MedEd renal 2 Flashcards
what is CKD?
progressive decrease in kidney function over a minimum of 3 months
what is eGFR in end stage renal disease?
under 15
what are the different ways of staging chronic kidney disease?
G stages which is based on GFR
A stages which is based on albumin
what are the main causes of CKD?
hypertension
diabetes
all causes of AKI can cause CKD if persisitent (pre renal, renal or post renal)
how does hypertension lead to CKD?
high BP causes renal wall thickening, this leads to hypoperfusion, glomerular ischaemic injury and glomerulosclerosis
how does diabetes cause CKD?
high blood sugar leads to non enzymatic glycosylation of efferent arterioles which causes increased resistance to blood flow and a high pressure state
what are pre renal causes of CKD?
chronic heart failure
cirrhosis
what are renal causes of CKD?
renal vascular disease- eg hypertension, renal artery stenosis
glomerular disease eg nephritic and nephrotic syndrome
nephrotoxins eg NSAIDs
what are post renal causes of CKD?
prostatic disease
stones
repeated pyelonephritis
what functions are affected in CKD and how does this manifest?
water regulation= results in oedema (ankle, SOB when lying down), patients may say they have gained weight
waste removal= excess urea (can cause neurological deficits and pericarditis)
electrolyte regulation= hyperkalemia, high phosphate levels, reduced sodium and calcium, acidosis
hormone production= ACE, renin (causes hypertension), 1 alpha hydroxylase (reduces vit d levels), EPO (causes anaemia
what hormones do the kidneys produce and what does defiiency of the in CKD cause?
renin and ACE- deficiency causes hypertension
1 alpha hydroxylase- deficiency causes reduced vitamin D levels
EPO- deficiency causes anaemia
what are signs and symptoms of CKD? explain why these symptoms arise?
fatigue- reduced EPO causes anaemia oligouria- lack of fluid regulation nausea- due to electrolyte imbalance pitting oedema- reduced water clearance neurological deficit- raised urea levels SOB- pulmonary oedema
what ix are done for CKD? what will you see?
Bloods- cr (high), eGFR (low), FBC, ABG, UEs, PTH (high- chronic hypocalcaemia causes tertiary hypoparathyroidism)- measure them over 3 months multiple times to make sure its chronic
Bedside- urinalysis
Imaging- renal US, AXR and MRI, biopsy if nephrotic/nephritic
how is CKD managed?
stop all nephrotoxic medication
manage underlying cause eg glucose control in diabetes
smoking cessation
medical= ARB and ACEi for proteinuria and HTN, loop diuretic for oedema, statin for hyperlipidaemia
what medications are given in CKD?
ACEi/ARB for hypertension or proteinuria
Loop diuretic for oedema
Statin for hyperlipidaemia
