Fatigue (I Feel Tired) Flashcards
How are acute, subacute and chronic fatigue defined?
Acute = fatigue lasting one month or less
Subacute = fatigue lasting between one and six months
Chronic = fatigue lasting over six months
What can cause proteinuria on a urine dipstick (7)?
-Pregnancy
-Abnormally high BP
-Chronic Kidney Disease
-Urinary Tract Infection
-Nephrotic/nephritic syndrome
-Fever
-After physical exercise
How is Chronic Kidney Disease (CKD) defined?
Abnormalities of kidney function or structure present for more than 3 months, with implications for health.
What does a decreased MCV reflect?
A defect in cellular haemoglobin synthesis.
What can cause microcytic hypochromic anaemia? (2)
Iron deficiency
Thalassaemia
How is ‘accelerated progression of Chronic Kidney Disease (CKD)’ defined? (2)
-A sustained decrease in GFR of 25% or more and a change in GFR category within 12 months
OR
-A sustained decrease in GFR of 15 ml/min/1.73 m2 per year
How is Chronic Kidney Disease (CKD) diagnosed? (2)
-Any patient with markers of kidney damage present for more than 3 months
OR
-Patient with eGFR < 60ml/min/1.73m² on at least 2 occasions, separated by a period of at least 90 days (with or without markers of kidney damage).
What factors is Chronic Kidney Disease (CKD) classification based on? (3)
CGA:
-Cause
-GFR category (G1-G5)
-Albuminuria category (A1-A3)
When should ACE inhibitors/ARBs be stopped in a patient with poor renal function?
Renal function needs to be checked 7-10 days following commencement and if there is a decline >25%, you should stop these medications.
What four patient variables are used in the Kidney Failure Risk Equation?
-Age
-Gender
-eGFR
-Albumin:creatinine ratio
What does the Kidney Failure Risk Equation calculate?
Estimated risk of end stage renal disease requiring dialysis or transplantation over the next 2 or 5 years.
Name two ACE inhibitors.
Ramipril
Lisinopril
Name three angiotensin receptor blockers (ARBs).
Candesartan
Irbesartan
Losartan
What is Aranesp?
A re-engineered form of erythropoietin, given for symptomatic anaemia associated with chronic renal failure, chronic kidney disease or chemotherapy (helps the body increase RBC production).
What are the advantages of commencing a Chronic Kidney Disease (CKD) patient on bicarbonate (if indicated)?
Correcting acidosis delays CKD progression, improves erythropoietin response, protects the bones and controls hyperkalaemia.
What is calcium acetate?
A calcium-containing phosphate binder used to treat hyperphosphataemia and hypercalciuria; used in end-stage renal disease (ESRD) to limit phosphate rise, improve calcium levels and thereby inhibit PTH.
Name two glucagon-like receptor 1 agonists (GLP1).
Semaglutide
Dulaglutide
How should metformin be given in patients with renal impairment? (2)
The dose of metformin should be reviewed if the eGFR is below 45 ml/minute/1.73m2, and stopped if the eGFR is below 30 ml/minute/1.73m2.
What is the primary approach for treating secondary hyperparathyroidism?
Inhibition of parathyroid hormone (PTH); this can be achieved by giving active and inactive vitamin D (this may cause increased phosphate absorption, which can be managed with a phosphate binder such as calcium acetate).
What is Alfacalcidol?
A vitamin D analogue used to treat vitamin D deficiency and hypocalcaemia.
What is sodium zirconium?
A potassium chelating agent, used only to control hyperkalaemia.
How can ACE inhibitors/angiotensin receptor blockers delay progression of kidney disease?
They dilate the efferent arteriole, lowering intraglomerular pressure and preventing loss of protein, protecting the kidney in the long term.
How can SGLT2 inhibitors be used to delay progression of kidney disease?
SGLT2 inhibitors can lower intraglomerular pressure by constricting the afferent arteriole and limiting the blood flow to the glomeruli.
What effect of intraglomerular pressure lowering medications on GFR do we need to worry about?
Anything over a 25% drop in glomerular filtration rate (GFR) from baseline; this indicates we should stop intraglomerular pressure lowering medications.
