Chronic Kidney Disease Flashcards
definition of chronic kidney disease?
abnormal kidney function and/or structure (includes genetic/inherited)
requires a minimum of two positive samples at least 90 days apart
chronic kidney disease often co-exists with other diseases?
cardiovascular disease
diabetes
best indication of kidney function? what does this include?
eGFR based on - creatinine level - age - sex - race
5 stages of CKD based on eGFR?
1 = >90 2 = 60-89 3a = 45-59 3b = 30-44 4 = 15-29 5 = <15
stages of CKD based on description?
1 = normal function but urine findings/structural abnormalities/genetic trait point to kidney disease 2 = mildly reduced function but findings point to kidney disease 3 = moderately reduced kidney function 4 = severely reduced kidney function 5 = established renal failure
chroni kidney disease epidemiology collaboration (CKD EPI)?
equation to estimate GFR creatinine
only given as >60, no specific value if GFR more than 60
categories of ACR (albumin:creatinine ratio)?
A1 = ACR <3 A2 = ACR 3-30 A3 = >30
why is albumin used?
leaks out of the glomerulus when kidney function is reduced
how are eGFR and ACR used?
stage of CKD and category of ACR used to determine severity and requirement for follow up
how does acute kidney injury relate to CKD?
increased risk of CKD (nephrons can be damaged/lost)
therefore need monitoring for development/progression of CS for at least 2-3 years after acute kidney injury (even if serum creatinine has returned to baseline)
what is eGFRcystatinC?
test used at initial diagnosis to confirm or rule out CKD in people with eGFRcreatinine of 45-59 but no other marker of CKD (no proteinuria etc)
- > 60 = not CKD
- used as diagnosis of CKD can affect life insurance etc
definition of accelerated progression of CKD?
sustained decrease in GFR of 25% or more and a change in GFR category within 12 months
or
sustained decrease in GFR of 15ml/min/1.73m2 per year
risk factors for CKD progression?
cardiovascular disease proteinuria acute kidney injury hypertension diabetes smoking African, African-Caribbean or Asian family origin chronic NSAID use untreated urinary outflow tract obstruction
indications for referral for specialist assessment of kidney function?
GFR <30
ACR 70 or more (unless due to diabetes and already being treated)
ACR 30 or more with haematuria
sustained decrease in GFR of 25% or more and a change in GFR category
sustained decrease in GFR of 15ml/min or more within 12 months
hypertension which is poorly controlled despite use of 4 antihypertensive drugs
known or suspected rare or genetic causes of CKD
suspected renal artery stenosis
blood pressure control in CKD?
target BP in CKD = 120-139 systolic, diastolic <90
target BP in people with CKD AND diabetes and also people with ACR >69 = <130 systolic and diastolic <80
introduction of RAAS inhibitor medications (antihypertensives) are expected to have which effects which are considered normal?
GFR decrease up to 25% at most
increase in serum creatinine of at most 30%
any more than this then need to modify dose of drug
