Chronic Kidney Disease (core) Flashcards
What does dysmorphic RBC in urine indicate?
Travel through the osmotic gradients of the kidney
What happens to calcium with CKD?
It goes down
How do you screen for CKD?
ACR - Albumin to creatinine ratio
How is polycystic kidney disease inherited?
Autosomal dominant
What is the BP target for CKD?
<130/80
What eGFR is require to avoid dialysis?
10-15ml/min/1.73m2
What are the indications for testing for CKD?
Smoker
DM
HTN
Obesity
Established cardiovascular disease
FHx
Aboriginal or Torres Strait Islander >30 years
How can you image the kidneys?
Renal ultrasound
CT
Nuclear isotope scans
What different techniques are available for measuring GFR?
- IV inulin - measure serum and urine clearance rates
- Inject radiolabelled substance and measure serum clearance rates in kidney with nuclear scans
- Use an endogenous substance - creatinine
What happens to PTH in CKD?
It goes up
Why does HbA1c change with CKD?
Insulin isn’t as well metabolised - HbA1c drops
How is CKD defined?
eGFR <60 for >3 months
Evidence of kidney disease >3 months
- microalbuminea
- proteinuria
- glomerular haematuria
Why isn’t serum creatinine a perfect indicator of GFR?
GFR can drop 50% before creatinine rises
What happens with phosphate in CKD?
It goes up
What is the normal size of the kidney?
10-12cm
When might an elevated creatinine be benign?
If the person who has a very large muscle mass
What determines the speed of decline in GFR?
Rate of protein leak
How can you manage a patient with CKD?
Reduce further progression - BP
Reduce cardiovascular risk factors
Early detection of metabolic complication
Medication adjustment
What are some physiological complications of kidney disease?
Accumulation of solutes and waste products
Accumulation of acids
Sodium/water imbalance
Anaemia
Ca/PO4/PTH imbalance (CKD mineral bone disorder)
What Hb do you aim for in someone with CKD?
100-120 g/L
How is renal osteodystrophy treated?
Phosphate binders
Control hyperparathyroidism with 1,25-OH VitD and Cinacalcet (mimics Ca)
What are some symptoms of CKD?
General - Fatigue, malaise, fluid overload, nocturia
Cardiovascular - HTN, IHD, Pericarditis, HF
GI - Anorexia, N/V, metalic taste in mouth
Skin - Pruritis
Neurological - Restless legs, peripheral neuropathy, seizures
Ophthalmic - HT changes
At what eGFR is it advisible to start dialysis?
10ml/min/1.73m2
