bone disease, pruritus, bleeding, malnutrition
5 causes of anaemia in CKD
Iron deficiency Hypothyroidism Active blood loss Hemoglobinopathies Haemolysis Hyperparathyroid Folic acid deficiency Vit B12 deficiency
describe the management of anaemia in CKD (6 steps)
1) Exclude other causes
Iron def vit B12 def blood loss etc
2) IV iron if ferritin <200
3) Erythropoietin 30 ug/week
4) Monitor Hb every 2 weeks
5) adjust EPO 25% increase
6) Target Hb (10.5-12.0g/dl)
Ferritin 200-500 ng/ml
Why is calcium low in CKD
In kidney disease, the plasma calcium is low because vit D isn’t properly hydroxylated. Kidney tissue isn’t making enough hence absorption in intestine is low. Negative feedback loop is effected, hence no negative feedback and more PTH is secreted- calcium is released from bone hence fragile bones
describe the abnormalities in phosphate in CKD (4)
Decreased excretion of phosphate
Phosphate accumulation
Decrease serum calcium
Stimulation of PTH – PO4 excretion
describe the abnormalities in vitamin D seen in CKD (6)
Lack of 1 hydroxylation of Vit D Decreased absorption of calcium Low serum calcium High PTH – Vit D production Mobilisation of calcium from the bone Decreased calcium sensing receptors
4 types of bone diseases in CKD
Osteitis fibrosa: increased PTH
Osteomalcia: defective mineralisation
Adynamic bone: low bone turnover
Osteoporosis: defective bone formation
how do bone changes present
Bone pain – backs, hips, legs
Joint pain
Fractures
Poor mobility
Children - Growth retardation, deformities
5 changes in other tissues seen in CKD
Periarticular calcification Blood vessel wall calcification Muscle weakness Calciphylaxis Calcification of the heart
what is calciphylaxis?
calcification of the small vessels in the skin
Give the 2 basic platelet and coagulation abnormalities
platelet dysfunction and haemorrhage
prothrombotic tendency
3 neurological complications in CKD
Uraemic encephalopathy
Autonomic neuropathy
Peripheral neuropathy
