Progressive Kidney Disease Flashcards
Demographics-wise, how has chronic kidney disease progressed?
- Major public health issue
- # of patients requiring renal replacement therapy in the form of dialysis or transplantation is increasing at about 6-8% per annum
- 4.9% of the UK population likely to have chronic kidney disease stage 3 or worse
- Greatest increase is in the elderly population (65+)
What is chronic kidney disease?
- Progressive loss in kidney function
- Over a period of months or years
- The symptoms of worsening kidney function are not specific, and might include feeling generally unwell and experiencing a reduced appetite
- Chronic kidney disease may be caused by diabetes, high blood pressure and other disorders
What is the most accurate and least accurate way to measure kidney disease?
Most people don’t notice any symptoms until the disease becomes advanced. What are symptoms of CKD?
- feel more tired and have less energy
- have trouble concentrating
- have a poor appetite
- have trouble sleeping
- have muscle cramping at night
- have swollen feet and ankles
- have puffiness around your eyes, especially in the morning
- have dry, itchy skin
- need to urinate more often, especially at night.
What are risk factors for chronic kidney disease?
- have diabetes
- have high blood pressure
- have a family history of kidney failure
- are older
- belong to a population group that has a high rate of diabetes or high blood pressure, such as African Americans, Hispanic Americans, Asian, Pacific Islanders, and American Indians.
What are the stages of kidney disease?
What is rapid deterioration defined as?
- a fall in GFR of 5mL/min/1.73m2 in 1 year or
- a fall of 10mL/min/1.73m2 over 5 years
What are the categories of causes of acute kidney injury?
- prerenal (70%) - caused by decrease prerenal perfusion, often bc of volume depletion
- intrinsic - caused by process within the kidneys
- postrenal - caused by inadequate drainage of urine distal to the kidneys
What are pre-renal processes that can cause kidney function to worsen?
- Hypovolaemia - haemorrhage/diarrhoea/vom
- Reduced perfusion - septic shock, cardiac failure
- Drugs - ACE inhibitors, NSAIDs
What are intrinsic causes of renal disease?
- glomerular (glomerulonephritis, systemic disease)
- tubular (acute tubular necrosis)
- interstitial (interstitial nephritis)
What are post-renal causes of renal disease?
- Hydroureter
- Hydronephrosis
- Typically from obstruction of urinary flow
What are the functions of the kidney?
- Excretes waste substances
- Important for acid-base balance
- Vitamin D activation
- Blood pressure control
- Red blood cell production
- Helps regulate water balance
- Regulates minerals in extracellular fluid
*be able to explain the processes and underlying physiology of these functions
What are the consequences of worsening kidney function?
- Fluid retention
- Hyperkalaemia -> cardiac arrhythmias
- Secondary hyperparathyroidism and bone disease
- Renal anaemia
- CKD increases cardiovascular risk
How does worsening kidney function lead to secondary hyperparathyroidism and bone disease?
- decreased kidney function
- decreased glomerular filtration rate
- decreased phosphate excretion
- therefore there is phosphate retention
- elevated serum phosphate suppresses calcitriol production
- reduced calcitriol (AKA activated Vit D3)
- consequent reduced calcium absorption at gut
- hypocalcaemia
- this directly increases PTH
- longterm leads to secondary hyperparathyroidism + bone disease
How does worsening kidney function cause anaemia?
- Reduced erythropoietin produced by kidney
- Functional iron deficiency
Explain strategies that can slow the rate of decline
- Blood pressure control
- Diabetic control
- Reducing proteinuria (blocking RAAS, statins)
- Stop smoking
- Weight loss/exercise
- Remove nephrotoxic drugs/avoid renal insults (lithium, NSAIDs)
- Pregnancy - in most cases, CKD may worsen during pregnancy
How do NSAIDs and ACE inhibitors lower GFR?
- Both lower pressure in glomerulus
- NSAIDs inhibit prostaglandins -> cause afferent constriction
- ACE inhibitors block Ang II -> cause efferent dilation
- Both actions lower pressure and lower GFR
- Reduces progression to end stage renal failure
- Reduces proteinuria
- Reduces cardiovascular events
What are the options available to patients as kidney function approaches end stage?
- End of life care
- Transplantation
- Haemodialysis
- Peritoneal dialysis
What are the clinical advantages of transplantation over other renal failure therapies?
- Fewer fluid and diet restrictions than when receiving dialysis
- No dialysis schedule -> can work full time
- Improved quality of life
- Free from restrictions
- Lead a more normal life
