Chronic Kidney Disease Flashcards Preview

Hugh's MD2 Core Conditions and Presentations > Chronic Kidney Disease > Flashcards

Flashcards in Chronic Kidney Disease Deck (20):
1

Why do you get hypocalcaemia in CKD?

Phosphate isn't excreted in the kidney

High phosphate stimulates PTH secretion

PTH stimulates osteolysis to increase serum Ca

Total Ca falls and osteoporosis occurs

 

Ca combines with PO4 and deposits in tissue

Damaged kidney doesn't reabsorb as much Ca

Ca binds to albumin and is lost

Vitamin D isn't activated > less Ca

2

How can you interrogate the kidney function?

Bloods - Creatinine, eGFR

Urine - Albuminuria, haematuria

US - Size

Biopsy

3

How do you determine the eGFR?

Serum creatinine equated with a number of other factors eg weight, height, ethnicity

4

What is the cut of a normal eGFR?

>90 is normal

5

What is the normal size of the kidney?

12cm

6

What is the blood pressure target in kidney disease?

<125/75

7

What are the stages of CKD?

1. eGFR = >90ml/min, with proteinuria

2. eGFR = 60-90

3. eGFR = 30-60

4. eGFR = <30

5. eGFR = <15

8

What is the ACEi of choice in CKD?

Ramipril

9

What does urea accumulation cause?

Itch

Serositis

Encephalopathy

10

At which stage of CKD might you expect EPO deficiency?

3b

11

What does high phosphate cause?

Increase PTH

Hypocalcaemia

Conjugates with Ca and deposits in soft tissues - attributes to IHD and renal osteodystrophy

12

Why does bicarb drop in CKD? What are some implications?

Decreased carbonic anhydrase = decreased production

Harder to compensate for acidosis

13

Which big classes of drugs are renally excreted?

Enoxaparin (reduce to 40mg)

NOAC

B-lactams

Metformin

14

What is H+ exchanged with in the kidney?

K+

15

What happens to PO4 in CKD?

Can't excrete therefore it goes up

16

What happens to vitamin D in the kidney?

Vitamin D2 (from skin, liver) is activated to D3 (required from Ca absorption in SI)

17

What is the consequence of vitamin D2 not being activated in CKD?

Renal osteodystrophy due to reduced absorption of Ca in the SI (among other things)

18

What is causes the increased CVD risk in CKD?

Ca3(PO4)2 deposition in the soft tissue

19

What are the principles of treatment of CKD?

Treat underlying cause

- eg control BSL

Prevent further damage

- ACEi and ARB

- Control BSL

- Lipids

Prevent CVD

- Statins

Lifestyle control

Mx Complications

Avoid renally excreted/nephrotoxic drugs

20