session 8- CKD Flashcards
What is CKD?
the progressive loss of kidney function (aka reduction in eGFR) over a number of months or years, which is present for >90 days (differentiate from AKI)
what are the risk factors for CKD?
age: 65+ diabetic hypertension family history of CKD PKD
what are the causes of CKD?
glomerulonephritis pyelonephritis PKD- polycystic kidney disease SLE- systemic lupus erythromatous long term use of: NSAIDS/Lithium blockages due to kidney stones/prostate disease
What value do you use to stage CKD? and what are the stages?
eGFR
Stage 1: >90 is normal GFR, but urine analysis, genetic traits or other abnormalities suggest they will develop kidney disease in the future
Stage 2: 60-89 is mild reduction in kidney function
Stage 3: 30-59 is a moderate reduction in kidney function
Stage 4: 15-29 severe reduction in kidney function
Stage 5- end stage kidney failure: GFR of less than 15
(mL/min/1.73m2)
What other test might you do on someone you thing has reduced kidney function?
urine analysis
proteinuria
looking for albumin/creatinine ratio
How do you monitor/treat those at different stages of CKD?
Frequency: must be agreed with patient, Most people 1-2 a year. Max 4 times a year, only in ESRF patients.
Stages 1-3: monitor regularly, CONTROL BP modify risk factors (exercise, maintain healthy weight, stop smoking)
Stage 4: plan for ESRF(stage 5)
Stage 5: treat- dialysis/transplant
What pharmacotherapy might you give to someone with CKD trying to control their hypertension?
ARB- angiotensin receptor blocker (NB: not ACEi as can cause AKI due to contraction of the efferent arteriole)
antiplatelets- to prevent secondary CV disease
What other problems might you get when the kidney has reduction function and why?
Osteoporosis - Kidney is responsible for the production of Vitamin D. Low calcium will lead to PTH being produced to compensate. Chronically, a high PTH will increase the bone resorption and therefore bone demineralisation.
Anaemia (of chronic disease) - as the kidney is responsible for producing EPO.
What is ESRF?
end stage renal failure- where there is irreversible loss of kidney function (GFR <15) so low that if not given dialysis or kidney transplant will lead to death within a few days- weeks due to pulmonary oedema or hyperkalemia etc
What is the optimum type of RRT?
renal replacement therapy
most cost effective and best outcomes for the patient is a straight renal transplant.
dialysis (both peritoneal and hemo) is very very expensive and the patient will eventually die
If the patient could not find a kidney donor at stage 4 of their CKD, which might you do before they progress to stage 5?
prepare the AV fistula, so that when they reach stage 5 they are ready to begin hemodialysis straight away when they do progress
What types of dialysis are there?
peritoneal
hemodialysis
What things must you take into account when considering someones suitability to be a transplant recipient?
Are they likely to adhere to the immunosuppression medication?
Do they have an underlying chronic malignancy which will be worsened by immunosuppressant medication?
Are they fit enough to undergo surgery? i.e. Cardio/resp disease which can make anaesthesia difficult, PVD/obesity which makes the surgery technically difficult
What are the different types of kidney transplant one can receive?
Deceased Donor Kidney recipient list- approx 3 year wait
live donor- i.e. like a sibling
if T1 diabetes also- kidney and pancreas dual transplant (less than 8 months wait)
How long does HD take compared to PD?
HD- 3x weekly, 3-5 hours each time in hospital or at home
PD- normally done at home
CAPD- continous ambulatory: done at home, change fluid 4 times a day, fluid stays in for 4 hours each time
CCPD- continuous cycling: done 10-12 hours at night time whilst you sleep at home
