Flashcards in Chronic Kidney Disease Deck (28)
MRD4 calculates the GFR for which people?
-correction factor for women and for black race
GFR and muscle mass
Overestimates GFR if muscle mass is low
Underestimates GFR if muscle mass is high
Stage 1 CKD
GFR >90ml/min, with evidence of kidney damage
Stage 2 CKD
GFR 60-90ml/min, with evidence of kidney damage
Stage 3 CKD
Stage 4 CKD
Stage 5 CKD
GFR <15 or on renal replacement therapy
CKD and cardiovascular risk
CKD increases cardiovascular risk
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
GFR at which symptoms occur.
Occur late (GFR<20ml/min)
Symptoms of chronic kidney disease?
Non-specific – tiredness, poor appetite, itch, sleep disturbance
Impaired urinary concentrating ability – symptoms may occur earlier - nocturia
Drugs which reduce BP and proteinuria?
ACE inhibitors and ARBs
-also evidence for spironolactone
-CAUTION: initial fall in GFR (then gets better), hyperkalemia
How do you reduce cardiovascular risk in CKD?
BP and proteinuria
(good glycemic control)
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
You should check which vitamin levels in CKD?
Check vitamin B12 and folate deficiency
Which organ hydroxylates vitamin D?
-this is impaired in CKD
-Leads to reduced calcium absorption, leading to secondary hyperparathyroidism
In advanced CKD, serum phosphate rises – also increases PTH secretion
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
Consequences of high calcium and high phosphate?
Leads to vascular calcification
-this makes calcified vessels stiff
-HEART VALVES also calcified!
Drug you can give for CKD bone disease?
Alfacalcidol (hydroxylated vitamin D)
What is alfacalcidol?
Hydroxylated vitamin D
Name some phosphate binders
What are calcium carbonate, calcium acetate and sevelamer?
What GFR would you start dialysis?
Around 20ml/min (earlier if progressing fast)
If you give a fistula, what GFR would you refer patient to vascular surgeon?
Refer at about 15ml/min
When can someone be listed for transplantation?
When within 6 months of dialysis
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)
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