19 - CKD Flashcards

1
Q

What is adult polycystic kidney disease?

A
  • Autosomal dominant with PKD 1 or 2 gene mutation (1 causing earlier disease)
  • Cysts grow with age and diagnosed on ultrasound. Kidneys enlarge and decline in function
  • Prognosis depends on rate of increase in kidney size
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2
Q

What are some secondary complications of APCKD?

A
  • Pain, bleeding in cyst, infection, renal stones (stasis)
  • Hypertension
  • Intracranial aneurysms
  • Heart valve abnormalities
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3
Q

How is APCKD managed?

A
  • Treat hypertension by blocking RAAS
  • Low salt diet
  • Lots of fluids
  • Tolvaptan
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4
Q

What is the definition of chronic kidney disease?

A
  • Progressive and irreversible loss of renal function over a period of years to months. Functioning renal tissue is replaced by extracellular matrix giving rise to glomerulosclerosis and tubular interstitial fibrosis
  • Loss of excretory and endocrine function of kidney
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5
Q

Why is CKD hard to define and what is the prevalence in the UK?

A
  • Usually asymptomatic or just proteinuria/hypertension
  • 6.1% of the population had CKD in 2001 in the UK. Worldwide 11-13% most in stage 3
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6
Q

What are the common causes of CKD?

A
  • Diabetes (most common)
  • Hypertension
  • Arteriopathic renal disease
  • Immunologic e.g glomerulonephritis
  • Infection e.g pyelonephritis
  • Myeloma, lupus
  • Genetics e.g PKCD or history of kidney disease
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7
Q

What are some risk factors of developing CKD?

A
  • Hyperlipidaemia
  • Proteinuria
  • Any form of AKI
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8
Q

What are some effects that CKD has on the body, e.g haemotologic and CNS?

A
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9
Q

What are some of the symptoms of CKD?

A
  • Tiredness
  • Breathlessness
  • Restless legs
  • Sleep reversal
  • Aches and pains
  • Itching
  • Chest pain
  • Seizures
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10
Q

How do we treat end stage renal disease?

A
  • Lower life expectancy and quality of life
  • Transplant
  • Nocturnal HD comes close
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11
Q

What are the advantages and disadvantages of peritoneal and haemodialysis?

A
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12
Q

What are the advantages and disadvantages of having a kidney transplant to treat CKD?

A
  • Better quality of life
  • Malignancy and infection risk
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13
Q

What are the different stages of CKD?

A
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14
Q

What groups is CKD more common in?

A
  • Elderly
  • Multimorbidities
  • Ethnic minorities
  • Social deprivation
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15
Q

What are the first things you should measure if you suspect CKD?

A
  • Also measure creatinine and eGFR
  • eGFR measures CKD, creatinine AKI
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16
Q

What investigations should you do into CKD?

A
  • Blood tests e.g U and Es, CRP, PTH, iron levels
  • Antibody levels for different diseases
17
Q

How can we prevent the progression of CKD?

A
  • Lifestyle
  • Stop smoking
  • Obesity lose weight
  • Exercise
  • Control diabetes and hypertension
18
Q

How can we stop someone with CKD being hypertensive, and why are they hypertensive?

A
  • They retain Na and fluid
  • Fluid restrict
  • Diuretics
  • Antihypertensives
19
Q

At what point in CKD do we get hyperkalaemia and how do we manage this?

A
  • When eGFR goes below 20 mls/min
  • Stop ACE inhibitors
  • Avoid drugs that increase K+ e.g amilioride
  • Avoid foods high in potassium
20
Q

How do we treat metabolic acidosis in CKD?

A
21
Q

Why do you get anaemia in CKD and how do you fix this?

A
  • Check iron stores and replace them orally or IV
  • If iron stores fine give EPO
22
Q

Why do you get bone disease in CKD and how can this be managed?

A
  • Get thin bones and bony deposits
  • Reduce phosphate intake, take phosphate bindes
23
Q

What can happen to drug metabolism in CKD?

A
  • Reduced metabolism and excretion so need to alter dose
  • Side effects more likely, e.g statins
24
Q

What is the definition of end stage established renal failure?

A
  • When death is likely without renal replacement therapy
  • eGFR< 15 mls/min
25
Q

When should you consider renal replacement therapy?

A
  • eGFR <15mls/min or symptomatic
26
Q

What are some of the risk factors of acute tubular injury?

A

Hypotension, obstetric complications, obstructive jaundice, sepsis, medications, toxins