S12) Chronic Kidney Disease Flashcards
What is adult polycystic kidney disease?
- APCKD is an autosomal dominant disease due to a mutation in either PKD1 gene (~85%) or PKD 2 gene
- Cysts grow with age, it generally presents in adulthood and is diagnosed with ultrasound and genetic testing
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What are the secondary complications of APCKD?
- Pain
- Bleeding into cyst
- Infection
- Renal stones (stasis)
Identify three other co-morbidities of APCKD
- Hypertension very common (before renal function changes)
- Increased incidence of intra-cranial aneurysms
- Increased incidence of heart valve abnormalities
What is Chronic Kidney Disease?
- CKD is the irreversible and sometimes progressive loss of renal function over a period of months to years
- Renal injury causes renal tissue to be replaced by extracellular matrix in response to tissue damage
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Describe the aetiology of chronic kidney disease
- Diabetes
- Hypertension
- Immunological e.g. glomerulonephritis
- Infection e.g. pyelonephritis
- Genetic e.g. APCKD, Alport’s
Which groups of patients have an increased incidence of CKD?
- Elderly
- Multi-morbid
- Ethnic minorities
- Socially disadvantaged
Classify the different stages of CKD in terms of GFR
- G1 – normal/high GFR ( ≥ 90)
- G2 – midly decreased (60-90)
- G3a – midly/moderately decreased (45-59)
- G3b – moderately/severely decreased (30-44)
- G4 – severely decreased (15-29)
- G5 – kidney failure (< 15)
Classify the different stages of CKD according to proteinuria
- A1 – normal/mildly increased (< 30 mg/g)
- A2 – moderately increased (30 - 300 mg/g)
- A3 – severely increased (>300 mg/g)
What investigations should one request for a patient with suspected CKD?
- Blood pressure
- Urine dipstick
Describe the usage of eGF
- Only accurate in adults
- Correction needed for black patients (not Asians)
- Defines CKD but not useful in AKI
In 5 steps, outline the clinical approach for CKD
⇒ Define degree of renal impairment
⇒ Define cause of renal impairment
⇒ Provide patient with diagnosis and prognosis
⇒ Identify complications of CKD
⇒ Plan long term treatment (delay progression, plan for dialysis/transplantation)
Identify the 5 general blood tests performed for a patient with suspected CKD
- Urea & Electrolytes
- Bone biochemistry
- Liver function tests (albumin)
- Full blood count
- C reactive protein
- ± PTH / iron levels (ferritin, iron, reticulocyte haemoglobin)
Which other blood tests are performed for a patient with suspected CKD and when should they be performed?
Clincial suspicion of…
- Auto-immune disease – auto-antibody screen, complement levels
- Vasculitis – anti-neutrophil cytoplasmic antibody
- Myeloma – serum immunoglobulin screen, protein electrophoresis
Which imaging techniques are used for a patient with suspected CKD, and why are they performed?
- Ultrasound scan – kidney size, evidence of obstruction (hydronephrosis)
- Kidney biopsy – cause unknown, haematuria, proteinuria (USS first)
- Other investigations:
I. CT scan (stones / mass)
II. MRI scan (mass)
III. MR angiogram (renal artery stenosis)
Identify four modifiable risk factors for CKD
- Lifestyle
- Smoking
- Obesity
- Lack of exercise
Identify two non-modifiable risk factors for CKD
- Uncontrolled diabetes
- Hypertension
Identify three drugs which act as risk factors for CKD
- Proton pump inhibitors
- ACE-Inhibitors / Angiotensin Receptor Blockers (proteinuria)