Renal GP Flashcards

1
Q

Chronic kidney disease (CKD) - definition?

A

Chronic kidney disease (CKD) is an abnormality of kidney function or structure that is present for more than 3 months, with implications for health.

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2
Q

Chronic kidney disease (CKD) -

how do we measure it?

A

Both a

Blood test for serum creatinine, to calculate estimated glomerular filtration rate (eGFR), a test of renal function

and

Early morning urine for Albumin/Creatinine ration (ACR), a test for proteinuria.

Also

Dipstick the urine for haematuria.

In stages 4 and 5 also

monitor calcium, phosphate, Vitamin D and PTH, as well as haemoglobin.

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3
Q

CKD -

Albuminuria stages?

A

Albuminuria (Proteinuria) stages based on urine Albumin/Creatinine ratio (ACR, in mg/mmol)

<3 = mildly increased = A1

3-30 = moderately increased = Microalbuminuria = A2

>30 = severely increased = Proteinuria = A3

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4
Q

CKD -

renal function stages?

A

Renal function stages based on eGFR:

>90 = normal

60-89 = mild reduction

45-59 = mild-moderate reduction = CKD stage G3A

30-44 = moderate-severe reduction = CKD stage G3B

15-29 = severe reduction = CKD stage G4

<15 = kidney failure = CKD stage G5

QOF: keep a register of patients with CKD stages 3, 4 and 5

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5
Q
A
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6
Q

CKD -

when to refer?

A
  • eGFR <30 = Stages 4 or 5 (with or without diabetes)
  • ACR >70
  • ACR >30 with Haematuria
  • Decline of 25% and change in GFR category, or of 15ml/min/1.73m2 in a year
  • Poorly controlled BP despite 4 antihypertensives
  • Rare or genetic causes of CKD
  • Suspected renal artery stenosis (RAST)
  • Complications like anaemia or renal bone disease
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7
Q

CKD -

when to prescribe an ACE Inhibitor?

A

Prescribe an ACE Inhibitor in CKD with

  • Diabetes + ACR >3
  • Hypertension + ACR >30
  • ACR >70

Avoid ACE if potassium >5, and stop again if >6

A decrease of eGFR of 25% or Creatinine of 30% after starting ACE would be acceptable

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8
Q

CKD -

blood pressure targets?

A

CKD: < 140/90

CKD + diabetes: < 130/80

CKD + ACR >70: < 130/80

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