Chronic Kidney Disease Flashcards
(19 cards)
What is CKD?
Abnormal kidney structure or function for > 3 months with implications for health
How is CKD classified? What factors affect serum creatinine?
Flomerular filtration rate (estimated using serum creatinine, age, gender, ethnicity
Serum creatinine is affected by muscle mass.
Can be classified by presence of albuminuria as a marker of kidney damage
What are the stages of CKD and what do they indicate?
1 GFR>90ml/min - only if other evidence of kidney damage - protein/haematuria/ pathology on biopsy/imaging/ transplant
2 GFR 60-89 only CKD with some sign of kidney damage
3a GFR 45-59 Mild-moderate
3b GFR 30-44 Moderate-severe
4 GFR 15-29 Severe
5 GFR<15ml/min Kidney failure - dialysis or transplant
What is CKD stage 1?
GFR > 90ml/min with some sign of kidney damage persistent - haematuria,, proteinuria, pathology on imaging, biopsy or transplant, tubule disorder
What is CKD stage 2?
GFR 60-89ml/min with some sign of renal damage
What is CKD stage 3a?
GFR 45-59ml/min mild-moderate reduction kidney function
What is CKD stage 3b?
GFR 30-44ml/min moderate-severe reduction in kidney function
What is CKD stage 4?
GFR 15-29ml/min severe
What is CKD stage 5?
<15ml/min GFR kidney failure indicating transplant or dialysis
What are causes of CKD?
Diabetic nephropathy Chronic glomerulonephritis Hypertension Chronic pyelonephritis Adult polycystic kidney disease
How else can CKD be classified?
By albuminuria or albumin:creatinine ratio
1: albuminuria < 30
2: 30-300
3: >300
ACR
1: < 3
2: 3-30
3: 30
By underlying disease:
Glomerular, tubulointerstitial, blood flow/vessels, congenital, transplant
What examination in CKD?
Peripheral oedema Signs of immunosuppression - bruising from steroids, skin lesions Uraemia flap/encephalopathy Anaemia JVP for fluid state CVS - if right heart failure, JVP does not reflect fluid state Pulmonary oedema/effusion Catheter Ballotable polycystic kidneys Signs of transplant
What investigation in CKD?
Bedside:
Urine: dipstick, MC&S, ACR, PCR
Bloods: U&E FBC - normochromic, normocytic anaemia Glucose - DM Calcium , phosphate, PTH ANA/ANCA/ antiphospholipid antibodies, anti-GBM
Imaging:
USS KUB - kidneys may be small <9cm
If asymmetrical consider renovascular disease
Other:
Histology
renal biopsy if progressive, nephrotic syndrome, systemic disease, AKI
How is renal function monitored in CKD?
GFR and albuminuria monitored at least annually
High risk monitored at 3-4 months
Drop in eGFR stage is significant
What are risk factors for decline in CKD?
DM HTN Metabolic disturbacne Infection NSAIDs Smoking Volume depletion
What metabolic complications occur with CKD?
low vitamin D as hydroxylation of 1-vitamin D occurs in kidney
Low calcium due to lack of vitamin D
–> High phosphate
Secondary hyperparathyroidism due to low calcium and high phosphate
Leads to:
Hyperparathyroid bone disease
Osteomalacia - softening of bone due to low vitamin D
Osteoporosis
Anaemia:
Reduced erythropoietin levels leads to Normochromic (normal Hb conc within cells), normocytic anaemia
What is the cause of anaemia in renal failure?
Reduced erythropoietin levels
Reduced erythropoiesis due to toxic effects of uraemia on bone marrow
Reduced absorption of iron
Anorexia/nausea due to uraemia
Reduced red cell survival
Blood loss due to capillary fragility and poor platelet function
What type of anaemia in CKD? When does it present?
Normochromic (normal Hb conc within cells) normocytic (normal cell size) anaemia
What is the management for anaemia in CKD?
Treat deficiencies: iron, B12 and folate
Iron therapy may be needed to be given IV
Erythropoietic stimulating agent (ESA) if Hb < 110g/L if likely to benefit in terms of function and quality of life.
