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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
Management of acidaemia in CKD
1. Sodium bicarbonate | 2. Dialysis
26
Management of hyper-phosphataemia in CKD
1. Low phosphate diet | 2. Drugs which bind phosphate (eg calcium carbonate)
27
Target HbA1c in CKD
HbA1c <53
28
Target blood pressure in CKD
<140/90
29
Target Hb levels in CKD. What happens if levels are too low/high
10.5-12.5 g/dl <10 = more symptoms, higher mortality >12.5 = improved QoL but higher mortality
30
Management of anaemia in CKD
1. Epo replacement drugs | 2. Iron
31
At what stage of CKD does anaemia tend to occur
Stages 3 and above. If pt is anaemic at earlier stages, check for other causes of anaemia
32
What endocrine abnormalities are risk factors for diabetic nephropathy
1. Poor glycaemic control 2. Longer duration of diabetes 3. Hypertension 4. Dislipidaemia 5. Obesity
33
What kidney function factors are predisposing factors for diabetic nephropathy
1. High albuminuria 2. Glomerular hyperfiltration (GFR>125) 3. Inflammatory disorders affecting kidneys
34
SCREENING: | Pts with which kidney conditions should be screened for CKD
1. AKI 2. Structural renal tract disease 3. Recurrent renal stones 4. Any detection of haematuria
35
SCREENING: | Pts with which cardiac/ vascular conditions should be screened for kidney disease
1. Ischaemic heart disease 2. Chronic heart failure 3. PVD 4. Cerebral vascular disease 5. Hypertension
36
SCREENING: | Pts with which prostatic conditions should be screened for kidney disease
BPH
37
SCREENING: | Pts with which prostatic conditions should be screened for kidney disease
BPH
38
SCREENING: | Pts with which endocrine conditions should be screened for kidney disease
Diabetes
39
SCREENING: | Pts with what Family History should be screened for kidney disease
Family history of 1. End stage CKD (G5 stage) 2. Hereditary kidney disease
40
How does hypertension cause CKD
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
Histological features of diabetic nephropathy
1. Kimmelstiel-Wilson nodule (expanded mesangium) 2. Nodular glomerulosclerosis 3. GBM thickening
42
Which immunoglobulins/ complement proteins may be found on immuno-stain in diabetic nephropathy
1. IgG, IgM | 2. C3, C1q
43
How does high blood sugar lead to nephron damage (3 different pathways) 1. hormone levels 2. vascular 3. VEGF levels
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
How does hyperfiltration lead to nephron damage
1. Hyperfiltration 2. Mesangial cells make more matrix 3. Glomerular sclerosis
45
Why does carpal tunnel syndrome occur in CKD
due to beta2 microglobulin related amyloidosis
46
Which electrolyte, if changed, is more likely to suggest a chronic renal failure
Phosphate (takes a while to change)

Stage 4: CSIM 2 (47 decks)

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