Urinary: CKD Flashcards
What is done to investigate al renal diseases?
- Blood pressure
- Urine dipstick
What is the aetiology of CKD?
- Diabetes
- Hypertension
- Immunologic
- Infection
- Genetic – APKD, Alport
- Obstruction and reflux nephropathy
- Vascular
- Systemic disease
What are the risk factors of CKD?
- Elderly
- Multi-morbid
- Ethnic minorities
- Socially disadvantaged
Describe the staging of CKD
G1 – normal or >90 G2 – 60-90 G3a – 45 - 59 G3b – 30-44 G4 – 15-29 G5 - <15
A1 - normal
A2 - microalbuminuria
A3 – proteinuria
What are the general blood tests used for investigation of CKD?
- Urea & Electrolytes
- Bone chemistry
- Liver function tests (albumin for proteinuria)
- Full blood count
- CRP
+/- iron levels (check iron stores first before EPO treatment)
+/- parathyroid hormone
What are blood tests used to determine the cause of the CKD?
- Autoantibody screen
- Complement levels
- Anti neutrophil cytoplasmic antibody
- Serum immunoglobulin
What are other investigations done in CKD?
- Ultrasound scan (Kidney size, evidence of obstruction)
- Kidney biopsy (cause unknown, Haematuria, Proteinuria)
- Other for specific causes (CT scan, MRI scan, MR angiogram)
What are methods used to manage CKD?
- Modifiable risk factors of CKD (Lifestyle, Smoking, Diet , Lack of Exercise)
- Stopping proton pump inhibitors/NSAIDS
- Uncontrolled diabetes
- Hypertension (antihypertensive, diuretics, fluid restriction)
- Proteinuria
- Lipids
What are the effects of CKD on water/salt handling by the kidney?
- Reduced GFR
- Lose ability to maximally dilute and concentrate urine
- Small glomerular filtrate but same solute load cause osmotic diuresis and nocturia
- Low volume of filtrate reduced maximum ability to excrete urine therefore maximum urine volume is much smaller
What are the effects of acidosis in CKD?
- Muscle (enzymes denature)
- Bone
- Renal function progression to worsen
What is acidosis in CKD treated with?
Treat with NaHCO3 tablets
How is hyperkalaemia managed in CKD?
May require
- Stopping ACE-ihibitor/ Angiotensin receptor blocker
- Avoidance of potassium
- Altering diet to avoid food with high potassium
What are the effects of accumulation of waste products in CKD?
- Contribute to uraemic syndrome
- Reduce apetite
- Nausea and vomiting
- Pruritis
What is the effect of CKD on drug management?
- Dose alteration in CKD/ERSD due to reduced metabolism and elimination
- Drug sensitivity increased even if elimination unimpaired meaning side effects more likely
What are the causes of anaemia in CKD?
- Decreased EPO
- Absolute iron deficiency. High hepcidin so less iron absorbed from gut
- Blood loss
- Short red blood cell life span
- Bone marrow suppression
- Mineral and bone disorders
- ACE inhibitor can cause anaemia
- Deficiency in B12 and folate
Why is treating anemia in CKD important for the patient?
- Improve exercise capacity
- Improve cognitive function
- Helps regulate left ventricular hypertrophy
- Helps slow progression of renal disease
- Reduces mortality
How does mineral bone disease occur in CKD?
- Phosphate retention
- Leads to bone resistance to PTH and low Vitamin D levels
- Leads to Hypocalcaemia
- Parathyroid hormone is triggered
- Phosphate retention leads to less calcium sensors and less vitamin D sensors
- This leads to secondary parathyroidism
What are the effects of mineral bone disease in CKD?
- Leads to bone loss
- Can cause bone cysts
- Non bone calcification (deposits in the skin which causes ulceration, deposits in joints)
What are the treatment for mineral bone disease in CKD?
- Phosphate intake
- Phosphate binders
- 1 alpha calcidol
- Vitamin D
What are the symptoms of CKD?
- Tiredness (Overwhelming fatigue, Guilt, physically and mentally incable)
- Difficulty sleeping
- Difficulty concentrating
- Volume overload
- Nausea vomiting
- Itching
- Restless legs
- Sexual dysfunction/ reduce fertility
- Increased risk of infections
What are advantages and disadvantages of haemodyalysis?
Advantages
- Less responsibility
- Days off
Disadvantages
- Travel time/waiting
- Tied to dialysis times
- Big restriction on fluid/food intake
What are the contraindications of haemodyalysis?
- Failed vascular access
- Heart failure a relative contraindication
- Coagulopathy a relative contraindication
What are advantages and disadvantage of peritoneal dialysis?
Advantages
- Self sufficient/independence
- Generally less fluid/food restrictions
- Fairly easy to travel with CAPD
- Renal function may be better preserved initially
Disadvantages
- Frequent daily exchanges and overnight
- Responsibility
What are the contradictions of peritoneal dialysis?
- Failure of peritoneal membrane (surface area)
- Adhesion, previous abdo surgery, hernia, stoma
- Patient unable to connect
- Obese or large muscle mass
What are the complications of peritoneal dialysis?
- Peritonitis
- Ultrafiltration failure
- Leaks
- Development of a hernia
