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MSPA- Nephrology > CKD - Melani > Flashcards

CKD - Melani Flashcards

1
Q

What is CKD ?

A

Progressive loss of nephrons resulting in
permanent compromise of renal function with GFR
<60ml/min/1.73m2 for 3+ months with or w/o
evidence of kidney damage.

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2
Q

What is ESRD?

A

GFR <15ml/min/1.73m2 or need for renal replacement therapy such as dialysis or transplant.

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3
Q

What are the GFR and Albumin class in low risk KDIGO CKD ?

A

GFR class G1 or G2 + Albumin class A1

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4
Q

What are the GFR and Albumin class in moderate risk KDIGO CKD ?

A

*GFR class G3a + Albumin class A1
* GFR class G1 or G2 + Albumin class A1

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5
Q

What are the GFR and Albumin class in high risk KDIGO CKD ?

A

G3b + A1 / G3a + A2 / G1 or G2 + A3

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6
Q

What are the GFR and Albumin class in very high risk KDIGO CKD ?

A

G3a + A3/ G3b + A2 or A3/ G4 or G5 + Any Albumin category

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7
Q

What are GFR rates classification of KDIGO ?

A

G1= GFR > or = to 90 ( normal or high)
G2= GFR 60-89 ( mild decrease)
G3a= GFR 45 to 59 ( Mild to moderate decrease)
G3b = GFR 30 to 44 ( Moderate to severe decrease)
G4= GFR 15 to 29 ( severe decrease)
G5= GFR < 15 ( very severe decrease)

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8
Q

What are albumin level classification of KDIGO ?

A

A1= normal to mildly increased ( 30 mg/g or 3 mg/mMol)
A2= Moderate increase ( 30 to 300 mg/ gm)
A3= severe increase > 300 mg/ gm.

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9
Q

What are the causes of CKD ?

A
  • Diabetic nephropathy (38%)
  • Hypertensive nephropathy (25%)
  • Glomerulonephritis (14%)
    – IgA nephropathy
  • Adult polycystic kidney disease (PCKD, 5%)
  • Tubulointerstitial nephropathy
  • Obstructive nephropathy
  • Chronic pyelonephritis
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10
Q

What are the risk factors for CKD ?

A
  • Diabetes, Hypertension and Vascular disease
  • Heart failure, Liver failure and Obesity
  • Previous AKI
  • Family history and Older age
  • HIV and Malignancy
  • African ethinicity
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11
Q

What is the symptomatology of CKD ?

A

Asx until late Stage 4 or Stage 5. It is found on routine blood tests or screening in at risk patient groups. To call it CKD Reduced GFR must persist to 3 months for diagnosis.

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12
Q

What is the advanced presentation of CKD ?

A

– Fatigue, swelling
– Anorexia, vomiting
– Symptoms of anaemia
– Anuria
– Changes to mental status, seizures

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13
Q

What are the signs of CKD ?

A

No signs until stage 4 or 5. Later stages may present with:
– Anaemia
– Oedema
– Uraemia
* Encephalopathy, pericarditis

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14
Q

What should be the evaluation approach in CKD ?

A

– Screen for CKD risk factors.
– Screen for causes of AKI
* Clinical examinatio: BP, Fundoscopy (diabetic or
hypertensive retinopathy)
– Cardiovascular exam and peripheral pulses
– Signs of uraemia and fluid overload

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15
Q

What are the diagnostic investigations for staging CKD ?

A
  • Urea and Creatinine
  • Electrolytes: Na+, K+
  • eGFR to stage disease
  • Dipstick urinalysis
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16
Q

What is the approach to stable CKD ( Stage -03)

A

– Generally none required
– Consider serum glucose / HbA1C (Diabetes) if albuminuria
– Consider lipid levels to assess cardiovascular risk

17
Q

What should be the approach to active sediments in urine ?

A

– Urine microscopy – casts (Glomerulonephritis)
– ANCA (GPA)
– Anti-GBM antibody (Goodpasture’s)
– Lupus serology – ANA / dsDNA (SLE)
– Hepatitis Serology

18
Q

What should be the approach to patients over 50 with anaemia and or high Ca2+ ?

A

Urine and serum protein electrophoresis (Myeloma)

19
Q

When is renal ultrasound indicated in CKD ?

A

CKD 4 or 5 only

20
Q

When is renal biopsy indicated ?

A

When there is hematuria or protenuria suggesting glomerulonephritis.

21
Q

What are the contraindications to renal biopsy ?

A

Uncontrolled HTN, active UTI, bleeding diathesis and severe obesity.

22
Q

What is the management of stage 3 CKD ?

A

*It is very common and Managed at primary care or generalist level.
* Focus on ‘4 risks’
– Risk of cardiovascular disease
– Risk of AKI
– Risk of medication toxicity
– Risk of progression of CKD to ESRD

23
Q

What are the indications for nephrology referral?

A
  1. CKD 4 or worse (GFR < 30 mL/min/1.73m2)
  2. Persistent albuminuria (ACR ≥30 mg/mmol)
  3. Rapid decline in GFR from baseline <60 mL/min
  4. Haematuria with albuminuria
  5. CKD and HTN not at target despite 3 agents
24
Q

What are the indications for managing CKD without nephrology referral ?

A

– Stable eGFR ≥30 mL/min/1.73m2
– Urine ACR < 30 mg/mmol (with no haematuria)
– Controlled blood pressure

25
Q

What is the management of CKD 4 ?

A
  • Nephrology referral usually required
  • Specific renal complications only seen at this stage
  • Screen for secondary complications such as anaemia, Secondary hyperparathyroidism, Metabolic acidosis, hyperkalaemia and uremia.
26
Q

When is uremia related pericardial effusion seen in CKD ?

A

Stage 5

27
Q

What is the pathogenesis of stage 4 CKD anaemia ?

A

Decreased EPO causes decrease in bone marrow function and Shortenes red cell survival. In addition elevated PTH level induces EPO resistance. The dietary deficiency or iron and folate also contributes.

28
Q

What is the management of anaemia of stage 4 CKD ?

A

– Iron replacement – usually given IV in advanced CKD/ESKD
– Folic acid supplementation
– Erythropoiesis stimulating agent (ESA)
– Avoid blood transfusions in patients who may require a renal transplant in future

29
Q

What is the management of renal bone disease in CKD 4 ?

A
  • Dietary phosphate restriction
  • Phosphate binders such as Calcium acetate or calcium carbonate.
  • phosphate binding drug such as Sevelamer
  • Vitamin D analogues
  • Calcimimetic (Cinacalcet) – binds to Ca2+ sensing receptor and suppresses PTH
  • Parathyroidectomy
  • Correction of chronic acidosis with sodium bicarbonate
30
Q

What is the management of stage 5 CKD ?

A
  1. Haemodialysis (HD)- Clinic based and home haemodialysis both now available in Ireland
  2. Peritoneal dialysis (PD)
  3. Renal transplantation
31
Q

What are the symptoms of stage 5 CKD ?

A

– Anorexia, Nausea and Pruritis
– Volume overload and Hyperkalaemia
– Acidosis

32
Q

What are the complications of continuous ambulatory peritonial dialysis ?

A
  • Abdominalwall hernia and Back pain
    *Fluid leaks: oedema of external genitalia, hydrothorax.
  • Respiratory problems and constipation.
  • Infections and metabolic complications.
33
Q

What are the complications of renal transplant ?

A
  • Side effects of immunosuppression such as skin malignancy, Post-transplant lymphoproliferative disorders, Cervical carcinoma
  • Post transplant diabetes mellitus
  • Opportunistic infections – Aspergillus, Nocardia, BK virus, and Herpes zoster.
  • Chronic rejection/Recurrent renal disease
  • Tertiary hyperparathyroidism
  • CVD and HTN

MSPA- Nephrology (7 decks)

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