Renal: CKD Flashcards
How is CKD staged?
1 = >90ml/min = normal or increased GFR with other evidence of renal disease
2 = 60-89ml/min = slight decrease In GFR with other evidence of renal damage
3a = 45-59ml/min = moderate GFR decrease with/without evidence of renal damage
3b = 30-44
4 = 15-29ml/min = severe GFR decrease with/without evidence of renal damage
5 = <15ml/min = established renal failure
What causes CKD?
DM = T2>T1
Glomerulonephritis = commonly IgA nephropathy
Unknown (20%) = many present late with small/shrunken kidneys
HTN, renovascular disease
Pyelonephritis and reflux nephropathy
What are the symptoms and signs of CKD?
Pallor
Uraemic tinge to the skin (yellowish)
Purpura
Increased BP
Cardiomegaly
Ballotable polycystic kidneys
Weight loss and poor appetite
Swollen ankles, feet or hands – as a result of water retention (oedema)
SOB
Tiredness
Haematuria
Polyuria, nocturia
Insomnia
Itchy skin
How should CKD be investigated?
Blood = Hb, ESR, U+Es, glucose, decreased Ca, increased phosphate, increased alk phos, PTH
Urine = dipstick, microscopy, C+S, albumin:creatinine
Imaging = USS (<9cm in CKD)
Histology = renal biopsy
How should CKD be managed?
Identifying and treating reversible causes = obstruction, nephrotoxic drugs, high Ca, lower CVS risks, tight glucose control in DM
BP = target <130/80, ACEi, ARB
CVS = statins for patients with raised lipids, aspirin
Diet = review by dietitian, K restriction if hyperkalaemia
Anaemia = replace iron/B12/folate, EPO
Acidosis = Na bicarb supplements
Oedema = high dose loop diuretic (furesemide), restriction on fluid and Na intake
Restless legs/cramps = check ferritin, gabapentin
What complications can arise from CKD?
Anaemia
HTN
Pulmonary oedema
CKD mineral bone disease
Secondary hyperparathyroidism
CVD
As a Dr how should you plan for the future for a CKD pt?
Start discussions of what options they have if they reach ESRF
Home care team input
Discuss disadvantages + advantages of types of RRT
- Home therapies – APD, CAPD, Home HD
- Unit-based therapies – Nocturnal HD, conventional HD
- Active conservative management
- Transplant
Refer for fistula
- Venous mapping
Refer for PD tube insertion
Work-up for transplant
- Further tests
- Refer to Transplant work-up clinic
How does the patient’s CKD affect any medications they need?
Statins = pts with high lipids
BP medication = target <130/80 - ACEi, ARBs
Anaemia = replace iron/b12/folate, EPO
Oedema = high dose loop diuretic (furosemide)
Restless leg/cramps = gabapentin
What is adult polycystic kidney disease?
Aetiology = genetic (ADPKD/ARPKD)
Pathophysiology = renal tubules become structurally abnormal, cysts develop, kidneys enlarge and lose function - over time
S/S = HTN, back or side pain, headache, abdo fullness, increased abdo size, haematuria, kidney stones, UTI
Investigations = BUN, Cr, eGFR, aCT, exam - enlarged liver, heart murmurs
Management = no current therapies proven effective to prevent progression, end stage - renal replacement therapy (RRT): dialysis and/or transplantation
Complications = HTN (activation of RAAS - use ACEi), kidney failure, liver cysts, mitral valve prolapse (1/4), diverticulosis, chronic pain, aneurysms, infected cysts
How can you differentiate between acute and chronic kidney damage?
Hx
Exam
Bloods = establish baseline (median value 1 year prior to event)
- Hb - normocytic, normochromic
- Acid-base balance
- PTH, Ca, phosphate
Imaging = US
- CKD = shows loss of differentiation between cortex and medulla - thin cortex due to sclerosed nephrons
