Lecture 11: Chronic Kidney Disease Flashcards
how do we classify chronic kidney disease using GFR?
how do we assess kidney filtering function?
Filtration (excrete out) function:
- use estimates of GFR (eGFR) from creatinine blood test.
Filtration (keep in) function:
- should be no blood or protein measurable in urine if filtering properly
- urinalysis (‘dipstick’) looking for blood and protein
- protein quantification: protein creatinine ratio (PCR)
chronic kidney disease definition
CKD is defined by either the presence of kidney damage (abnormal blood, urine or x-ray findings) or GFR < 60ml/min/1.73m^2 that is present for 3 or more months.
CKD aetiology
- diabetes
- glomerulonephritis (and all causes of that)
- hypertension
- renovascular disease
- polycystic kidney disease
- pyelonephritis
CKD investigations
- bloods: FBC, U&Es, LFTs, HbA1c, bone profile, bicarbonate, total protein, albumin, calcium, phosphate
- urine: dipstick (looking for blood and protein), microscopy, culture and sensitivities (MC&S) (exclude infection), uPCR/uACR
- renal US
a renal screen and kidney biopsy may be undertaken if the cause of CKD is unclear
complications of CKD
think about functions of the kidney
- Waste excretion – uraemia and hyperphosphataemia
- Regulation of fluid balance – HTN and peripheral/pulmonary oedema
- Acid–base balance – metabolic acidosis
- Erythropoietin production – anaemia
- Activation of vitamin D – hypocalcaemia
symptoms and signs of CKD
Symptoms:
- SOB
- itch and cramps
- cognitive impairment
- GI symptoms: anorexia, vomiting, taste disturbance
- change in urine output
- peripheral oedema
Signs:
- hypertension
- pallor (due to anaemia)
- abnormal kidney appearance on imaging
- haematuria
- proteinuria
list possible interventions to slow the rate of renal decline
- BP control most important
- control proteinuria (particularly ACE inhibitors/ARBs)
- treat underlying cause
- others
