Chronic Kidney Disease (core) Flashcards Preview

Hugh's MD2 Intersession 2 > Chronic Kidney Disease (core) > Flashcards

Flashcards in Chronic Kidney Disease (core) Deck (23)
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1

What does dysmorphic RBC in urine indicate?

Travel through the osmotic gradients of the kidney

2

What happens to calcium with CKD?

It goes down

3

How do you screen for CKD?

ACR - Albumin to creatinine ratio

3

How is polycystic kidney disease inherited?

Autosomal dominant

4

What is the BP target for CKD?

<130/80

5

What eGFR is require to avoid dialysis?

10-15ml/min/1.73m2

6

What are the indications for testing for CKD?

Smoker

DM

HTN

Obesity

Established cardiovascular disease

FHx

Aboriginal or Torres Strait Islander >30 years

7

How can you image the kidneys?

Renal ultrasound

CT

Nuclear isotope scans

9

What different techniques are available for measuring GFR?

1. IV inulin - measure serum and urine clearance rates

2. Inject radiolabelled substance and measure serum clearance rates in kidney with nuclear scans

3. Use an endogenous substance - creatinine 

10

What happens to PTH in CKD?

It goes up

11

Why does HbA1c change with CKD?

Insulin isn't as well metabolised - HbA1c drops

12

How is CKD defined?

eGFR <60 for >3 months

Evidence of kidney disease >3 months

- microalbuminea

- proteinuria

- glomerular haematuria

13

Why isn't serum creatinine a perfect indicator of GFR?

GFR can drop 50% before creatinine rises

14

What happens with phosphate in CKD?

It goes up

15

What is the normal size of the kidney?

10-12cm

16

When might an elevated creatinine be benign?

If the person who has a very large muscle mass

17

What determines the speed of decline in GFR?

Rate of protein leak

18

How can you manage a patient with CKD?

Reduce further progression - BP

Reduce cardiovascular risk factors

Early detection of metabolic complication

Medication adjustment

19

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)

20

What Hb do you aim for in someone with CKD?

100-120 g/L

21

How is renal osteodystrophy treated?

Phosphate binders

Control hyperparathyroidism with 1,25-OH VitD and Cinacalcet (mimics Ca)

22

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

23

At what eGFR is it advisible to start dialysis?

10ml/min/1.73m2