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Year 3 > CKD > Flashcards

CKD Flashcards

(53 cards)

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1
Q

What GFR level indicates abnormal kidney function?

A

GFR below 60ml/min

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2
Q

What are the clinical findings for CKD?

A

Hypertension
Pallor (due to anaemia)
Abnormal fluid status
Fluid overload with peripheral and/or pulmonary oedema
Dehydration
Cachexia
Ammonia-like smelling breath due to uraemia
Tachypnoea (due to anaemia, pulmonary oedema, pleural effusion or acidosis

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3
Q

What is the management of CKD?

A

ACE inhibitors or ARB first line for ACR over 30mg/mmol

-> if suboptimal control continues, indapamide should be prescribed

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4
Q

When should ACE inhibitors/ARBs be avoided first line?

A

Patients with hyperkalemia over 5 mmo/L

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5
Q

What is second line for CKD pharmacology?

A

SGLT2 inhibtiors for type 2 diabetics

> if this fails, indapmaide

Antiplatelet

Atorvostatin -

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6
Q

What classification is used for CKD?

A

KDIGO based on GFR and ACR

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7
Q

What is G1?

A

GFR over 90ml/min

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8
Q

What is A1?

A

ACR over 3 mg/mmmol

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9
Q

What is A2?

A

ACR 3 to 30 with moderate risk

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10
Q

What is A3?

A

ACR over 30 which is very high risk

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11
Q

What is G2?

A

60-89 ml.min

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12
Q

What is G3A?

A

45-59 ml/min

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13
Q

What is G3b?

A

30-44 ml/min

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14
Q

What is G4?

A

15-29ml/min

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15
Q

What is G5?

A

Less than 15ml/min with renal failure

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16
Q

What causes a false positive low EGFR?

A

False-positive low eGFR results may occur due to high serum creatinine results, for example in patients with high muscle mass, or after consumption of meat

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17
Q

What causes high urinary ACR?

A

Urinary ACR may also be high due to menstruation, strenuous exercise, orthostatic proteinuria or UTI

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18
Q

Which electrolytes are lowered in CKD?

A

HYPOcalcaemia
Sodium

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19
Q
A
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20
Q

How does CKD affect calcium levels?

A

Sustained parathyroid stimulation due to low vitamin D synthesis initially causes low calcium and high phosphate known as secondary hyperparathyroidism with lethargy and intermittent pins and needles.

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21
Q

How does hyperparathyroidism progress in CKD?

A

This causes the development of an autonomous parathyroid nodule, resulting in high PTH and hypercalcaemia known as tertiary hyperparathyroidism with renal stones, back pain and confusion

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22
Q

What warrants a referral to nephrology with the use of antihypertensives?

Study These Flashcards
A

Failure to control hypertension after a trial fo 4 different antihypertensives

23
Q

What is the general criteria for referral to nephrology?

Study These Flashcards
A

eGFR <30
GFR decreased by >5 in 1 year
Albumin:creatinine ratio (ACR) >70 (unless known to be associated with diabetes)
ACR >30 with persistence haematuria (must exclude UTI first)
Suspected rare or genetic causes of CKD
Suspected renal artery stenosis
Suspected complications of CKD e.g. anaemia, gout, secondary hyperparathyroidism

24
Q

What is given for anaemia?

Study These Flashcards
A

Anaemia is typically normocytic normochromic and should be treated with EPO subcutaneous injections UNLESS it is microcytic

25
What are the principles for EPO treatment?
Any existing iron defieicny must be treated, indicated by low ferritin or transferrin despite normal MCV
26
What is the most common cause of mortality in CKD from diabetes?
Cardiovascular disease
27
What is a side effect of EPO treatment?
Rapid rise in BP can cause hypertensive encephalopathy and thrombosis
28
Which scan is used to estimate renal function?
DMSA scan based on radio-isotope uptake
29
What causes an Enlarged left kidney on ultrasound and raised serum urea and creatinine?
Hydronephrosis
30
Which SGLT2 inhibitor is reccomended?
Empagliflozin which increases the risk of vaginal candiadiasis
31
How are calcium and phosphate levels affected in CKD?
High phosphate and low calcium and low vitamin D due to secondary hyperparathyoridism
32
How are claciuma nd phosphate changes managed in CKD?
Dietary phosphate restriction from dietary sources like dairy, cola and processed meat
33
What is required for diagnosis of CKD?
Markers of kidney damage like proteinuria, haematuria or histological abnormalities REGARDLESS of CKD
34
HOW TO CONFIRM CKD?
Urine dip for raised ACR
35
What is the most common cause of peritonitis in peritoneal dialysis?
Staphylococcal epidermidis
36
When should RAAS antagonists be stopped for managmeent of hypertension?
Potassium exceeeds 6.0 EGFR decreases by 25% minimum Serum creatinine increases more than 30%
37
What to do if egFR decrease by more than 25% and creatinine rise while taking RAAS antagonist?
Reduce dose of RAAS antagonist
38
What is a case of anaemia unrelated to EPO levels?
hepcidin is an inflammatory marker raised in CKD which decreases iron absorption from the gut and impaires release of stored iron from macrophages and hepatocytes.
39
What is tha e target Hb for CKD?
10-12
40
When is EPO given to treat anaemia in CKD?
When 3 months of iron have not treated the deficiency.
41
42
Which factors affect result of serum creatinine in GFR?
pregnancy muscle mass (e.g. amputees, body-builders) eating red meat 12 hours prior to the sample being taken
43
Which type of parathyroidism occurs in CKD?
Secondary hyperparathyoridism due to low calcium, high phosphate and low vitamin D
44
What is first line to treat secondary hyperparathyroidism in CKD?
Reducing dietary intake of phosphate
45
What is alternative management of secondary hyperparathyroidism in CKD?
Vitamin D supplements Phosphate binders
46
How is albumin creatinine sample collected?
first-pass morning urine specimen by collecting a 'spot' sample it avoids the need to collect urine over a 24 hour period in order to detect or quantify proteinuria
47
What ACR level is clinically important according to NIE?
Over 3
48
Which ACR even requires referral to nephrology?
70
49
When does a repeat sample required for ACR?
If initial ACR is between 3 and 70
50
What is thr target BP for diabetic nephropathy?
Less than 130/80
51
When to start ACE inhibitor with diabetic nephropathy?
ACR of 3 or more
52
What is the target BP for patients with CKD and ACR <70 mg/mmol?
Less than 135/85mmHg
53
What is the target BP for patients with CKD and ACR over 70mg/mmol (significant proteinuria)
Less than 130/80

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