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Stage 4: CSIM 2 > Week 11: CKD > Flashcards

Week 11: CKD Flashcards

1
Q

Definition of CKD

A

> 3 months of abnormal kidney function/ structure

  • GFR <60 ml/min/1.73m^2
  • ACR >3 mg/mmol
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2
Q

Why does CKD cause hypertension

A

Falling GFR causes the kidneys to increase renin secretion

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3
Q

2 main causes of CKD

A
  1. Hypertension

2. Diabetes

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4
Q

5 stages of CKD based off GFR (G1-G5)

A 
G1. >90 (normal)
G2. 60-89 (mild)
G3a. 45-59 (mild-moderate)
G3b. 30-44 (moderate-severe)
G4. 15-29 (severe)
G5. <15 (kidney failure)
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5
Q

3 modifier stages of CKD based off albuminuria (A1-A3)

A

A1. <3 micog/dl
A2. 3-2.9 microg/dl
A3. >30 microg/dl

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6
Q

In which groups of people might the CKD stage classification not be as accurate

A
  1. Elderly pts
  2. Extremes of weight (assumes everyone is 72kg)
  3. Advanced stages of CKD
  4. Certain ethnic groups
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7
Q

Explain the difference in interpreting Albumin: Creatinine Ratio (ACR) vs Protein: Creatinine Ratio (PCR) results

A

Not all protein in urine is albumin.

Proteinuria without albuminuria could be due to other protein types (eg light chain proteins in myeloma)

–> Look at ACR to define CKD

ACR is the albumin to URINE creatinine ratio

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8
Q

What is creatinine

A

Waste product of muscle metabolism.

Comes from creatine (which is synthesised in liver, stored in muscle)

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9
Q

What factors would alter a serum creatinine

A
  1. Muscle mass
  2. Muscle catabolism
  3. Liver function
  4. A high protein meal
  5. Trimethoprim (competes with creatinine for same tubular transport)
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10
Q

Complications of CKD on electrolytes

A
  1. Hyperkalemia (cannot excrete as much potassium)
  2. Hypocalcaemia (less Ca2+ absorbed from diet due to less Vit D)
  3. Hyperphosphataemia
  4. Hyperparathyroidism
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11
Q

Complications of CKD on

blood

A
  1. Anaemia (less production of epo)

2. Uraemia/Azotaemia

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12
Q

Complications of CKD on

blood pressure and fluid retention

A
  1. Hypertension
  2. Peripheral oedema
  3. Pulmonary oedema, pleural effusion, raised JVP
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13
Q

Describe the pathophysiology of the impact of CKD on calcium metabolism (when GFR <30)

A
  1. Less Vit D can be activated
  2. Less Ca2+ absorbed from diet
  3. Hypocalcaemia
  4. Hyperparathyroidism
  5. PTH causes resorption of calcium from bones –> renal osteodystrophy
  6. Increased fractures, bone pain
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14
Q

Neuro complications of CKD

A
  1. Cognitive impairment
  2. Tremors/ twitching/ seizure (due to low Ca)
  3. Neuropathy
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15
Q

How are AKI stages modified when someone has CKD

A

AKI stages remain the same

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16
Q

Complications of CKD on blood vessels

A

Coronary disease

Hyperphosphaetaemia causes deposition of calcium in vessels

-> leads to hypertension and LVH

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17
Q

How are AKI stages modified when someone has CKD

A

AKI stages remain the same

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18
Q

Which drug is the most important in slowing progression of renal failure

A

ACEi/ ARB

-> improves proteinuria and hypertension

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19
Q

What drugs reduce CVS risk in CKD

A
  1. ACEi/ ARB

2. Statins

20
Q

Management of blood sugar in CKD

A

SGLT2 inhibitors

21
Q

Management of reduced kidney function in CKD

A
  1. Dialysis
  2. Kidney transplant

No drugs are available to treat progressive fibrosis in kidneys

22
Q

Management of reduced kidney function in CKD

A
  1. Dialysis
  2. Kidney transplant

No drugs are available to treat progressive fibrosis in kidneys

23
Q

Management of fluid retention in CKD

A
  1. Diuretics
  2. ACEi/ ARB/ CCB
  3. Dialysis
24
Q

Management of uraemia in CKD

A
  1. Supportive treatment (treat symptoms)

2. Dialysis

25
Q

Management of acidaemia in CKD

A
  1. Sodium bicarbonate

2. Dialysis

26
Q

Management of hyper-phosphataemia in CKD

A
  1. Low phosphate diet

2. Drugs which bind phosphate (eg calcium carbonate)

27
Q

Target HbA1c in CKD

A

HbA1c <53

28
Q

Target blood pressure in CKD

A

<140/90

29
Q

Target Hb levels in CKD.

What happens if levels are too low/high

A

10.5-12.5 g/dl

<10 = more symptoms, higher mortality

> 12.5 = improved QoL but higher mortality

30
Q

Management of anaemia in CKD

A
  1. Epo replacement drugs

2. Iron

31
Q

At what stage of CKD does anaemia tend to occur

A

Stages 3 and above.

If pt is anaemic at earlier stages, check for other causes of anaemia

32
Q

What endocrine abnormalities are risk factors for diabetic nephropathy

A
  1. Poor glycaemic control
  2. Longer duration of diabetes
  3. Hypertension
  4. Dislipidaemia
  5. Obesity
33
Q

What kidney function factors are predisposing factors for diabetic nephropathy

A
  1. High albuminuria
  2. Glomerular hyperfiltration (GFR>125)
  3. Inflammatory disorders affecting kidneys
34
Q

SCREENING:

Pts with which kidney conditions should be screened for CKD

A
  1. AKI
  2. Structural renal tract disease
  3. Recurrent renal stones
  4. Any detection of haematuria
35
Q

SCREENING:

Pts with which cardiac/ vascular conditions should be screened for kidney disease

A
  1. Ischaemic heart disease
  2. Chronic heart failure
  3. PVD
  4. Cerebral vascular disease
  5. Hypertension
36
Q

SCREENING:

Pts with which prostatic conditions should be screened for kidney disease

A

BPH

37
Q

SCREENING:

Pts with which prostatic conditions should be screened for kidney disease

A

BPH

38
Q

SCREENING:

Pts with which endocrine conditions should be screened for kidney disease

A

Diabetes

39
Q

SCREENING:

Pts with what Family History should be screened for kidney disease

A

Family history of

  1. End stage CKD (G5 stage)
  2. Hereditary kidney disease
40
Q

How does hypertension cause CKD

A
  1. Narrowing of renal arteries
  2. Less oxygen delivery to kidney
  3. Ischaemic injury to kidney
  4. Foam cells slip into glomerulus and secrete TGF-B1
  5. TGF-B1 cause mesangial cells to regress to immature state and secrete extracellular matrix
  6. Extracellular matrix causes glomerular sclerosis
  7. Reduced ability for nephron to filter blood
  8. CKD
41
Q

Histological features of diabetic nephropathy

A
  1. Kimmelstiel-Wilson nodule (expanded mesangium)
  2. Nodular glomerulosclerosis
  3. GBM thickening
42
Q

Which immunoglobulins/ complement proteins may be found on immuno-stain in diabetic nephropathy

A
  1. IgG, IgM

2. C3, C1q

43
Q

How does high blood sugar lead to nephron damage (3 different pathways)

  1. hormone levels
  2. vascular
  3. VEGF levels
A
  1. Hyperglycaemia –> Increased aldosterone production –> tissue damage
  2. Hyperglycaemia –> Excess glucose sticks to proteins in blood –> stiffening and narorwing of efferent arteriole–> hyperfiltration
  3. Hyperglycaemia –> increased VEGF expression –> podocyte damage, endothelial injury
44
Q

How does hyperfiltration lead to nephron damage

A
  1. Hyperfiltration
  2. Mesangial cells make more matrix
  3. Glomerular sclerosis
45
Q

Why does carpal tunnel syndrome occur in CKD

A

due to beta2 microglobulin related amyloidosis

46
Q

Which electrolyte, if changed, is more likely to suggest a chronic renal failure

A

Phosphate (takes a while to change)

Stage 4: CSIM 2 (47 decks)

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