S7 L1 Chronic Kidney Disease Flashcards
Defining CKD
- What does this mean?
- What is it?
- When does it happen? Mechanism of the process of what happens…
- Measured by…
Staging CKD
- eGFR
- Description of each stage
eGFR
Staging CKD
- Proteinuria
- Description of each stage
Summary CKD Staging
- 2 types
Causes of CKD
- Some causes
- Most common causes
Diabetes Mellitus
HTN
CKD Screening
- When do they do the screening?
Blood tests - General
Blood tests - Determine Cause of CKD
Other investigations
CKD screening:
NICE recommend that the people in the following at risk groups should be offered testing for CKD:
• Diabetes
• Hypertension
• CVD
• Structural renal tract disease, renal calculi or prostatic hypertrophy
• Multisystem diseases with potential kidney involvement e.g. SLE
• Family history of stage 5 CKD or hereditary kidney disease
• Patients on know nephrotoxic drugs
• Opportunistic detection of hematuria or proteinuria
Blood tests - General
When thinking about CKD, measure: blood pressure, urine analysis (to see if presence of proteins, blood etc), also…
• Urea & Electrolytes
• eGFR
• Bone biochemistry
• Liver function tests (albumin)
• Full blood count
• CRP
• +/- iron levels (ferritin, iron, reticulocyte haemoglobin) - Kidneys are important in iron levels and anaemia
• +/- PTH - As kidneys are important in calcium homeostasis
Blood tests - Determine Cause of CKD
If there is clinical suspicision of the following:
• Auto-antibody screen (auto-immune disease)
• Complement levels (auto-immune disease)
• Anti-neutrophil cytoplasmic antibody (vasculitis)
• Serum immunoglobulin screen (myeloma)
• Protein electrophoresis & serum free light chain measurement (myeloma)
Renal Pathology in CKD
Management of CKD
- Prevention of CKD… Delaying Progression of CKD…
Functions of the kidneys:
- Regulation of…
- Other roles of the kidneys…
- What functions are affected particularly in CKD’s that aren’t affected in AKI
Modifiable risk factors for CKD
• Lifestyle
• Smoking
• Obesity
• Lack of exercise
• Uncontrolled diabetes
• Hypertension
• Proteinuria (ACE-inhibitors/Angiotensin Receptor Blockers)
• Lipids
Regulation of Water and Salt
- Hypertension…
- What drugs?
- How does kidney function affect water excretion?
Water Handling in the Kidney:
- Amount of urine produced depends on…
- How does CKD affect GFR and urine?
CKD:
Reduced GFR
CKD continued.
- How this affects GFR?
Hyperkalaemia:
- How can CKD lead to hyperkalaemia?
- How to stop this from happening/treatment
Acidosis:
- How to treat this?
Anaemia in CKD:
- Why?
- Improving hb, leads to improvements in…
Treating anaemia in CKD
- How to do this?
Diabetes in CKD
- How to monitor it?
CKD - Bone Mineral Disease…
Calcium homeostasis, role of the kidney?
- Management of CKD in relation to Ca2+ metabolism?
Management of CKD- BMD
• Reduce phosphate intake (as much as is practical)
• Phosphate binders
• Many contain calcium – caution re: how much calcium patient given
• 1-α-calcidol
• (Vitamin D)
Altered Drug Metabolism
- How do CKD and ESRD affected drug metabolsim…
CKD… Accumulation of waste products…
Established (End-Stage) Renal Failure
Renal Replacement Therapy
- ESRF
- RRT
Symptoms of ESRD/Dialysis
Haemodialysis
- What is this
- Positives and negatives of it?
Peritoneal Dialysis
- How does it work?
- Positives and negatives?
Kidney transplant
