Flashcards in Chronic Kidney disease Deck (33):
why might a body builder have high creatinine?
High creatinine due to elevated muscle breakdown
or they might take creatinine supplements
with kidney disease- what forms of dysfunctions can occur?
1. accumulate waste products and solutes
2. accumulation of acids
3. sodium and water imbalance
5. Ca PO4 PTH imbalance
how might we measure GFR?
Need to measure a substance that is freely filtered, but not secreted or reabsorbed.
So we can use:
1. IV inulin (not really used anymore)
2. inject radiolabelled substance and measure serum clearance rates in the kidney with nuclear scans (chromium EDTA)
3. Use an endogenous substance that is largely freely filtered and not reabsorbed or secreted that much e..g creatinine and cystatin C (this option is most widely used)
How might we estimate GFR using serum creatinine?
24 creatinine clearance- (however overestimates GFR)
what are the 3 types of GFR estimation equations?
1. Cockcroft- Gault equation
2. MDRD equation
3. CKD- EPI (currently used in Aus)
at what age does eGFR start to fall in healthy adults?
by 40 years of age. eGFR falls by up to 10 mL per decade
when should eGFR NOT be used?
in acute kidney injury
how is chronic kidney disease defined?
GFF less than 60 ml/min/1.74 m2 for greater than 3 months with or without evidence of kidney damage
key risk factors for chronic kidney disease?
Hypertension and diabetes
Established CV disease
Family hx of chronic kidney disease
Being of indigenous Australian descent
how else can CKD be classified?
by the presence or absence of urinary protein/albumin
what are the key Ix for kidney function?
Urine Albumin to creatinine ration, eGFR and blood pressure
how might we detect albumiuria and proteinuria?
1. urine-analysis dipstick
2. urine albumin to creatine ratio
3. 24 hr urine collection (gold standard)
what are some false positives for albuminuria?
UTI, sepsis, CCF, strenuous exercise, heavy protein intake, menses
what is the relationship between proteinuria and CKD?
the higher the level of proteinuria- the greater risk of kidney decline. So high protein leak= poor prognostic sign,
what happens to HbA1c with CKD?
What happens to PTH with CKD?
what happens to calcium and phosphate in CKD?
calcium goes down, phosphate goes up
what sort of imaging can we order for CKD?
renal ultrasound, computed tomography, nuclear isotope scans
what size is a normal kidney?
as big as your fist. 10-12 cm length
What are the underlying principles of management for ALL patients with CKD?
1. reduce further progression of kidney disease (BP)
2. control cardiovascular risk factors
3. make changes to medications
creatinine levels should be lower in women than men. Why?
because women have less muscle mass than men
what do you think when you see red cell casts in urine?
what is the single most important management of CKD?
management of hypertension!
how can we treat metabolic acidosis
sodium bicarbonate (but has problems bc again delivering salt to the patient)
when do we start dialysing CKD?
we decide to dialyse from symptoms such as constitutional symptoms like lethargy, malaise, pruritis etc.
key roles for dialysis?
fluid balance and solute removal
how does the kidney play a role in vitamin D activation?
converts 25-OH vitamin D to 1, 25- OH vitamin D
when do we start dialysis in a patient with CKD?
when GFR is less than 10
why are indigenous individuals more predisposed to CKD?
other comorbidities e.g. diabetes
studies have shown lower birth weights = lower glomeruli/nephron number
do you consider 60-90 GFR abnormal?
only if associated with proteinuria/albuminuria
what are the 3 screening tests for CKD?
1. urine test looking for proteinuria (albumin:creatinine ratio)
2. blood test to calculate eGFR
3. Bp check to look for HT
Describe the 5 levels of CKD?
Stage 1: GFR normal but evidence of proteinuria
Stage 2: mild impairment of GFR with evidence of proteinuria
Stage 3: moderate impairment of GFR 30-60, evidence of anaemia (becomes symptomatic)
Stage 4: severe impairment of GFR 15-30
Stage 5: renal failure GFR