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Met3 > Renal: CKD > Flashcards

Renal: CKD Flashcards

1
Q

Define CKD [1]

A

Abnormal kindey structure or function, present for > 3 months, with implications for health

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2
Q

What are the two ways of classifying CKD? [2]

A

Via GFR; and albumin excretion

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3
Q

What are the classifications of CKD by GFR? [5]

A

· Stage 1: any kidney problem, but eGFR >90
· Stage 2: any kidney problem, eGFR 60-90
· Stage 3a: eGFR 45-59
Stage 3b eGFR 30-44
· Stage 4: eGFR 15-30
· Stage 5: eGFR < 15

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4
Q

What are the classifications of CKD by albuminuria? [6]

A

A1:
* Albumin excretion (mg/24hr): < 30
* ACR: < 3

A2:
* Albumin excretion (mg/24hr): 30-300
* ACR: 3-3-

A3:
* Albumin excretion (mg/24hr): >300
* ACR: >30

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5
Q

What are primary renal disease causes of CKD:

Glomerular [1]
Tubolinterstitial [1]
Blood flow [1]
Cystic / congenital [1]
Transplant [1]

A

What are primary renal disease causes of CKD:

Glomerular: MCD; membranous nephropathy
Tubolinterstitial; UTI; pyelonephritis; stones
Blood flow: renal limited vasculitis
Cystic / congenital: renal dysplasia
Transplant: recurrence of renal disease

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6
Q

What are systemic causes of CKD:

Glomerular [1]
Tubolinterstitial [1]
Blood flow [1]
Cystic / congenital [1]
Transplant [1]

A

What are systemic causes of CKD:

Glomerular: diabetes; amyloid
Tubolinterstitial: drugs, toxins, sarcoid
Blood flow: heart failure
Cystic / congenital: alport syndrome
Transplant: rejection, calcineruin toxicity

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7
Q

Who manages stages 3-5 of CKD? [3]

A

Stage 3 CKD with eGFR 30-60: the most important effect of this is the increase on your vascular risk: mostly managed by GP to reduce vascular risk and prevent progression of CKD to the point where it needs serious intervention + likely dialysis.

Stage 4 CKD: is also quite poor kidney function and will likely need nephrology attention.

Stage 5 CKD: patients need immediate nephrology attention and are very close to needing dialysis.

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8
Q

State 5 pathological systemic consequences of CKD [5]

A

Anaemia
Renal bone disease
HTN
Acid / base imbalance
Uraemia

(Basic roles of the kidneys

  1. Get rid of fluid (and sodium)
  2. Control serum pH
  3. Control serum potassium
  4. Regulate BP
  5. Regulate Hb via EPO production
  6. Control bone and mineral metabolism both through Ca/PO excretion and through Vit D

So, in cases of CKD, all of these things go wrong as they cannot go ahead as normal like they do in a healthy kidney)

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9
Q

Describe how anaemia can occur due to CKD [5]
Which stage of CKD does this occur in? [1]

A
  • Reduced secretion if EPO; relative deficiency
  • Reduced erythropoiesis due to toxic effects of uraemia on bone marrow
  • Reduced absorption of iron
  • Anorexia due to uraemia
  • Reduced RBC survival}}

G3B+

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10
Q

How can acidosis occur due to CKD? [2]

A

Increased tendency to retain hydrogen ions (due to abnormalities in acid-base homeostasis)
Leads to low levels of bicarbonate

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11
Q

Describe what the mineral disturbances in CDK MBD (CKD mineral bone disorder) are [3]

A

Disturbances in Ca & P metabolism, causing:
High serum phosphate (reduced excretion)

Low vitamin D activity - causing low serum calcium (healthy kidneys metabolise vitamin D into it’s active form, which is essential for Ca reabsorption& regulating bone turnover

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12
Q

What are the pathological consequences of low Ca2+ in CKD MBD? [3]

A

Low serum calcium and high serum phosphate causes the parathyroid glands to excrete more PTH: secondary hyperparathyroidism.

PTH stimulates osteoclast activity, increasing calcium absorption from bone. This results in osteomalacia

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13
Q

How can osteosclerosis occur in CKD patients? [2]

A

Osteosclerosis occurs when the osteoblasts respond by increasing their activity to match the osteoclasts, (which are increased due to secondary hyperparathyroidism) creating new tissue in the bone.

Due to the low calcium level, this new bone is not properly mineralised.

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14
Q

What is the name for this radiographical finding of CKD MBD? [1]

Describe why this occurs [2]

A

Rugger jersey spine

Sclerosis of both ends of each vertebral body (denser white)
Osteomalacia in the centre of the vertebral body (less white)

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15
Q

Describe the type of anaemia seen in CKD [1]

A

normocytic normochromic anaemia

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16
Q

Which medication classes may worsen hyperkalaemia caused by CKD? [2]

A

NSAIDs and potassium-sparing diuretics

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17
Q

How do you manage acute rises in K? [2]

A

calcium gluconate (stabilises myocardium)
insulin dextrose (drives potassium into the intracellular compartment)

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18
Q

How do you manage CKD MBD? [3]

A

· Vitamin D analogues & dietary supplements
· Dietary restriction of phosphate and prescribe phosphate binders around the time of meals
· Calcimimetics: bind to PTH receptors and mimic the normal action of calcium to prevent PTH release

19
Q

What effect does CKD have on BP? [1]
Why is this clinically significant? [2]

A

CKD raises BP
- High BP worsens CKD
- Which makes proteinuria more likely

20
Q

What’s important to note about the mortality of CKD? [1]

A

More likey to die from CKD than need renal replacement

21
Q

What level of serum P do you treat CKD bone-mineral disease at? [1]

A

P > 1.5mmol/L

22
Q

What is the BP aim for patients with CKD? [1]

What is the BP aim for patients with CKD & DM or ACR > 70? [1]

A

What is the BP aim for patients with CKD? [1]
* < 140/90
What is the BP aim for patients with CKD & DM or ACR > 70? [1]

:< 130/80

23
Q

When should you refer a patient to a renal specialist? [5]

A
  • eGFR less than 30 mL/min/1.73 m2
  • Urine ACR more than 70 mg/mmol
  • proteinuria > 30 mg/mmol & haematuria
  • Accelerated progression (a decrease in eGFR of 25% or 15 mL/min/1.73 m2 within 12 months)
  • 5-year risk of requiring dialysis over 5%
  • Uncontrolled hypertension despite four or more antihypertensive
24
Q

Describe the managment for CKD patients:

To slow disease progression [2]

To reduce risk of complications [1]

A

Slow disease progression:
- ACE inhibitors (or angiotensin II receptor blockers)
- SGLT-2 inhibitors (specifically dapagliflozin)

To reduce risk of complications:
- Atorvastatin 20mg (prevents CV disease)

25
Q

Which CKD patients should be offered ACE inhibitors? [3]

When is a SGLT-2 inhibitor be given to CKD patients? [1]

A

ACE inhibitors are offered to all patients with:
* Diabetes plus a urine ACR above 3 mg/mmol
* Hypertension plus a urine ACR above 30 mg/mmol
* All patients with a urine ACR above 70 mg/mmol

SGLT-2 Inhibitors
Dapagliflozin is the SGLT-2 inhibitor licensed for CKD. It is offered to patients with:
* Diabetes plus a urine ACR above 30 mg/mmol

26
Q

Describe the dietary requirements of patients with CKD [3]

A

· Low sodium diet: potato crisps, anchovies, adding salt to anything, prawns, any sort of processed or pre-manufactured food has lots of sodium

· Low potassium diet: bananas, oranges and orange juice, mangos, yogurt, pulses and lentils (kidney beans)

· Low phosphate; widely prevalent in foods; chicken, fish, dairy product, nuts, coca cola

27
Q

What is normal protein daily excretion? [1]

A

< 150mg/day

28
Q

How is proteinuria measured? [4]

A
  • Urine dipstick (not specific, but tells prescence)
  • Total urine protein
  • Urine albumin measurements: total albumin excretion; albumin creatitine ratio
29
Q

What is the most common cause of CKD? [1]

A

Diabetes

30
Q

First line treament for reducing proteinuria is? [2]

A

ACE inhibitors
ARBs

31
Q

How do you treat anameia of CKD? [2]

A

Iron deficiency is treated before using erythropoietin.

Anaemia may be treated with erythropoiesis-stimulating agents, such as recombinant human erythropoietin.

32
Q

Why do blood transufusions need to be carefully considered when treating anaemia of CKD? [1]

A

Blood transfusions can sensitise the immune system (allosensitization), increasing the risk of future transplant rejection.

33
Q

What is important to note about stages 1 & 2 CKD? [2]

A

CKD: only diagnose stages 1 & 2 if supporting evidence to accompany eGFR

34
Q

How do they kidneys for most patients with CKD appear on US? [1]

A

Most patients with chronic kidney disease have bilateral small kidneys

35
Q

How does HIV-associated nephropathy appear on US? [1]

A

Chronic HIV-associated nephropathy will have large/normal sized kidneys on ultrasound

36
Q

In a patient with suspected anaemia of chronic disease secondary to CKD, what should be checked prior to commencing EPO? [1]

A

In a patient with suspected anaemia of chronic disease secondary to CKD, iron status should be checked prior to commencing EPO

37
Q

What is important to note about prescribing anti-hypertensives in patients with CKD? [1]

A

A combination of renin-angiotensin system antagonists should NOT be prescribed to patients with CKD

38
Q

All patients with chronic kidney disease should be started on a []

A

All patients with chronic kidney disease should be started on a statin

39
Q

Name a drug that is phosphate binder used to treat bone disease of CKD [1]

A

Sevelamer is a non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease

40
Q

*

All patients who are diagnosed with CKD should be prescribed what drug / drug class? [1]

A

Statins

41
Q

What is the most likely cause of death for someone on haemodialysis with CKD? [1]

A

Ischaemic heart disease

42
Q

A patient presents with CKD and A:CR greater than 30. What drug class should be prescribed? [1]

A

ACE Inhibitor

43
Q
A

Met3 (52 decks)

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