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Renal Week 2 2017/18 > 3: Chronic kidney disease > Flashcards

Flashcards in 3: Chronic kidney disease Deck (50)
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1

What is chronic kidney disease?

Abnormal kidney function AND/OR structure

U&Es may be normal

2

CKD significantly increases your chances of ___ to other diseases.

mortality

3

CKD is closely linked to which two other diseases?

Cardiovascular disease

Diabetes

4

Your risk of developing CKD (increases / decreases) with age.

increases with age

5

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

6

How long does kidney function need to be abnormal for a patient to be given a diagnosis of chronic kidney disease?

90 days

7

What is the difference between GFR and eGFR?

eGFR is modified based on creatinine, age, sex and race

8

How is CKD staged?

Stages G1 to G5 (including G3a and G3b)

Learn the egfr thresholds and descriptions

9

An eGFR of > ___ is normal.

> 90

average is 125

10

An eGFR of < ___ is abnormal.

< 90

11

How is proteinuria actually measured?

Albumin/creatinine ratio

ACR measured alongside eGFR to quantify degree of kidney disease

12

How is ACR classified?

A1 to A3

>300 is nephrotic

13

What two values are used to classify CKD?

eGFR

ACR

14

Is eGFR used for AKI?

Only used for CKD

15

What is measured to quantify the degree of an AKI?

Creatinine only

eGFR not useful

16

People who have had an AKI need to be monitored for several years afterwards.

How?

Why?

eGFR

AKI massively increases CKD risk (loss of nephrons, remaining nephrons have to work really hard and burn out quicker)

17

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

18

People with which particular diseases should have their CKD and ACR checked?

AKI

CKD

Cardiovascular disease

Diabetes

loads but existing renal disease, cvd and diabetes are the main ones

19

How can you tell if haematuria has come from the kidneys or bladder?

Microscopy

Kidneys - red cells will be dysmorphic from being squeezed through tract

Bladder - red cells will be intact

20

What is the definition of accelerated CKD progression?

eGFR decrease in 25% within a year

OR

Consistent decrease by 15 units per year

21

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

?!?!?!?!

22

Which common drugs are nephrotoxic?

NSAIDs

23

Elderly patients with advanced CKD and extensive co-morbidities (will / won't) benefit from treatment.

probably won't

24

criteria for CKD referral for treatment

gfr < 30

ACR > 70 (>30 with haematuria)

resistant hypertension

genetic stuff

renal artery stenosis

25

What are the blood pressure targets in CKD?

140 / 90 if no proteinuria

130 / 80 if protein/haematuria

26

Anti-hypertensives like ACE inhibitors are nephrotoxic, but also reduce glomerular BP.

When should they be withdrawn?

Significant enough decrease in eGFR / ACR 

check slides

27

What prevention drug should be offered to all patients with CKD?

Statin

look up side effects of these

28

2/3rds of CKD are caused by which diseases?

Diabetes

Hypertension (i.e CVD)

29

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)

Small-vessel ​vasculitis

(like GWP, EGWP and microscopic polyangiitis)

30

What are some glomerular / tubular causes of CKD?

Glomerulonephritis

Tubulonephritis

v complicated so come back to this