Renal Flashcards
1
Q
Give 3 common causes of CKD
A
- renovascular disease
- hypertension
- diabetes
- glomerular nephritis (nephrotic and nephritic syndromes)
- Hereditary diseases like APCKD
less common causes in autoimmune disease (SLE), myeloma etc
2
Q
What are the 3 classic findings in nephrotic syndrome?
A
- high cholesterol
- gross protein urea (causes frothy urine)
- Low serum albumin
3
Q
How does nephrotic syndrome usually present?
A
- pitting odema in legs
- odema in face worse in morning
- any age
- predisposing factor eg diabetes, fhx
- frothy urine
- incidental finding of gross protein urea
4
Q
Give 3 secondary causes of nephrotic syndrome?
A
- diabetes
- lupus nephritis
- myeloma
- amyloid
- pre- eclampsia
5
Q
give 3 primary causes of nephrotic syndrome
A
- FSGS
- minimal change
- membranous nephropathy
6
Q
What are the classical findings of nephritic syndrome?
A
- blood and small amounts of protein in urine
- no swelling
- vague symptoms
7
Q
How may CKD present?
A
- vague symptoms like fatigue, malaise, anorexia, weakness
- swelling of face and legs
- breathlessness due to pulmonary odema
- pruritis, lethargy, cramps and headaches due to raised urea
- insomnia
- polyurea
- sexual dysfunction
- predisposing factors often present
- usually picked up incidentally by urine dips
8
Q
How is CKD investigated?
A
- urine dip
- 24 hr urine collection/ spot urine collection to look at ACR
- bloods: u&e, alk phos, parathyroid hormone, plasma glucose and HbA1c, serum ablumin, lipid screen (usually high), FBC (normocytic anaemia), anti nuclear antibodies, c ANCA and p ANCA, anti GMB if no clear cause
- ECG and echo as heart failure is often a differential and LVH often occurs due to fluid overload
- Renal USS if suspect APCKD, obsutruction, haematuria, low GFR
- renal biopsy when indicated
9
Q
When should a renal biopsy be done in someone with CKD
A
Progressive disease, nephrotic syndrome, systemic disease, AKI without recovery, unknown cause
10
Q
When should the GP refer someone with CKD to a nephrologist?
A
- When reach stage 4
- ACR>70 mg/mmol unless due to DM
- ACR >30 with haematuria
- eGFR decrease by 15% in 12 months
- high BP poorly controlled despite >4 antihypertensives at theraputic dose
- known or suspected rare or genetic cause of CKD
11
Q
Describe stage 1-5 CKD
A
1= eGFR> 90 2= 60-89 3= 30-59 4= 15-29 5= <15
12
Q
List 5 complications of CKD
A
- hypertension
- odema
- hyperkalaemia
- uremia
- coagulopathies
- acidosis
- anaemia of chronic disease
- hypocalcamia with hyperparathyroidism
- rugger jersey spine/mineral bone disease (related to above)
- CVD due to high BP, vascular stiffness, inflammation, oxidative stress, abnormal endothelial function
13
Q
What treatment is given in CKD to slow disease progression
A
- ACEi or ARB (not both) and check K+ before and 2 weeks after starting treatment
- Good glyaemic control
- lifestyle advice
- Avoid NSAIDS, nephrotoxic drugs and K+ sparing diuretics (amiloride and spironolactone)
- Adjust doses of renal metabolised/ excreted drugs
14
Q
What treatments are given for CKD complications?
A
- odema: furosemide/ bumetanide, restrict sodium and fluid intake
- Anaemia: ferrous sulphate or IV iron then EPO if not work
- Acidosis: sodium bicarb supplements
- high phosphate and K+: reduce in diet (refer to dietician), calcium acetate works as phosphate binder
- hyperparathyoidism/ hypocalcaemia: give adcal D3/ alphacalciferol
- CVD: anti platelets (aspirin) and statin
15
Q
Describe the management of hyperkalaemia? inc doses
A
- Do ECG and VBG to confirm
- If K+> 6.5 or ECG changes, give IV calcium gluconate 10mg 10% over 10 mins and actrapid 10 units and 50mls 50% dextrose immediately
- Also give calcium resonium (15-45mg) to bind the Ca2+
- Give 5-10mg salbutamol neb if K+ not coming down
- sodium bicarb and call renal reg if still refractory
- Final option is dialysis
- If k+ 6-6.5 or no ECG changes, give calcium gluconate usually, stop K+ sparing diuretics, give fluids/ hydrate, think about loop diuretics if refractory
