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#Phase 2.1: GI > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

(49 cards)

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1
Q

What is the timeframe for CKD to be CKD?

A

3+ months

of damaged kidney / reduced function

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2
Q

What are the Risk Factors for CKD? (5 things)

A
  1. Age
  2. HTN
  3. DM
  4. Smoking
  5. Nephrotoxic meds
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3
Q

How does HTN cause CKD? (7 steps)

A
  1. High BP
  2. Hypertrophy / Sclerosis of Renal Arteries
  3. Hypoperfusion –> Ischaemic Injury to Kidney
  4. MAC secrete GF
  5. Mesangial cells regress –> Mesangioblasts –> secrete ECM
  6. Glomerulosclerosis
  7. Loss of kidney function (CKD)
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4
Q

How does DM cause CKD? (6 steps)

A
  1. High glucose
  2. Non-enzymatic glycosylation of Efferent arterioles
  3. Hyperinflation
  4. Mesangial cells secrete Structural Matrix
  5. Nodular Glomerulosclerosis
  6. Loss of kidney function (CKD)
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5
Q

What 3 things classify CKD into groups? (3 things)

A
  1. GFR category
  2. Albuminuria (kidney damage marker)
  3. Cause of damage
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6
Q

What is GFR Group G1? (2 things)

A
  1. GFR = 90+
  2. Only classed as CKD if other evidence of kidney damage:
    • Proteinuria / Haematuria
    • Biopsy / Imaging pathology
    • Tubule disorder
    • Transplant
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7
Q

What is GFR Group G2? (2 things)

A
  1. GFR = 60 - 89
  2. Only classed as CKD if other evidence of kidney damage:
    • Proteinuria / Haematuria
    • Biopsy / Imaging pathology
    • Tubule disorder
    • Transplant
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8
Q

What is GFR Group G3a? (2 things)

A
  1. GFR = 45 - 59
  2. Mild - Moderate CKD
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9
Q

What is GFR Group G3b? (2 things)

A
  1. GFR = 30 - 44
  2. Moderate - Severe CKD
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10
Q

What is GFR Group G4? (2 things)

A
  1. GFR = 15 - 29
  2. Severe CKD
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11
Q

What is GFR Group G5? (2 things)

A
  1. GFR = 15-
  2. Kidney Failure
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12
Q

What is Albuminuria Class A1? (2 things)

A
  1. Albumin Secretion: 30-
  2. Albumin:Creatine Ratio: 3-
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13
Q

What is Albuminuria Class A2? (2 things)

A
  1. Albumin Secretion: 30-300
  2. Albumin:Creatine Ratio: 3-30
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14
Q

What is Albuminuria Class A3? (2 things)

A
  1. Albumin Secretion: 300+
  2. Albumin:Creatine Ratio: 30+
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15
Q

What are the Glomerular causes of CKD? (2 Primary + 2 Systemic things)

A

Primary:

  1. Minimal Change Disease
  2. Membranous

Systemic:

  1. DM
  2. Amyloid
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16
Q

What are the Tubulointerstitial causes of CKD? (3 Primary + 2 Systemic things)

A

Primary

  1. UTI
  2. Pyelonephritis
  3. Stones

Systemic

  1. Drugs
  2. Toxins
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17
Q

What are the Blood flow / Vessels causes of CKD? (1 Primary + 1 Systemic things)

A

Primary: Renal Limited Vasculitis

Systemic: HF

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18
Q

What are the Cystic / Congenital causes of CKD? (1 Primary + 1 Systemic things)

A

Primary: Renal dysplasia

Systemic: Alport syndrome

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19
Q

What are the Transplant causes of CKD? (1 Primary + 2 Systemic things)

A

Primary: Recurrence of renal disease

Systemic:

  1. Rejection
  2. Calcineurin toxicity
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20
Q

What are the most common cause of CKD in the UK? (3 things)

21
Q

What are the CF of CKD? (10 things)

Study These Flashcards
A
  1. Asymptomatic (but dev symptoms later @ eGFR 45-)
  2. Pallor
  3. N+V
  4. LOA
  5. HTN
  6. Muscle cramps
  7. Pruritus (itching) (2ndary to uraemia)
  8. Oedema
  9. Peripheral neuropathy
  10. Polyuria
22
Q

Why do you get HTN in CKD?

Study These Flashcards
A

Low GFR –> High Renin –> HTN

23
Q

Why do you get Hypocalcaemia in CKD?

Study These Flashcards
A

Low vit D activation –> Reduced intestinal absorption of Ca –> Hypocalcaemia

24
Q

Why do you get anaemia in CKD?

Study These Flashcards
A

Bc reduce erythropoietin (EPO) which is made in kidney

25
Why can you get Encephalopathy in CKD? (5 steps)
1. Reduced GFR 2. Reduced waste prod excretion 3. Build up of nitrogenous compounds (BUN aka Blood Urea Nitrogen / Urea / Creatinine) 4. Interferes with neurotransmitter metabolism 5. Encephalopathy
26
Why can you get Uraemic Pericarditis in CKD? (4 steps)
1. Reduced GFR 2. Reduced waste prod excretion 3. Build up of nitrogenous compounds (BUN aka Blood Urea Nitrogen / Urea / Creatinine) 4. Inflammation (pericarditis)
27
Why do you get Hyperparathyroidism in CKD?
Low vit D --\> -ve fdbck causes increase PTH secretion
28
What investigations should you do for sus CKD? (4 things)
1. Bloods 2. Urinalysis 3. Imaging 4. ECG (bc high risk of CVS disease) 5. Biopsy (to identify intrinsic CKD causes)
29
What bloods should you do in sus CKD and what will the results show? (7 things)
1. **UnE**: Low eGFR 2. **FBC + Hb**: Normochromic Normocytic Anaemia (normal colour + size) 3. **Glucose** (if DM) 4. Low **Ca** 5. High **Phosphate** 6. High **PTH** (renal osteodystrophy) 7. AI screen: high **ANCA / ANA / anti-GBM** = GN
30
What are you looking for in Urinalysis of sus CKD? (2 things)
1. Proteinuria (High Urine Albumin:Creatine Ratio aka **ACR**) 2. Haematuria (in urine dipstick)
31
If you have Haematuria in sus CKD, what's your next step?
Prompt investigation for bladder cancer
32
What imaging can you do for sus CKD? (4 things)
1. Renal US 2. MRA 3. Echo
33
What are the indications for a Renal US? (5 things)
1. Visible / Persistent invisible Haematuria 2. Obst uropathy 3. FHx of PCKD (PolyCystic Kidney Disease) 4. eGFR = 30- 5. Accelerated CKD progression
34
What will you see in US of CKD? (3 things)
1. **Small kidney** (under 9cm) (EXCEPT in Amyloid / Myeloma / DM / APKD) 2. **Asymmetrical kidneys** = Renovascular disease 3. **Scarring**
35
When should you refer a CKD patient to a specialist aka nephrologist? (NICE) (4 things)
1. eGFR = 30- (aka Stage G4 / G5) 2. Proteinuria (ACR: 70+) 3. Accelerated progression (15-25% decrease in eGFR in 1 year) 4. Uncontrolled HTN despite 4+ anti-HTN
36
What are the aims of CKD management? (3 things)
1. Slow disease progression 2. Reduce complications risk 3. Treat complications
37
What is the FIRST LINE treatment for CKD? Who qualifies for this treatment? (3 things)
ACE inhibitors 1. DM + ACR: 3+ 2. HTN + ACR: 30+ 3. ACR 70+
38
What is the BP aim in CKD? (2 things)
1. Under 140 / 90 2. 130 / 80 if ACR: 70+
39
Why does Serum K need to be monitored when CKD pt are on ACEi?
Both CKD + ACEi cause Hyperkalaemia (med emergency)
40
What are the complications of CKD? (7 things)
1. CVS disease 2. Anaemia 3. Renal Bone disease 4. Dialysis related problems 5. Metabolic Acidosis 6. End Stage Renal Failure (ESRF) 7. Peripheral Neuropathy CARD MEP
41
What are the management options for Slowing disease progression in CKD? (3 things)
1. DM control 2. HTN control 3. Treat GN
42
What are the management options for Reducing complications risk in CKD? (3 things)
1. Atorvastatin (to prevent CVS diseases) 2. Antiplatelets (aspirin) (to prevent CVS diseases) 3. Low P / Na / K / diet 4. Lifestyle (exercise + X smoking)
43
How should you treat Metabolic Acidosis (CKD complication)?
Oral Sodium Bicarbonate
44
How should you treat Anaemia (CKD complication)? (2 things)
1. Iron supplementation 2. Erythropoietin
45
How should you treat Renal Bone Disease (CKD complication)? (4 things)
Reduce Phosphate + PTH levels: 1. FIRST LINE: Reduce dietary intake of Phosphate 2. Phosphate binders 3. Vit D (calcitriol) 4. Parathyroidectomy (sometimes)
46
How should you treat End Stage Renal Failure (ESRF) (CKD complication)? (2 things)
1. Dialysis 2. Renal Transplant
47
What are the features of Renal Bone Disease (CKD complication)? (3 things)
1. Osteomalacia (bone softening) 2. Osteoporosis (brittle bones) 3. Osteosclerosis (bone hardening)
48
What investigation should you for for sus Renal Bone Disease (CKD complication)?
XR
49
What will you see on a XR of Renal Bone Disease (CKD complication)?
Sclerosis of both Ends of each Vertebra (denser white) Osteomalacia @ Centre of each Vertebra (less white) = Rugger Jersey Spine (named after rugby shirt stripes)

#Phase 2.1: GI (29 decks)

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