Session 10: Chronic Kidney Disease Flashcards
Define chronic kidney failure.
Progressive and irreversible loss of renal function renal function over a period of months to years.
This leads to renal tissue being replaced by extracellular matrix in the response to the damage.
How would CKD present on histology?
Gives rise to glomerulosclerosis and tubular interstitial fibrosis.
What are most glomerular diseases that lead to chronic renal failure characterised by?
Proteinuria and systemic hypertension
Why might incidence of CKD be difficult to define?
Because CKD is usually asymptomatic.
Global prevalence of CKD.
11-13%
What is CKD most commonly associated with in developed countries?
Old age
Diabetes
Hypertension
Obesity
CVD
Common causes of CKD.
Diabetes
Hypertension
CVD
Immunologic
Systemic like myeloma or lupus
Infection like pyelonephritis
Obstructive/reflux
Genetic like polycystic disease or Alport’s.
What is this?
Adult Polycystic kidney disease.
What is APCKD?
An autosomal dominant disease where there is most commonly a mutation in PKD 1 Gene.
Cysts in the kidneys grows with age and generally present in adulthood.
Diagnosis of APCKD.
Ultrasound however this can’t exclude diagnosis if less than 30 years old as cysts might not have developed much by then.
Genetic testing
Complications of APCKD.
Pain
Bleeding into cysts
Infection
Renal stones
Hypertension
Intra-cranial aneurysms
Heart valve abnormalities
Management of CKD.
Treat the hypertension (most commonly by blocking RAAS)
Plenty of fluids
Low salt
Normal proteins
Tolvaptan
Stages of CKD.
1 - >90 GFR
2 - 60-89 GFR
3 - 30-59 GFR
4 - 15-29 GFR
5 - <15 GFR
Investigation of CKD.
Define degree of renal impairment
Define the cause of renal impairment
Diagnosis and prognosis
Identify complications
Long term treatment plan
eGFR
Give two investigations that are absolutely necessary and always done in CKD.
Blood pressure
Urine dipstick
How is eGFR used?
Only accurate in adults and needs to be corrected in black patients.
Explain how mineral bone disease may arise in CKD.
Impaired renal function can lead to decreased enzyme that converts vitamin D into its active form calcitriol.
This leads to lower Ca2+ absorption in the intestines and impaired mineralisation of bone.
This leads to less plasma Ca2+ and increase in PTH.
This increase in PTH further more resorbs bone in order to increase Ca2+ levels and can lead to weak bones.
What is dialysis?
A process where there is passage of molecules through a semi-permeable membrane down a concentration gradient.
