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Z Year3 Urology > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

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1
Q

What is CKD?

A

Proteinuria or haematuria and/or a reduction in glomerular filtration rate for more than 3 months duration

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2
Q

What are RF for CKD?

A
  1. age >50 year
  2. male sex
  3. black or Hispanic ethnicity
  4. family history
  5. smoking
  6. obesity
  7. long-term analgesic use
  8. diabetes
  9. hypertension
  10. autoimmune disorders
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3
Q

What is the presention of CKD?

A
  1. Fatigue
  2. Oedema
  3. Nausea with/without vomiting
  4. Pruitis
  5. Restless leg
  6. Anorexia
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4
Q

What are the most common cause of CKD?

A
  1. DM
  2. Hypertension
  3. Glomerulonephritis
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5
Q

What will bloods show for CKD?

A
  1. Elevated serum creatinine
  2. Electrolyte abnormalities
  3. GFR <60
  4. Serum cystatin C and cystatin C-based estimation of GFR
  5. Urinalysis
  6. Urinary albumin: increased
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6
Q

What imaging is done in CKD?

A

Renal US

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7
Q

What are DDx for CKD?

A
  1. Diabetic kindey disease
  2. Hypertensive nephrosclerosis
  3. Ischaemic nephropathy
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8
Q

What is the management for CKD?

A

1st Line: ACEi or ARBs
Adjunct: dapagliflozin
2nd line: Non-dihydropyridine CCB

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9
Q

What is the general management for CKD?

A
  1. Glycaemic control and optimisation of BP

2. SGLT-2 and agents than block renin-angiotensin system

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10
Q

What is the 1st line management for GFR category G5 or with uraemia?

A

1st line dialysis

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11
Q

What is the CKD a RF for?

A

CVD

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12
Q

What is G1 class?

A

GFR >90 mL/minute/1.73 m², and evidence of kidney damage based on pathological diagnosis, abnormalities of radiographic imaging, or laboratory findings such as haematuria and/or proteinuria

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13
Q

What is G2 class?

A

GFR 60 to 89: mL/minute/1.73 m²

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14
Q

What is G3a class?

A

GFR 45 to 59: mL/minute/1.73 m² (mild-moderate)

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15
Q

What is G3b class?

A

GFR 30 to 44: mL/minute/1.73 m² (moderate-severe)

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16
Q

What is G4 class?

A

GFR 15 to 29: mL/minute/1.73 m² (severe CKD)

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17
Q

What is the G5 class?

A

GFR <15: mL/minute/1.73 m². (kidney failure)

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18
Q

What is the albumin category based on?

A

documented based on albumin excretion rate (AER) or albumin to creatinine ratio (ACR)

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19
Q

What is A1 category?

A

AER <30 mg albumin/24 hours or ACR <3 mg/mmol (<30 mg/g): normal to mildly increased

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20
Q

What is A2 category?

A

AER 30 to 300 mg albumin/24 hours or ACR of 3 to 30 mg/mmol (30 to 300 mg/g): moderately increased

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21
Q

What is A3 category?

A

AER >300 mg albumin/24 hours or ACR >30 mg/mmol (>300 mg/g): severely increased

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22
Q

What is Low GFR and albuminuria are independently associated with a higher risk of?

A
  1. All cause mortality
  2. Cardiovascular mortality
  3. Progressive Kidney Disease and Kidney Failure
  4. AKI
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23
Q

What is the monitoring in CKD like?

A
  1. GFR and albuminuria should be monitored at least annually according to risk
  2. If high risk, monitor every 6 months
  3. If very high risk monitor at least every 3-4months
  4. Small fluctuations are common but a drop in eGFR stage >25% is significant and rapid progression in drop in eGFR>5/yr
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24
Q

What are different types of RRT?

A
  1. Transplant
  2. Conservative care (v comorbid)
  3. Peritoneal Dialysis
  4. Haemodialysis
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25
What is best for of RRT?
pre-emptive live donor renal transplant
26
When is a patient eligible for transplant?
1. GFR<15ml/min or GFR>15mil/min and likely need RRT in less than 6months 2. Better for pre-emptive transplantation when GFR around 30ml/min
27
When is kidney transplant contraindicated?
1. Untreated malignancy 2. Active infection 3. Untreated HIV infection 4. LE under 2 years
28
What type of donor is better?
live donor is better than deceased donor
29
How are kidneys matched?
1. HLA matching and Cross-match 2. HLA 3 out of 6 mismatch (1-1-1 mismatch) 3. Cross-matching and anti-HLA antibodies 4. Sharing scheme for blood group incompatible or HLA incompatible donors
30
How does peritoneal dialysis work?
- utilises the peritoneum dialysis membrane - Large SFA - highlight vascular - Based upon exchanges - Fluid rained out > new fluid drained in > leave for 1-8 hours
31
What are different types of peritoneal dialysis?
1. Continuous ambulatory peritoneal dialysis (CAPD) | 2. Automated peritoneal dialysis (APD)
32
What are adv of PD?
1. Easy to travel 2. Low tech 3. Flexibility
33
What are disadv of PD?
1. Need to be continuous therapy 2. Peritonitis risk 3. Membrane failure
34
How does haemodialysis work?
1. Uses and extracorporeal circuit 2. Usually 3-4 hours x3/week 3. Predominantly in centre Predominantly diffusion using a counter-current Needs 120-300: of purified water per patient per dialysis
35
What are Adv of haemodialysis?
1. Less time than PD | 2. No issues with membrane failure
36
What are disadv of haemodialysis?
1. Fixed dialysis session 2. Dialysis access “achilles heel;” 3. Expensive 4. Need large volumes of purified water
37
How do you get access for dialysis for HD?
HD arteriovenous fistula: AVF preferred 6-8 weeks to develop
38
What is another way of access for HD dialysis?
Tunnel dialysis line – quicker but high risk of infection
39
How do you get dialysis access in PD?
ideally 2-4 weeks before starting dialysis
40
When should you start dialysis in chronic renal disease?
1. GFR<8ml/min 2. Uraemic symptoms 3. Fluid overload refractory to diuretics
41
What are uraemic symptoms?
- Weight loss - Anorexia - Fatigue
42
When do you used RRT in AKI?
- Often as part of multi-organ failure - Delivered in ICUS - Often using Haemofiltration (CVVHF)
43
Why is RRT in AKI not great?
1. Slower and less efficient 2. Convection rather than diffusion 3. Continuous therapy but less haemodynamic instability 4. Expensive 5. Anticoagulation an issue
44
How does hypertension cause CKD?
1. High BP 2. Leads to thickening of wall of renal artery 3. Leads to hypoperfusion 4. Leads to glomerular ischaemic injury 5. Leads to glomerulosclerosis (aka scarring)
45
How does Diabetes cause CKD?
1. High blood sugar 2. Leads to non-enzymatic glycosylation of efferent arterioles 3. Leads to increased resistance to blood flow 4. Leads to high pressure state
46
What are the categories for intrarenal causes of CKS?
1. Renal vascular disease 2. Glomerular disease 3. Tubulointerstitial disease 4. Nephrotoxins
47
How does renal vascular disease cause CKD?
1. Hypertension | 2. Renal artery stenosis
48
How does glomerular disease cause CKD?
* Nephritic disease | * Nephrotic disease
49
What tubulointerstitial disease cuases CKD?
PCKD
50
What nephrotoxins can cause CKD?
NSAIDs
51
What are pre-renal causes of CKD?
1. CHF | 2. Cirrhosis
52
What are post renal causes of CKD?
1. Prostatic disease 2. Repeated pyelonephritis 3. Repeated stones
53
How does oedema present in CKD?
1. swelling 2. weight gain 3. SOB (pulm oedema)
54
What are signs of azotemia?
N&V, loss of appetite
55
What are signs of encephalitis?
asterixis, coma, seizures
56
How can hypocalcaemia present?
Renal osteodystrophy (hyperphosphatameia, hypocalcaemia, skeletal abnormalities, extraskeletal calcifications i.e:. Coronary arteries)
57
How can anaemia present in CKD?
paleness, tiredness, cold intolerance
58
What are key functions of the kidney?
1. Water regulation 2. Waste removal 3. Electrolyte regulation 4. Hormone production
59
What happens when water regulation is affected?
oedema
60
What happens when waste removal probelm?
azotemia (high ntriogen and creatintie) - coma, seizures, pericarditis
61
What does electrolyte regulation problem lead to?
1. Increase K+ 2. Increase PO3+ 3. Decrease Na+ 4. Decrease Ca2+ (acidosis)
62
What does hormone production problem lead to?
1. ACE and Renin: hypertension 2. 1-alpha hydroxylase: decrease Vit D 3. EPO: anaemia
63
Why is there fatigue in CKD?
2º to anaemia or uraemia
64
Why can there be N and V in CKD?
2º to hyponatraemia or uraemia
65
What are the key blood results in CKD?
1. Increase Cr 2. Decreased eGFR 3. FBC, ABG, U&Es, PTH
66
What bedside tests are done?
Urinalysis (Haematuria? Proteinuria? Albuminuria?)
67
How often are bedside tests and bloods done?
Multiple assessments over 3 months to confirm chronicity
68
What imaging is done?
* Renal US (kidney size?, mass lesions?, obstruction?, blood flow?) * AXR (kidney stones?) * MRI (cancer?)
69
What can USS show in CKD?
Small and echogenic kidneys 2º to scarring (some causes of CKD causes normal sized kidneys)
70
What invasive Ix is done in CKD?
Kidney biopsy
71
What is the conservative management for CKD?
1. Stop nephrotoxic drugs 2. Manage underlying cause 3. Weight management 4. Diet changes: protein/ sodium/ calcium/ potassium restriction 5. Smoking cessation
72
What is the medical management for HTN and proteinuria in CKD?
ARB or ACEi | Target: 130mmHg > SBP > 110mmHg and DBP< 80mmHg
73
What is the medical management of oedema in CKD?
loop diuretic
74
What is the medical management if hyperlipidaemia in CKD?
statin
75
What is the interventional management for CKD?
- Renal replacement therapy: Reserved for G5 CKD and patients with refractory complications 1. Haemodyalisis 2. Peritoneal dialysis 3. Kidney transplant
76
What is G1 stage?
GFR>90 underlying kidney disease
77
What is G2 stage?
GFR 60-89, midly decreased
78
What is G3a stage?
45-59, mild-moderate decrease
79
What is G3b stage?
30 to 44, moderate-severe disease
80
What is G4 stage?
15-29, severely decreased
81
What is G5 stage?
GFR<15 end stage renal disease
82
What is A1?
AER<30mg underlying kidney disease
83
What is A2?
AER 30-300, midly decreased
84
What is A3?
AER>300, mild-moderate decrease
85
Why is staging important?
higher the stage the higher the risk of rapid CKD progression
86
Why no CT in CKD?
as contrast affects kidneys!

Z Year3 Urology (18 decks)

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