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Flashcards in Chronic Kidney Injury Deck (38):
0

Stages of CKD

Stage 1 - eGFR > 90ml/min
Stage 2 - eGFR 60-89ml/min
Stage 3 - eGFR 30-59ml/min
Stage 4 - eGFR 15-29ml/min (usually only symptomatic after here)
Stage 5 - eGFR <15ml/min

1

Causes of CKD

Commonest - diabetic or hypertension
Poly-cystic kidney
Long term Nephrotoxic drugs (gentamicin or NSAIDs)
Autoimmune diseases (SLE) and glomerulonephritis
Recurrent UTIs or Hx of kidney trauma

2

Symptoms of CKD

Asymptomatic until stage 4
Uraemia
Hyperkalaemia
Low erythropoietin Abnormal Vit D metabolism
Fluid overload (oedema)
Metabolic acidosis (increased RR, treat with oral bicarbonate)

3

Symptoms of Uraemia

Confusion
Pruritus
Restless legs/Cramps
Nausea
Parasthesia

4

Symptoms of low erythropoietin

Anaemia, Dyspnoea, Fatigue
Need to be monitor Hb and if below 11 give weekly EPO injections + iron
If below 8Hb transfuse to 11

5

Stages of CKD

Stage 1 - eGFR > 90ml/min
Stage 2 - eGFR 60-89ml/min
Stage 3 - eGFR 30-59ml/min
Stage 4 - eGFR 15-29ml/min (usually only symptomatic after here)
Stage 5 - eGFR <15ml/min

6

Chronic kidney Disease (CKD)

A gradual decline in renal function over months to years, classified by a decrease in eGFR

7

Symptoms of disrupted Vit D metabolism

Osteomalacia (bone pain)
Secondary or tertiary hyperparathyroidism
Treat with calcium and cholecalciferol and monitor PTH levels
Phosphate binders can be used to treat hyperphosphataemia

8

Treating hypertension in patients with CKD

ACEi can be used if K+ is below 6
If above then use a loop diuretic --> if resistant add thiazides

9

Treatment of stage 4/5 of CKD

Transplant or haemodialysis
Especially if --> serum creatinine >500mmol/L OR GI symptoms OR peripheral neuropathy OR pericarditis OR malnutrition

10

Polycystic kidney disease (PCKD)

One cause of chronic kidney disease --> genetic condition
Can be painful or asymptomatic --> multiple cysts in kidney but can also be in liver, brain or heart
Can autosomal dominant (commonest, onset in early adulthood) or recessive (rarer with worse prognosis, onset in infancy)

11

Causes of pain in polycystic kidney disease (PCKD)

Cyst haemorrhage or infection
Pyelonephritis
Kidney stones
Chronic cyst pain

12

Common presentations of PCKD

Asymptomatic cysts on imaging or family screening --> genetics too complex to screen
Renal pain, haematuria/proteinuria, hypertension or CKD
Non-renal manifestations --> cerebral aneurysms, liver cysts/failure, pancreatic cysts, valvular disease, diverticulitis

13

Cyst haemorrhage

Sudden onset, sharp localised pain over 2-5 days
Afrebrile, blood cultures and MSU -ve --> N+V with occasional haematuria
Diagnose by CT or MRI
Analgesia and rest, hydration, compression+transfusion if major

14

Cyst infection

Sub-acute, localised sharp pain
Pyrexial, N+V and blood cultures often +ve but MSU -ve
Diagnose by CT or MRI
Requires at least 4 weeks of antibiotics (long-term+penetrating)

15

Pyelonephritis

Sudden onset, progressive, diffuse pain
High grade Pyrexia, N+V, rigours and dysuria
Blood cultures and MSU Both +ve
USS may show perinephric
Requires prolonged up to 4 weeks of Antibiotics

16

Symptoms of kidney stones

Sudden onset, localised, sharp but intermittent colic
Apyrexial, N+V, and frank haemorrhage
Blood culture and MSU both negative
KUB,IVP, CT, MRI and X-ray
Analgesia, rest and hydration. Treat with PCUL or surgery

17

Chronic cyst pain

Poorly understood
Constant, positional, diffuse pain with gradual onset
Apyrexial and occasionally with chronic haematuria
Blood cultures and MSU negative, imaging not helpful
Analgesia, aspiration if due to a single cyst or surgery

18

CKD as a complication of polycystic kidney disease

Onset in 40's --> 65% progress to end stage disease (ESRD) needing renal replacement therapy (RRT) of some form --> dialysis or transplant
Generally leave the original kidneys in unless -->need the space, painful, recurrently bleeding or infected or cancerous

19

ESRD

End stage renal disease

20

RRT

Renal replacement therapy
Either dialysis or transplant

21

Hypertension in patients with PCKD

Almost 100% of patients will have it by 4th decade

22

Causes of CKD

Commonest - diabetic or hypertension
Poly-cystic ovaries
Long term Nephrotoxic drugs (gentamicin or NSAIDs)
Autoimmune diseases (SLE) and glomerulonephritis
Recurrent UTIs or Hx of kidney trauma

23

Symptoms of CKD

Asymptomatic until stage 4
Uraemia Hyperkalaemia
Low erythropoietin Abnormal Vit D metabolism
Fluid overload
Metabolic acidosis

24

Symptoms of Uraemia

Confusion
Pruritus
Restless legs/Cramps
Nausea
Parasthesia

25

Symptoms of low erythropoietin

Anaemia
Dyspnoea
Fatigue
Need to be monitor Hb and if below 11 give weekly EPO injections

26

Symptoms of hyperkalaemia

Palpitations and/or ECG Changes
May be asymptomatic
Treat if K+ over 6 by stopping all K+ sparing drugs
ACEi cannot be used if K+ remains elevated

27

Stages of CKD

Stage 1 - eGFR > 90ml/min
Stage 2 - eGFR 60-89ml/min
Stage 3 - eGFR 30-59ml/min
Stage 4 - eGFR 15-29ml/min (usually only symptomatic after here)
Stage 5 - eGFR <15ml/min

28

Causes of CKD

Commonest - diabetic or hypertension
Poly-cystic ovaries
Long term Nephrotoxic drugs (gentamicin or NSAIDs)
Autoimmune diseases (SLE) and glomerulonephritis
Recurrent UTIs or Hx of kidney trauma

29

Symptoms of CKD

Asymptomatic until stage 4
Uraemia Hyperkalaemia
Low erythropoietin Abnormal Vit D metabolism
Fluid overload
Metabolic acidosis

30

Symptoms of Uraemia

Confusion
Pruritus
Restless legs/Cramps
Nausea
Parasthesia

31

Symptoms of low erythropoietin

Anaemia
Dyspnoea
Fatigue
Need to be monitor Hb and if below 11 give weekly EPO injections

32

Stages of CKD

Stage 1 - eGFR > 90ml/min
Stage 2 - eGFR 60-89ml/min
Stage 3 - eGFR 30-59ml/min
Stage 4 - eGFR 15-29ml/min (usually only symptomatic after here)
Stage 5 - eGFR <15ml/min

33

Causes of CKD

Commonest - diabetic or hypertension
Poly-cystic ovaries
Long term Nephrotoxic drugs (gentamicin or NSAIDs)
Autoimmune diseases (SLE) and glomerulonephritis
Recurrent UTIs or Hx of kidney trauma

34

Symptoms of CKD

Asymptomatic until stage 4
Uraemia Hyperkalaemia
Low erythropoietin Abnormal Vit D metabolism
Fluid overload
Metabolic acidosis

35

Symptoms of Uraemia

Confusion
Pruritus
Restless legs/Cramps
Nausea
Parasthesia

36

Symptoms of low erythropoietin

Anaemia
Dyspnoea
Fatigue
Need to be monitor Hb and if below 11 give weekly EPO injections

37

Treatment of acute pyelonephritis

Broad spectrum cephalosporin or quinolone