L3 - Chronic Kidney Disease Flashcards
1. Define stages of CKD and outline how they are derived 2. Recognise the disease burden that CKD has on the individual and society 3. Explain the importance of early detection of CKD 4. State the important investigations of CKD.
Define Chronic Kidney Disease?
Defined by the presence of markers of kidney damage or decreased kidney function , eGFR<60
What is the criteria for CKD?
Either one, both or two criteria for at least 3 months:
- GFR < 60mL/ min per 1.73m2
- Markers of Kidney damage
State some examples of markers of kidney damage?
- Albuminuria
- Urinary sediment abnormality
- Electrolyte or other abnormality due to tubular disorder
- Abnormalities on histology
- Structural abnormalities detected by imaging
- History of Kidney transplantation
A GFR < 15mL/min indicates?
- Severe renal disease.
- Ability to effectively dilute or concentrate urine is lost.
Why might anaemia be caused in CKD?
- Deficient erythropoietin production
- due to a reduction of functional renal mass.
What is nocturia?
Waking up in the middle of the night because you have to pee.
What are examples of some neuromuscular symptoms associated with severe renal disease? (4)
- Coarse muscular twitches
- Peripheral sensory and motor neuropathy
- muscle cramps
- hypereflexia
Describe some other symptoms associated with severe renal disease?
loads
- Uremic frost —> uric acid crystals deposited on skin
- yellow/brown skin
- anorexia
- nausea, vomiting
- weight loss
- stomatitis —> inflammation inside mouth
- pruritus —> itching
- unpleasant taste in mouth
What is Uremic frost?
- urea from sweat crystallises on skin
What is stomatitis?
Inflammation of mouth, lips.
Any inflammatory process affecting mucous membranes of mouth and lips.
What is Pruritus?
Severe itching of skin
In urinalysis what may be looked at?
loads
Urinary sediment
- e.g. epithelial cells, blood cells, casts
Electrolytes
Urea
Nitrogen
Creatinine
Phosphate
Calcium
Why might an ultrasound be useful when diagnosing CKD?
Will help distinguish between acute kidney injury from CKD based on kidney size.
CKD patients tend to have small shrunken kidneys
< 10cm.
What is the treatment for CKD?
Controlling underlying disorders and contributing factors.
Restriction of dietary protein, phosphate and potassium.
Vit D supplements
Anaemia
Dialysis if GFR severely low
State the stages of CKD?
G1, G2
G3a, G3b
G4
G5
Describe stage 1 -2 of Kidney disease?
Presence of markers of kidney damage.
Describe stages 3-5 of kidney disease?
GFR < 60
With or without markers of kidney damage.
GFR taken on two separate occasions around 90 days apart.
Describe End Stage Kidney disease?
GFR < 15mls/min per 1.73m2
Functions not enough to support life long term.
What options are available to a patient suffering from End Stage Kidney disease?
Transplant, dialysis and conservative care
Stages of CKD: G1
GFR: > 90
Normal or high
Stages of CKD: G2
GFR: 60 - 89
Mildly decreased
Stages of CKD: G3a
GFR: 45 - 59
Mildly to moderately decreased.
Stages of CKD: G3b
GFR: 30 - 44
Moderately to severely decreased
Stages of CKD: G4
GFR: 15 - 29
Severely decreased
Stages of CKD: G5
GFR: < 15
Kidney failure
Absolutely fucked
Why is it important to detect CKD?
Kidney failure independent risk factor for CV mortality.
14th rank on leading cause of death.
Give examples of investigations which may be conducted if CKD is suspected?
- Tests for determining filtration
- Urine testing
- Scanning of Kidneys
- Kidney biopsy
How is urine sediment obtained and what might it show?
Urine is centrifuged.
- RBC
- WBC
- Casts - cylindrical structures that are formed in the tubular lumen.
RBC in urine sediment might indicate…
- Kidney stones
- malignancy
- glomerular disease
WBCs in urine sediment might indicate…
- Infection
- interstitial nephritis
- renal tuberculosis
- nephrolithiasis
What is nephrolithiasis?
Process of forming a kidney stone.
What is interstitial nephritis?
Spaces between tubules inside the kidney become inflamed.
- Reduces the kidney’s ability to filter properly.
What do casts found in urine sediment represent?
RBC casts - suggest an underlying proliferative glomerulonephritis
WBC casts - indicative of interstitial or less commonly, glomerular inflammation.
What are some markers of kidney dysfunction?
1.Reduction in GFR
- Urine
- –> blood, protein, casts - Scan of kidneys
- –> small, polycystic, hydronephrosis
Hydronephrosis
Swelling of a kidney due to a build up of urine.
What tests are used to detect kidney dysfunction?
Creatinine eGFR Creatinine clearance GFR measurement Cystatin C measurement and Cystatin C eGFR
What is cystatin C?
Low-molecular weight protein.
- cystatin superfamily of cysteine protease inhibitors
High level may mean kidneys are malfunctioning.
Describe what should happen to cystatin C in the glomerulus?
Normally filtered at glomerulus and not reabsorbed.
- metabolised by tubules
