Lecture 22-CKD Flashcards
True or false: adult polycystic kidney disease (APCKD) is autosomal recessive
FALSE - autosomal dominant
Which gene is mutated to cause APCKD?
PKD1 or PKD2
What are the secondary complications of APCKD?
- pain
- bleeding into cyst
- infection
- renal stones
- hypertension
What is CKD?
Irreversible and sometimes progressive loss of renal function over months to years. Renal injury -> renal tissue is replaced by extracellular matrix
What are the causes of CKD?
- diabetes
- hypertension
- immunologic
- infection (pyelonephritis)
- genetic (APCKD)
- obstruction
Which investigations are used to confirm a diagnosis of CKD?
- BP
- urine dipstick
- bloods: LFT, U&E, FBC, CRP, iron
- ultrasound for kidney size and obstruction
- kidney biopsy
- CT
- MRI
How can CKD be prevented?
- stop smoking
- exercise
- lose weight
- stop PPIs and NSAIDs
- control diabetes and hypertension
What are the complications of CKD?
- fluid overload
- acidosis
- hyperkalaemia
- accumulation of waste products
- altered drug metabolism
- anaemia
- mineral bone disease
How does CKD affect water/salt handling?
Reduces GFR -> lose ability to maximally dilute and concentrate urine, smaller glomerular filtrate but same solute load -> osmotic diuresis -> nocturia, low volime of filtrate decreases maximum ability to excrete urine therefore maximum urine volume is reduced
How is acidosis caused by CKD treated?
NaHCO3 tablets
How can hyperkalaemia caused by CKD be treated?
- stop ACE-I, Ang receptor blocker
- avoid drugs that increase K+
- avoid foods with high K+
Which drugs should be avoided to prevent hyperkalaemia?
Amiloride, trimethoprim, spironolactone
What can an accumulation of waste products caused by CKD lead to?
- decreased appetite
- pruritis
- nausea and vomiting
What are the causes of anaemia caused by CKD?
- reduced EPO
- iron deficiency
- high hepcidin so cannot absorb iron from gut
- blood loss
- uraemia
- CKD mineral and bone disorder
- medication eg ACE-I
- vit B12 and folate deficiency
How is anaemia treated?
If iron low, replace iron and when iron okay, start EPO treatment
What can mineral bone disease cause?
- renal osteodystrophy: bone loss from important bones and calcification in important places
- non-bone calcification: phosphate and calcium complex and can calcify blood vessels, deposit in joints and ulcerate skin (high mortality)
How can mineral bone disease be treated?
- decrease phosphate intake
- phosphate binders
- 1 alpha calcidol
When is renal replacement therapy used?
When native renal function is reduced to a level that is no longer adequate to support health, usually when eGFR is 8-10 ml/min
What is established end stage renal failure?
When death is likely without renal replacement therapy
What are the symptoms of end stage renal disease?
- tiredness, physical and mental
- difficulty sleeping
- oedema
- nausea and vomiting
- restless legs
- pruritis
- sexual dysfunction
- increased infection
What are the three treatment options for when kidneys fail?
- haemodialysis
- peritoneal dialysis
- transplant
What are the advantages of haemodialysis?
- less responsibility
- days off (done 3 times a week)
What are the disadvantages of haemodialysis?
- travel time/waiting
- big restriction of food intake
- tied to dialysis times (4 hours)
- 19 tablets a day
What are the complications associated with haemodialysis?
- infections in lines
- thrombosis, bleeding
- CVS instability
- chronically unwell
What are the advantages of home/nocturnal haemodialysis?
- more hours but at home
- feel better and need fewer medications
What are the advantages of peritoneal dialysis?
- independence
- less fluid/food restrictions
- easy to travel with
What are the disadvantages of peritoneal dialysis?
- frequent daily exchanges
- responsibility
What are the complications of peritoneal dialysis?
- peritonitis
- ultrafiltration failure
- hernias
What are the advantages of transplant?
- decreased mortality and morbidity
- better QoL
What are the disadvantages of transplant?
- malignancy risk
- infection risk
- risk of diabetes and hypertension
