What is chronic kidney disease?
Abnormal kidney function AND/OR structure
U&Es may be normal
CKD significantly increases your chances of ___ to other diseases.
CKD is closely linked to which two other diseases?
Your risk of developing CKD (increases / decreases) with age.
increases with age
What is the difference between acute kidney injury and chronic kidney disease?
AKI has an onset of less than 48h
Prolonged - two samples indicating abnormal kidney function, 90 days apart
How long does kidney function need to be abnormal for a patient to be given a diagnosis of chronic kidney disease?
What is the difference between GFR and eGFR?
eGFR is modified based on creatinine, age, sex and race
How is CKD staged?
Stages G1 to G5 (including G3a and G3b)
Learn the egfr thresholds and descriptions
An eGFR of > ___ is normal.
average is 125
An eGFR of < ___ is abnormal.
How is proteinuria actually measured?
ACR measured alongside eGFR to quantify degree of kidney disease
How is ACR classified?
A1 to A3
>300 is nephrotic
What two values are used to classify CKD?
Is eGFR used for AKI?
Only used for CKD
What is measured to quantify the degree of an AKI?
eGFR not useful
People who have had an AKI need to be monitored for several years afterwards.
AKI massively increases CKD risk (loss of nephrons, remaining nephrons have to work really hard and burn out quicker)
Why is eGFRcystatinC more accurate than eGFR?
eGFR value is modified by creatinine levels
Creatinine is cleared by kidneys AND bowels
So technically eGFR can OVERESTIMATE kidney function
People with which particular diseases should have their CKD and ACR checked?
loads but existing renal disease, cvd and diabetes are the main ones
How can you tell if haematuria has come from the kidneys or bladder?
Kidneys - red cells will be dysmorphic from being squeezed through tract
Bladder - red cells will be intact
What is the definition of accelerated CKD progression?
eGFR decrease in 25% within a year
Consistent decrease by 15 units per year
What is the difference between ACR and PCR?
ACR picks up kidney damage due to extra-renal stuff e.g hypertension diabetes
PCR also factors in tubular damage and stuff
Which common drugs are nephrotoxic?
Elderly patients with advanced CKD and extensive co-morbidities (will / won't) benefit from treatment.
criteria for CKD referral for treatment
gfr < 30
ACR > 70 (>30 with haematuria)
renal artery stenosis
What are the blood pressure targets in CKD?
140 / 90 if no proteinuria
130 / 80 if protein/haematuria
Anti-hypertensives like ACE inhibitors are nephrotoxic, but also reduce glomerular BP.
When should they be withdrawn?
Significant enough decrease in eGFR / ACR
What prevention drug should be offered to all patients with CKD?
look up side effects of these
2/3rds of CKD are caused by which diseases?
Hypertension (i.e CVD)
What are some vascular causes of CKD?
Renal artery stenosis (for a variety of reasons, fools kidney into thinking systemic BP is low, so produces renin, but no effect, vicious cycle, systemic hypertension damages OTHER kidney)
(like GWP, EGWP and microscopic polyangiitis)
What are some glomerular / tubular causes of CKD?
v complicated so come back to this