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3703 > Chronic Kidney Disease > Flashcards

Chronic Kidney Disease Flashcards

1
Q

What is CKD?

A

Gradual and irreversible deterioration of renal function

Progressive loss of nephron function

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2
Q

What are the indicators of CKD?

A

Proteinuria

Haematuria

eGFR < 60ml/min for > 3 months

Structural abnormalities

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3
Q

Primary causes of CKD

A

Hypertension

Diabetes

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4
Q

Objectives for management of CKD

A

Prevent disease progression

Identify and treat underlying causes

Treat complications of renal failure

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5
Q

How does hypertension cause CKD?

A

High BP damages blood vessels in the body and kidney

Reduces blood supply to the kidney

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6
Q

What complication of CKD is also a cause of it?

A

Hypertension

Fluid builds up and raises BP

Kidneys cannot remove waste and excess fluid

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7
Q

What is the target BP for patients with diabetes?

A

130/80 mmHg

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8
Q

What is the target BP for patients without diabetes?

A

140/90 mmHg

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9
Q

How is blood pressure regulated?

A

By the kidneys

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10
Q

Which drugs are used for renoprotection in CKD?

A

ACE inhibitors first line

ARBs

Lower glomerular pressure and proteinuria

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11
Q

What monitoring is required for ACEi and ARBs?

A

Before initiation monitor U + Es (potassium), creatinine and eGFR

Then monitor again after 1-2 weeks of initiation or dose change

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12
Q

What is the cause of diabetic nephropathy?

A

Haemodynamic and metabolic changes

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13
Q

What is the recommended HbA1c target?

A

53 mmol/mol or 7%

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14
Q

Which drugs should be given for Type 2 in CKD?

A

SGLT2i - dapagliflozin

Renoprotective and ACE can be used

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15
Q

What are symptoms and management for uraemia?

A

Reduce protein intake

Gastro symptoms - antiemetic or laxative

Pruritis - chlorphenamine, promethazine (sedating antihistamine)

Muscle cramps - oral quinine (gluconate/ hydrochloride)

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16
Q

Management for fluid retention?

A

Restrict fluids to 1L per day

Reduce dietary sodium and medicines like gaviscon

Furosemide (high dose in advanced CKD eGFR <30ml/min)

Dialysis

17
Q

Management of metabolic acidosis

A

Oral sodium bicarbonate 1-6g

Severe/ persistent acidosis - dialysis

18
Q

How does CKD cause anaemia?

A

Kidneys can’t make enough erythropoietin (EPO) so less red bloods cells produced and haemoglobin

19
Q

What is the management for anaemia in CKD?

A

Blood transfusions

Erythropoeiesis-stimulating agents (ESAs)

20
Q

Why should you use Novel ESAs to treat anaemia?

A

Reduced frequency of administration (SC or IV):

Aranesp - once weekly or every 2 weeks

Mircera - once monthly

21
Q

When should you give ESAs for anaemia?

A

Hb 100 - 120 or symptoms affect quality of life

22
Q

What is the risk of ESAs and how is it caused?

A

Hypertension

Increase in RBC production, increases blood volume and viscosity

23
Q

What does CKD stage 3-5 affect to cause mineral and bone disorders ?

A

Calcium

Phosphate

Vitamin D

PTH levels

24
Q

What is the monitoring for ESA therapy?

A

Iron levels

Blood pressure

Hb level

25
Q

What are the complications of hyperphosphataemia?

A

Renal bone disease

Fractures

Bone and joint abnormalities

26
Q

Management for hyperphosphataemia

A

Reduce dairy and oily fish

Phosphate-binders if diet fails

27
Q

First line phosphate binders

A

Calcium carbonate

Calcium acetate

Can correct hypocalcaemia

28
Q

Management of Vitamin D deficiency

A

Calcitriol

Alfacalcidol (contraindicated in liver disease)

29
Q

What other complications are managed with Vitamin D therapy?

A

Hypocalcaemia

Hyperparathyroidism

30
Q

What is the cause of hypocalcaemia

A

High phosphate and low Vitamin D3

Phosphate binds to calcium making it less soluble

31
Q

Treatment for hypocalcaemia

A

Vitamin D

Phosphate binder- higher calcium

Calcium supplements

32
Q

Complications of hyperparathyroidism

A

Fractures

Soft tissue calcification

CVD (calcium in heart and blood vessels)

33
Q

Treatment for early hyperparathyroidism with normal/low calcium levels

A

Vitamin D

34
Q

Treatment for secondary hyperparathyroidism

A

Removal of parathyroid

Cinacalcet (for dialysis patients)

3703 (13 decks)

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