Renal Flashcards
CKD
what is chronic kidney disease
kidney damage or decreased kidney function for >3 months
kidney damage is defined by at least 1 of
albuminuria —- ACR (albumin-to-Cr ratio) >3.4mg/mmol
urinary sediment abnormalities
pathological (biopsy) or imaging abnormalities
kidney transplant
decreased kidney function = eGFR <60
common causes of CKD
DM nephropathy (common)
HTN (common)
glomerulonephritis
ADPKD
Alport’s
obstructive uropathy
presentation of CKD
asymptomatic – stage 1-3
Symptoms (Hx)
non-specific symptoms: N&V, anorexia, malaise, lethargy, fatigue, restless legs
palpitations — sec to hyperK
pruritus, disordered sleep — sec to uraemia
frothy urine or reduced urine output
LL swelling, orthopnoea, PND — due to fluid overload
bone pain +/- fractures — renal osteodystrophy
signs (exam)
general inspection
tachypnoea, accessory muscle use — sec to pulmonary oedema
grey-yellow discolouration to skin – sec to uraemia
cushingoid — chronic steroids
peripheral
thin skin – chronic steroids
asterixis — uraemia
AV fistula
LL oedema
abdomen
ascites
ballotable kidneys, hepatomegaly
renal angle scar, kidney transplant scar
striae — chronic steroids
renal bruit — renal A stenosis
Ix for CKD
bloods
FBC
U&E
ECG – if ?hyperK
urine
urinary sediment
ACR
dipstick
imaging
renal US
CT KUB
grading of CKD
acc to eGFR
stage 1: >90
stage 2: 60-89
stage 3A: 45-59
stage 3B: 30-44
stage 4: 15-29
stage 5: <15
Tx of CKD
conservative
address modifiable risk factors
HTN
DM, metabolic syndrome
smoking
dyslipidaemia
stop causative drugs — NSAIDs, ACEI, gentamicin, tetracyclines, etc
stop smoking
physio - increase exercise
dietician - lose weight + prevent hyperK + Na, fluid & PO4 restriction
vaccinations: influenza, pneumococcal, hep B vaccines
avoid gadolinium contrast if eGFR <30
medical Tx
for CVS risk: statins + low dose aspirin
for HTN — aim: <13/80
conservative: vol restriction + low salt diet
meds: diuretics + ACEI
for DM = SGLT2 inhibitors preferred
if fluid overload = furosemide
if hyperPO4
conservative: adequate hydration + reduced PO4 intake
meds: PO4 or Ca binders
if bone disease = calcichew D3 forte +/- cinacalcet (Ca mimetic) +/- bisphosphonates
if anaemic = recombinant EPO
if chronic HyperK = calcium resonium 15g PO or diuretics or haemodialysis
ensure all doses of the meds are ok for kidneys
if still cmi = renal replacement therapy
transplant = Tx of choice for ESRD
complications of CKD
CVD — angina, afib, MI
renal osteodystrophy — osteoporosis, hyperPTH, osteosclerosis, vascular calcification
fluid overload, HTN
electrolyte imbalance
anaemia
restless legs
sensory neuropathy
increased risk sepsis, AKI
metabolic acidosis
