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gi, liver, kidney > CKD > Flashcards

CKD Flashcards

1
Q

What is CKD?

A

More than 3 months reduction in kidney function or structural damage
<60 on eGFR

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2
Q

Diagnosis of CKD

A

-Markers of kidney damage
- Urinary albumin:creatinine ratio -ACR greater than 3mg/mmol
- Persistent reduction in kidney function <60

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3
Q

What measure determines staging of CKD?

A

Albumin and urea cretinine ratio
Underlyinh cause, GFR and proteinurua category

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4
Q

When do you offer dialysis in CKD?

A

On progression to kidney failure

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5
Q

Causes of CKD

A

diabetes
Hypertension
Glomerular disease
Polycystic kidney disease
History of AKI
Nephrotoxic drugs
Obstructive uropathy ass conditions eg structural renal tract disease, renal calculi
Multisystem diseases with renal involvement eg SLE, vasculutus, myeloma
FG of CKD stage 5, hereditary kidney disease
CVD
Obesity with metabolic syndrome
Gout
Incidental findings of haematuria or protein uria

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6
Q

Symptoms of CKD

A

Bubbly wee
Any changes in wee frequency
General - lethargy, itch, SOB, camps, sleep disturbance, bone pain, loss of appetite, vomitting, weight loss + taste disturbance

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7
Q

Features of CKD

A

Uraemic odour
Pallor
Cachexia + malnutrition
Cognitive impairment
Dehydration, hypovolaemua
Tachypnoea
HPTN
Palpable bilateral flank masses w possible hepatomegaly
Palpable distended bladder
Peripheral oedema
Peripheral neuropathy

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8
Q

How is CKD classified?

A

eGFR (G1-5) and urinary ACR (albumin creatinine ratio) categories (A1-3)

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9
Q

What is the eGFR value for each G stage of CKD?

A

> 90 = normal = G1
60-89 = G2 = mild reduction
45-59 = G3a - mild to mod reduction
30-44 = G3b mod to severe reduction
15-29 = G4 - severe reduction
<15 = G5 - kidney failure

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10
Q

ACR parameters each stage

A

<3 - normal to mildly increased
3-30 - moderately increased
>30 - severely increased

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11
Q

What is the parameters for CKD diagnosis?

A

eGFR consistently over 60mL/min/1.73m2 and/or urinary ACR persistently

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12
Q

Initial investigations for CKD

A

Blood tests for serum creatinine and eGFR
Urine smaple for urinary albumin to creatinine ratio
Uirne dipstick for haematuria, midstream sample if more than 1
Nutritional status, BMI, BP and serum HbA1c, lipid profile

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13
Q

When does a urine sample for CKD need ot be taken

A

Early morning

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14
Q

What is considered significant proteinuria in urine sample?

A

Over 70 mg/mmol

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15
Q

What values mean you repeat urine sample ACR in 3 months?

A

3-70mg/mmol

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16
Q

Indications for renal tract ultrasound

A

Renal tract ultrasound if indicated - urinary tract obstruction, FH of polycystic kidney disease, over 20 years

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17
Q

What is acclereated progression of CKD?

A

25% decrease in eGFR from baseleine and change in CKD category within 12 months OR
decrease in eGFR by 15mL/min/1.73min2 in a year
Assess eGFR at least 3 times over 3 months

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18
Q

Hoq long after an AKI do you monitor fr CKD?

A

2-3 YEARS even if serum creatinine has returned to baseline

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19
Q

When do you arrange FBC to exclude renal anaemia in CKD patients?

A

Stages 3b, 4 and 5 or if develop anaemia symtpoms

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20
Q

What do serum calcium, phosphate, vit D and parathyroid hormone tests in CKD test for?

A

Renal metabolic and bone disorder for stages 4-5 of CKD

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21
Q

When to do 2 week urgent referral in CKD?

A

Isolated perisitent haematuria and urological cancer suspected

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22
Q

When to reer to nephrology with CKD

A

ACR over 70mg/mmol or 30mg/mmol with persistnet hameaturia
Uncontrolled HPTN
Rare or genetic cause CKD
Sus renal artery stenosis
Accelerated progression
eGFR < 30
Sus complication of CKD

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23
Q

What to assess ofr with CKD in primary care?

A

CVD risk
Underlying causes, risk factors for progression
Nephrotoxic drugs
Anxiety and depression
HPTN

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24
Q

Why do yuo prescribe lipid lowering therapy in everyone with CKD?

A

Primary or secondary prevention of CVD

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25
Q

When is an antiplatelet drug prescribed in CKD

A

Secondary prevention of CVD

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26
Q

What OTC should people with kdney disease avoid?

A

NSAIDs eg naproxen, iburogen

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27
Q

Complications of CKD

A

AKI
HPTN
Dyslipidemia
CVS disease - IHD, Periph artery disease, HF, stroke
Renal miineral and bone disorder
Peripheral neuropathy and myopathy
MALNUTRITION
malignanacy
End stage renal disease
Mortality

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28
Q

Renal anaemia presenation

A

SOB, fatigue, pa

29
Q

What is renal anaemia?

A

Reduced production of erythropoietin by the kidney causes reduced RBC surcical, iron deficinecy

30
Q

Presentation of renal mineral and bone disorer

A

Bone paun
Increased bone fragility
-Extra skeletal calciication - skin, blood vessels

31
Q

What causes renal mineral and bone disorder?

A

Disturbed vit D, calcium, PTH and phosphate metabolism due to impaired regulation of intestinal absorption and renal tubular excretion

32
Q

Typical picture mineral levels in CKD

A

Calcium low or high
Vit D deficiency
Raised serum phosphate
Low serum calcium
Secondary or tertiary hyperparathyroidism

33
Q

What is tamulosin for

A

BPH

34
Q

Why do you test PSA before putting in a catherter?

A

Puting a catheter in can raise the PSA level -> false positive high

35
Q

What is post obstruction diruesis

A

Polyuric state - salt and water are elimianated after relief of urinary tract obstruction
Resolves when kidneys normaluse volume, solutte status

36
Q

Risk from post obstruction diuresis

A

Severe dehydration
Electrolye imbalances
Hypovolaemic shock
Death

37
Q

Questions to ask in pulmonary renal syndrome

A

Systemic symptoms - night sweats, abdo pain, bloody diarrhoea
Sepsis - fever, lymphadenopathy
AI conditions - joint pain, myalgia, rash, sicca, epistaxis, deaf, ulcers
prev DVT/PE, thrombotic disorders, SLE, AI conditions

38
Q

What is pulmonary renal syndrome?

A

Diffuse alveolar haemorrhage + glomerulonephritis
AI disorder - treat w corticosteroids and cytotoxic drugs

39
Q

Diagnosis of pulmonary renal syndrome

A

Serologic tests, sometimes lung and renal biopsy

40
Q

Systemic vasculitis that can cause renal damage

A

Behcets disease
Cryoglobulinaemia
Granulomatoisis with polyangitis
Microscopic polyangitis
Eosinophilic granulomatosis w polyangitis
IgA ass vasculitis

41
Q

Causes of pulmonary renal disorder

A

Connective tissue disorder
Good pasteurs syndrome
Renal disorders eg IgA nephropathy
Systemic vasculitis
Drugs eg propothyouracil
HF

42
Q

What antibody diagnosis for good pateurs syndrome

A

anti-GBM

43
Q

Treatment for good pasteurs syndrome

A

Plasma exchange (remove antiGBM antibodies)
Prednisolone + cyclophosphamide
V rare to relapse - smoking trigger
If remain on dialysis can have transplant if anti-GBM antibodies undetectable

44
Q

Markers of kidney damage

A
  • Albuminuria >3 mg/mmol
    -Abnormalities secondary to tubular disorders
    -Structural abnormalities
    -Abnormalities on histology
    -History of kidney transplant
    -Reduced eGFR <60
45
Q

A staging of kidney disease

A

A1 - <30mg/g / <3 mg/mmol
A2 - 30-300mg/g/3-30mg/mmol (microalbuminuria)
A3 - >300mg/g/>30mg/mmol (macroalbuminuria)

46
Q

How often do you monitor CKD

A

Low moderate risk - annually
High risk - every 6 months
V high risk - monitor every 3-4 months

47
Q

Common causes CKD

A

Diabetes
HPTN
vascular disease

48
Q

How is CKD normally detected?

A

HPTN
Haematuria/proteinuria
Reduction in GFR + increased serum creatinine

49
Q

G staging of CKD (eGFR)

A

G1 - normal or high >90
G2 - mild - 60-89
G3a - mild to mod - 45-59
G3b - mod to severe - 30-44
G4 - severe - 15-29
G5 - Kidney failure <15
G5D = dialysis

50
Q

Monitoring in CKD

A

FBC
Iron studies
Serum calcium
phosphate
PTH

51
Q

General CKD symptoms

A

Fatigue, N+V, cramps, insomnia, restless legs, taste disturbance, bone pain, pruritis
Abnormal urine output
Fluid overload
Sexual dysfunction
Severe uraemia

52
Q

Clinical findings in CKD

A

Uraemic fetor - ammonia smell breath
Pallor (anaemia)
Cachexia
Cognitive impairment
Tachypnoea
HPTN
Volume disturbance - overload or depletion
Peripheral neuropathy
Fundoscopy if HPNT/DM

53
Q

What do bilateral masses on flank palpation signal with kidney symptoms?

A

Polycystic kidney disease

54
Q

What does palpable bladder sugnal in kidney symptoms

A

Obstructive uropathy
Often accompanied by prostatic enlargement in men

55
Q

Urine investigations CKD

A

Dipstick
Microscopy
ACR spot test
ACR 24 hour
Electrophoresis eg myeloma

56
Q

What does urine electrophoresis detect?

A

Protein levels including M and BJ protein produced by abnormal plasma cells in multiple myeloma

57
Q

Bloods in CKD

A

FBC
U+Es
Bone profile
PTH
Bicarbonate
LFTs
Lipid profile
AI screen - ANCA, ANA
Myeloma screen

58
Q

Imaging

A

Renal US
MR angiograph
ECHO
ECG - high risk CVS disease

59
Q

When should a renal US scan be offered

A

Patients with visible/persistent non visible haematuria
Evidence of obstructive uropathy
FH PCKD
Reduced eGFR <30
Accelerated progression of CKD

60
Q

Prinicples of CKD management

A

Treat the underlying cause
Prevent or slow progression - Renoprotective therapy
Treat ass complications
CV disease prevention
Plan for RRT

61
Q

General measures for management CKD

A

Exercise
Healthy weight loss
Smoking cessation
Good glycaemic control
Control of blood pressure
Immunisations: influenza and Pneumococcus
Avoidance of nephrotoxic medication
Diet: adequate protein intake, restricted sodium and
phosphate intake
Statin

62
Q

What is renoprotective therapy

A

Reducing BP
Reducing protein uria

63
Q

BP target for CKD + <70 ACR

A

<140/90

64
Q

BP target CKD + ACR >70

A

<130/80

65
Q

What drug should be prescribed where significant proteinuria in CKD

A

ACEi/ARB
AntiHPTN and antiproteinuric

66
Q

When offer a ACEi/ARB (renin angiotensin system antagonists) in CKD

A

Diabetic and ACR>3
HPTNsive and ACR >30
ACR >70
1 and 3 even in absence of HPTN

67
Q

When should you not prescribe a ACEi/ARB in CKD

A

Pretreatment potassium is over 5

68
Q

When is it ok to carry on with ACEi/ARB in CKD

A

eGFR is less than 25% changed OR
<30% serum creatinine increase from baseline since commencing

69
Q

A WET BED complications of CKD

A

Acidosis
Water - pulmonary oedema
Erythropoiesis - anaemia
Toxin removal - uraemic encephalopathy
BP control - CVD disease
Electrolyte balance - hyperkalaemia
Vitamin D activation -BMD of CKKD

gi, liver, kidney (50 decks)

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