Lec 5- Acute and Chronic Kidney disease Flashcards
1
Q
Chronic kidney disease (CKD)
A
- Describes abnormal kidney function and or structure
- Common, but frequently unrecognised and often exists together with other conditions
- CVD and diabetes- most at risk
- Risk increases with age due to less functioning nephrons
- Usually asymptomatic but detectable
- Treatment can
- Prevent or delay progression
- Reduce or prevent the development of complications
- Reduce the risk of CVD
2
Q
CKD causes
A
- Diabetes- high glucose cause nephron death- sclerosis
- HTN- increase thickening of blood vessels- increase renal BP- activate RAAS further increasing pressure= nephron damage and death
- Hyperlipidaemia
- Infections/inflammation-
- Genetic/structural abnormalities- polycystic kidney syndrome
3
Q
CKD complications
A
- Renal bone disease
- Renal anaemia
- Hyperphosphateaemia
- Worsening co-morbidities e.g. HTN, diabetes and CVD
4
Q
Classification of CKD
A
- ACR needs to be done to diagnose CKD
5
Q
Signs and symptoms
A
6
Q
Aims of CKD treatments
A
- Reverse or stop the process responsible for CKD (Identify the cause and treatment)- main treatment is control of BP
- Relive symptoms
- Treat complications
- Reduce CV morbidity and mortality
- Prevent further renal damage
- Control BP
- Control proteinuria
7
Q
Monitoring ACEI
A
- Pre-therapy: Baseline creatinine and K+
- Start low and titrate
- Doubling the dose every 1–2weeks.
- Monitor creatinine, potassium and BP after each upward titration
- Do not increase the dose further if there is worsening renal
- If Cr rise >30%, then repeat the test, rule out volume depletion or other nephrotoxic drugs. If K> 6 rule out causes before stopping
- BP target:
- HTN, CKD and an ACR less than 70mg/mmol:
- Systolic blood pressure less than 145/90mmHg (target systolic range lower the better)
8
Q
Management of CKD
Symptoms and complications of advanced CKD
A
- Anaemia
- Osteodustrophy (Hypocal/phosphaturia, Vit D deficiency and Hyperparathyroidism)
- Fluid retention
- Pruritus
- Neurological problems (restless legs)
9
Q
Anaemia
A
- Damage of peritubular cells = inadequate secretion of erythropoietin
- Erythropoeitinproduced mainly by the kidney
- Regulator of red cell proliferation and differentiation
- Shortened red cell survival
- Marrow suppression by uraemic toxins
- A major cause of:
- Fatigue, breathlessness, lethargy and angina.
- Patients complain of feeling cold,
- poor concentration, reduced appetite and libido
- Treat with erythropoietin stimulating agents
10
Q
Anaemia (Erythropoetins)
A
- Human recombinant erythropoietin.
- Hormone to boost red blood cell production.
- Different types
- Biosimilars
- Target Hb: 100 to 120g/L
- Relieve symptoms, avoid the need for blood transfusions
- Correct iron, B12 or folate deficiency
- CAUTION
- Overcorrection of Hb can increase risk of death and serious cardiovascular events
- Cause HTN, hyperkalaemia and thromboses
11
Q
Hyperphosphataemia
A
- A decline in renal function reduces phosphate excretion
- Typically asymptomatic.
- Can cause bone and joint pain, rash, pruritus
- Dietary advice
- Phosphate binders- chelates phosphate, take with food
- Reduce absorption of orally ingested phosphate in the gut
- Form insoluble, non-absorbable complex
- Take a few minutes before food or with a meal
- Calcium acetate (calcification of heart and nephrons), Sevelamer Lanthanum
- Tablet burden/GI side effects •Aim:–0.9-1.5mmol/l in CKD stage 3b, 4 or 5 not on renal replacement therapy (RRT)–<1.8mmol/L if on RRT
12
Q
Bone disease (Renal Osteodystrophy)
A
13
Q
Bone disease
A
- Monitor Ca2+ levels
- Treat with synthetic Vit D analogues
- Vit D requires hydroxylation in the kidney to become active
- Alfacalcidol (0.25mcg to 1mcg/day) or calcitriol (1-2mcg/day)
- Calcium carbonate
- Increase calcium absorption and suppresses parathyroid gland
- Parathyroidectomy
- Clinical- calcium mimetic
14
Q
Other symptoms and treatment
A
- ITCH- Excess urea in the blood
- A common complaint, often worse at night
- Antihistamines (Chlorphenamine) topical (crotamiton
- Phosphate control
- LEG CRAMPS/RESTLESS LEGS
- Unpleasant (Burning, creeping, tugging or like insects crawling inside the legs)
- Occurs at night
- Clonazepam, haloperidol, carbamazepine, pramipexole, ropinirole, rotigotine•H2antagonists / PPIs
- NAUSEA
- Accumulation of urea and other toxins
- Anti-emetics (cyclizine, metoclopramide, ondansetron and prochlorperazine or dialysis)
- OEDEMA
- High dose diuretics (furosemide, bumetanide)
- Thiazides (metolazone)
- Fluid restrict- help control oedema due to excess fluid
- ACIDOSIS–Oral sodium bicarbonate (1-6g/day)
- PPI- urea can cause GI bleeds
15
Q
End-stage renal disease
A
- When life can only be sustained by dialysis or transplantation
- Options
- Haemodialysis
- Peritoneal dialysis
- Transplant
- Palliative care (Conservative management)
16
Q
Renal replacement therapy
A
- Remove uraemic toxins
- Removes fluid resistant to diuretics
- Correct acid-base imbalances and electroyltes
- Two types
- 1) Haemodialysis
- Does what a kidney does: remove toxins and correct acid balance
17
Q
2) Peritoneal dialysis
A
- Peritoneal membrane is the main membrane for diffusion
- Max use (5 years)
- Prone to infection by culturing peritoneal fluid
20
Q
Summary AKI v CVD
A
