CKD Flashcards
(22 cards)
what is the definition of CKD?
reduction in kidney function or structural damage (or both) present for more than 3months, with associated health implications.
what are the causes of CKD?
-conditions associated with intrinsic kidney damage (HTN, DM, glomerular disease, current/previous AKI, potentially nephrotoxic drugs)
-conditions associated with obstructive uropathy (structural renal tract disease, neurogenic bladder, BPH, recurrent kidney stones)
-multisystem disease with renal involvement (SLE, vasculitis, myeloma)
what are some of the common potentially nephrotoxic drugs that could cause CKD?
-aminoglycosides (vancomycin, gent)
-ACEis/ARBs
-bisphosphonates (alendronic acid)
-calcinuerin inhibitors (ciclosporin, tacrolimus)
-diuretics
-lithium
-mesalazine
-NSAIDs
what are the risk factors for CKD?
-having any of the conditions listed as causes
-FH of CKD stage 5 or hereditary kidney disease or familial glomerulonephritis
-cardiovascular disease
-obesity with metabolic syndrome (obesity itself not risk factor)
-gout
what is metabolic syndrome?
having a combination of diabetes, high blood pressure (hypertension) and obesity.
what are 2 examples of hereditary kidney disease?
autosomal dominant polycystic kidney disease
alport’s syndrome
what is alport’s syndrome?
sex linked recessive disease which typically causes haematuria as well as deafness and eye issues
what sort of monitoring do people on potentially nephrotoxic drugs need?
yearly monitoring of eGFR and urine ACR
what are the symptoms of CKD and why?
-anaemia cos kidney makes EPO: pallor, lethargy, breathlessness
-urea buildup: skin pigmentation and itchiness, bruising (platelet dysfunction), confusion, coma, fits, polyneuropathy, uraemic pericarditis
-toxin buildup: N+V, anorexia
-renal: nocturia, polyuria, oedema, bubbly urine
-renal bone disease: osteomalacia, bone pain, osteosclerosis, muscle weakness, cramps
-endocrine: amenorrhoea, erectile dysfunction, infertility
-CV: HTN, peripheral vascular disease
what are the signs/examinations you need to do for CKD?
-general examination: cachexia, signs of malnutitrion, uraemic odour
-CV exam: pallor, dehydration/hypovalaemia, tachypnoea, HTN, peripheral oedema, pulmonary oedema
-neurological exam: cognitive impairment, peripheral neuropathy, peripheral myopathy
-abdo exam: palpable bilateral flank masses with possible hepatomegaly suggests PCKD with possible liver cysts, palpable distended bladder suggests obstructive uropathy
when do you do initial investigations for CKD?
-someone with any risk factors for CKD
-incidental findings of: raised creatinine/eGFR <60, proteinuria (ACR>3), persistent haematuria, urine sediment abnormalities
-possible clinical features of CKD
what is persistent haematuria?
2/3 urine dipsticks showing 1+ or more of blood after exclusion of a UTI
what are the initial investigations for someone to do for CKD?
-serum creatinine and eGFR
-early morning urine sample to measure ACR
-urine dip for haematuria
-CV risk factors: BMI, BP, serum Hba1c, lipid profile
-renal tract USS if ?stones or ?PCKD
what’s a rule on what you can’t do before having your serum creatinine and eGFR measured?
can’t eat meat 12 hours before test
what do you do with the results of the initial serum creatinine/eGFR measurement?
if <60 repeat within 2 weeks. if remains <60 repeat within 3 months -obvi if reduced still and spanning 3 months indicates CKD
in which groups do you have to interpret eGFR with caution?
extremes of muscle mass
pregnant
oedema
malnourished
uses protein supplements
asian or chinese in origin
what do you do with the initial ACR results?
<3: no action needed
3-70: repeat test in 3 months
70+ no repeat needed as significant proteinuria
what do you do with the results of the urine dip for haematuria?
1+ or more -arrange MSU testing for ?UTI
isolated persistent haematuria -think about referral for ?urological cancer
what are the diagnostic criteria for CKD?
1) markers of kidney damage: urine ACR >3, urine sediment abnormalities (eg RBCs, WBCs, casts, renal tubular epithelial cells), electrolyte abnormalities, histological abnormalities, structural abnormalities, history of kidney transplant
2) a persistent reduction in renal function (3 months or more) shown by an eGFR <60.
what is accelerated progression of CKD?
decrease in eGFR or 25% or more AND change in CKD category within 12 months, or persistent decrease in eGFR of 15 within 12 months.
what is the staging of CKD?
Gs are stage 1-stage 5 and based on GFR. stage 1=90+, stage 2=60-90, stage 3=45 up to <60, stage 4=15 up to <30, stage 5=<15 (kidney failure)
As are A1-A3 and and based on ACR. 1=<3, 2=3-30, 3=30+
what is the management of CKD?
-proteinuria: if they have ACR>7- prescribe ACEi/ARB no matter what BP is-renoprotection
-manage HTN: 1st line =ACEi/ARB. targets =<130/80 if ACR 70+, <140/90 if ACR >70, <150/90 if 80+ with diabetes
-manage anaemia risk: measure FBC, check for other causes of anaemia, refer to nephrologist if renal anaemia suspected. iron tablets -> iron infusions -> EPO
-manage renal bone disease risks: arrange serum calcium, phosphate, vit D, and PTH tests for everyone with CKD. low phosphate diet, calcium supplements
-CVD prevention: atorvastatin 20mg for everyone with CKD, antiplatelet drug for everyone, consider dapagliflozin if optimised on ACEi/ARB and have DM or ACR>23
-flu and pneumococcal vaccines
