Chronic Kidney Disease Flashcards Preview

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Flashcards in Chronic Kidney Disease Deck (28)
1

MRD4 calculates the GFR for which people?

White/asian men

-correction factor for women and for black race

2

GFR and muscle mass

Overestimates GFR if muscle mass is low
Underestimates GFR if muscle mass is high

3

Stage 1 CKD

GFR >90ml/min, with evidence of kidney damage

4

Stage 2 CKD

GFR 60-90ml/min, with evidence of kidney damage

5

Stage 3 CKD

GFR 30-60
(3A: 45-60
3B: 30-44)

6

Stage 4 CKD

GFR 15-30

7

Stage 5 CKD

GFR <15 or on renal replacement therapy

8

CKD and cardiovascular risk

CKD increases cardiovascular risk

9

Proteinuria and CKD

Patients with proteinuria more likely to progress (and get worse kidney failure etc)

Younger patients have longer to progress and are more likely to reach stage 5

10

GFR at which symptoms occur.

Occur late (GFR<20ml/min)

11

Symptoms of chronic kidney disease?

Non-specific – tiredness, poor appetite, itch, sleep disturbance
Impaired urinary concentrating ability – symptoms may occur earlier - nocturia

12

Drugs which reduce BP and proteinuria?

ACE inhibitors and ARBs
-also evidence for spironolactone

-CAUTION: initial fall in GFR (then gets better), hyperkalemia

13

How do you reduce cardiovascular risk in CKD?

BP and proteinuria
Stop smoking
Statins

(good glycemic control)

14

Why do you get anaemia in CKD?

Erythropoietin produced by the kidneys
Production declines in CKD
May be other causes for anaemia
Check iron status; if deficient, may need further investigation
Also check for vitamin B12 and folate deficiency

15

You should check which vitamin levels in CKD?

Check vitamin B12 and folate deficiency

16

Which organ hydroxylates vitamin D?

Kidneys
-this is impaired in CKD

-Leads to reduced calcium absorption, leading to secondary hyperparathyroidism
In advanced CKD, serum phosphate rises – also increases PTH secretion

17

Why does serum phosphate rise in advanced CKD?

Kidneys cannot hydroxylate vitamin D

This leads to calcium absorption

This leads to secondary hyperparathyroidism

Phosphate also rises and this increased PTH secretion further

18

Consequences of high calcium and high phosphate?

Leads to vascular calcification
-this makes calcified vessels stiff
-HEART VALVES also calcified!

19

Drug you can give for CKD bone disease?

Alfacalcidol (hydroxylated vitamin D)

20

What is alfacalcidol?

Hydroxylated vitamin D

21

Name some phosphate binders

Calcium carbonate
Calcium acetate
Sevelamer

22

What are calcium carbonate, calcium acetate and sevelamer?

Phosphate binders

23

What GFR would you start dialysis?

Around 20ml/min (earlier if progressing fast)

24

If you give a fistula, what GFR would you refer patient to vascular surgeon?

Refer at about 15ml/min

25

When can someone be listed for transplantation?

When within 6 months of dialysis

26

How do you correct anaemia?

Correct deficiencies, usually IV iron
-If still anaemic, give erythropoietin (Epo) (by injection, week or fortnight
Target Hb – 10.5-12.5g/dl
As Epo works, iron stores depleted – need regular top-ups)

27

If IV iron fails to correct anaemia, what can you give?

If still anaemic – erythropoietin (Epo) may be indicated
Epo – by injection; every week or fortnight
Target Hb – 10.5-12.5g/dl
As Epo works, iron stores depleted – need regular top-ups

28

Target Hb?

10.5-12.5 g/dl