Chronic kidney disease Flashcards Preview

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Flashcards in Chronic kidney disease Deck (34):
1

What is chronic kidney disease?

Reduced GFR and/or evidence of kidney damage over a long period of time

2

How is GFR assessed?

24 hour urine collection (creatinine clearance)
eGFR (serum creatinine, age, sex & race)

3

Creatinine is a product of the breakdown of what?

Muscle

4

What are the drawbacks of eGFR?

Not sensitive over 60ml/min
Over estimates if muscle mass low
Under estimates if muscle mass high
Only valid is serum creatinine is stable (not acute illness)

5

When might we want to directly measure GFR with nuclear medicine?

Screening for kidney donation
Very high or low muscle mass

6

Describe the stages of CKD

Stage 1 - GFR >90 with evidence of kidney damage
Stage 2 - GFR 60-90 with evidence of kidney damage
Stage 3 - GFR 30-60 (A- 45-60 B- 30-44)
Stage 4 - GFR 15-30
Stage 5 - GFR

7

What do we mean by "evidence of kidney damage"?

Proteinuria
Haematuria
Abnormal imaging

8

How common in CKD?

Mild CKD is fairly common especially in the elderly

9

Why does CKD staging matter if most people don't progress to severe disease?

Must identify those at risk of progression through the stages
Increased CVS risk is important in patient health

10

Who is likely to progress to severe CKD? Why?

Those with proteinuria (more protein - faster progression)
Younger patients (longer to progress)

11

What are the common causes of CKD?

Diabetes mellitus
Hypertension
Vascular disease (renal artery stenosis, large vessel disease, etc)
Chronic glomerulonephritis
Reflux nephropathy
Polycystic kidneys

12

How does CKD present?

Asymptomatic until GFR

13

How is CKD managed?

Slow progression
Manage CVS risk
Treat complications
Prepare for replacement therapy

14

How can progression of renal disease be slowed?

Reducing proteinuria - control BP with ACE/ARB +/- spironolactone
Glucose control
Smoking cessation

15

How do ACE/ARBs characteristically affect the kidney when they are started? What is the risk of this? How is this monitored?

Initially reduce GFR --> risk of hyperkalaemia
Blood test a week or so post starting drugs

16

How might you reduce CVS risk in patients with CKD?

Smoking cessation
BP control
Statins (stage 4)

17

What are the complications of CKD?

Anaemia
Bone disease

18

Why is anaemia a complication of CKD?

Erythropoietin (stimulates RBC formation) production declines in CKD

19

If a CKD patient has anaemia what must be measured?

Iron
Vitamin B12
Folate

Can all be other causes of anaemia

20

How is anaemia of CKD treated?

IV iron
If iron doesn't work weekly/fortnightly SC injection of erythropoietin

21

What is the target haemoglobin in CKD anaemia?

105-125 g/dl

22

If giving erythropoietin for CKD what else must be given?

Iron (as stores depleted)

23

How is vitamin D metabolised in the kidney?

Hydroxylated

24

What happens to vitamin D metabolism in CKD?

Reduced calcium absorption --> secondary hyperparathyroidism
Serum phosphate raised (advanced disease) --> increases PTH secretion

25

Hyperplasia of all parathyroid glands occurs in CKD. T/F

True

26

Explain tertiary hyperparathyroidism and its main complication

Autonomous production of PTH even when serum calcium normal --> hypercalcaemia

27

What is the sequelae of CKD bone disease?

Severe bone disease (pain & imaging changes) uncommon
High phosphate and calcium --> calcification of vessels and heart valves

28

How is bone disease in relation to CKD managed?

Alfacalcidol (hydroxylated vit D)
Adjustment of phosphate intake in diet
Phosphate binders (bind to phosphate in gut to reduce absorption)

29

Name three phosphate binders

Calcium carbonate
Calcium acetate
Sevelamer

30

Name three types of renal replacement therapy

Haemodialysis
Peritoneal dialysis
Kidney transplant

31

What is the best form of dialysis access? How long does it take to mature?

Arteriovenous fistula
6 weeks

32

Why is an operation needed in peritoneal dialysis? How long does it take to mature?

Insertion of cannula
1-2 weeks

33

How long must people be able to live to be considered for a transplant?

At least 5 years

34

When is conservative management indicated over dialysis?

Older patients with multiple co-morbidities
Symptom control still given

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