Chronic Kidney Disease Flashcards Preview

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Flashcards in Chronic Kidney Disease Deck (23):
1

Diagnostic criteria for CKD

Proteinuria/ haematuria and/or reduction in eGFR of < 60 ml/min/1.73m^2 for atleast 3 months

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Two of the main causes of CKD

1. Hypertension

2. Type II DM

3

What is the triple whammy?

1. NSAIDs

2. Loop diuretics

3. ACE-I

4

Nephorotoxin drugs

1. NSAIDs or COX 2 inhibitor

2. Triple whammy

3. Lithium - bipolar disease 

4. Aminoglucosides - antibacterial gram -ive 

5. Radiographic contrast

5

Main investigations for CKD

1. Dipstick/urinanalysis for presence of haematuria and proteinuria

2. eGFR for staging and dx

3. Serum Creatinine  

4. Microalbuminuria - risk factor for CKD

6

Role of Renal U/S in diagnosis of CKD

Kidney atrophy in CKD +

  • show obstruction with hydronephrosis (swelling of kidney due to urine build-up),
  • bladder retention
  • loss of corticomedullary differentiation

7

Serum biochemistry in CKD

  1. HyPERkalaemia
  2. HyPERphosphatemia
  3. HyPOcalcemia
  4. Acidosis

8

Complication in CKD

  1. Anaemia
  2. Renal Osteodystrophy
  3. CVD
  4. Protein malnutrition
  5. Metabolic acidosis
  6. Hyperkalamia
  7. Pulmonary oedema

9

Outline the stages of Kidney Failure

Stage 1- normal or increased GFR >90

Stage 2- mild decrease in GFR 60-89

Stage 3a- mod decrease in GFR 45-59

Stage 3b- mod decrease in GFR 30-44

Stage 4- severe decrease in GFR 15-20

Stage 5- kidney failure (end stage renal failure) GFR <15

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Staging of albuminuria

Normal- M <2.5; F<3.5 mg/mmol

  • Microalbuminuria - M 2.5-25 ; F 3.5-35 mg/mmol
  • Macroalbuminuria - M >25; F>35 mg/mmol

11

Guildelines for BP in CKD

<140/90

In DM or microalbuminuria/proteinurea below 130/80

12

Lifestyles modifications in CKD

  • Smoking cessation - nicotine replacement therapy
  • Weight reduction
  • Salt restriction 
  • Exercise
  • Diet - low fat, low salt early, avoid high protein
  • Fluid intake restriction
  • Correct Anaemia if Hb <100g/L
  • Assess for osteoporosis - osteoporosis, tertiary hyperparathyroidism and Vit D deficiency

13

Management aims for DM in CKD

HbA1c <7%

Pre-prandial blood 4.0-6.0 mmol/L

14

Management aims for lipids during CKD

Total cholesterol <4.0 mmol/L

LDL <2.5 mmol/L

15

Indication for dialysis

  1. Severe metabolic acidosis
  2. Hyperkalemia refractory to medical emergency
  3. Pericarditis
  4. Encephalopathy
  5. Intractable volume overload
  6. Weight loss - persistent anorexia and worsening lathergy
  7. Peripheral neuropathy
  8. Intractable GI symptoms
  9. EGFR 5-9 ml/min/1.73m^2

16

DDx for CKD

  1. Diabetic nephropathy
  2. Hypertensive nephrosclerosis
  3. Ischaemic nephropathy
  4. Obstructive uropathy
  5. Nephrotic syndrome
  6. Glomerulonephritis

17

Screening age for Aboriginals and Torres Strait Islanders for CKD

30+

18

Screening for CKD

  • Everyone with risk factors (obesity, cigarette smoking, ATSI, fam hx, severe socioeconomical disadvantage)
  • Everyone over 50-69, Aboriginals over 30
  • Every 1-2 years 
    • 1 year with risk factors 
    • 2 years without 

19

What is involved in a CKD screen

Blood test - creatinine, which dertermines the eGFR

Urine test either dipstick for protein, urinary protein/creatinine ratio

BP 

20

What is used to estimate GFR

  1. Serum creatinine level
  2. Age
  3. Sex
  4. Race
  5. Body size

21

Urgent referals to renal unit

  • Nephrotic sydrome - proteinurea >3g/day, hypoalbuminaeminia, peripheral odema and hypercholestrolaemia - need renal biopsy
  • Severe hyperkalaemia >6.5mmol?/L
  • Abrupt ride in serum creatinine, esp when coupled with HT, haematuria and systemic symptoms
  • Oliguria urine output <400-500mL in adults
  • Accelerated HT 

22

Management of Dialysis Patients

  • BP control 
  • Dietary recommendation - increase protein if on a low protein diet 
  • Immunisation - Hep  B before dialysis begins 
  • Screening - cervical cancer, breast cancer and colorectal cancer 
  • polypharmacy - modify dose and timing 

Specifically consider

  • Fluid overload - esp in lungs
  • Abdo pain - esp in intraperitoneal antibiotics
  • Bone related issues 
  • Rheumatological complains - ayloidosis --> carpal tunnel, bone cyst, destructive spondylarthropathy or chronic shoulder pain 
  • Arterivenous fistulas - 
  • transfusion of blood and blood products - may develop HLA antibiotics 

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