CKD Flashcards
(17 cards)
Define CKD
It is defined as wither kidney damage or a GFR <60ml/min/1.73m2 of body surface area lasting longer than 3 months.
N/B: Even when GFR is normal, kidney damage longer than 3 months is defined as CKD
What are the formulas for calculating GFR
π Cockcroft-Gault Equation
π MDRD Formula (Modification Of Diet in Renal Disease Trial)
πCKD epidemiology Collaboration equation
What are the markers of Kidney damage?
π Proteinuria
π Haematuria.
π Other abnormalities in the urinary sediments (tubular cells, casts)
π Radiologic evidence of damage β hydronephrosis, polycystic kidneys, asymmetric kidneys, small echogenic kidneys.
π History of vesicourethral reflux in childhood.
π History of kidney transplantation.
Describe Stage 1 CKD
π >90ml/min/1.73m2βββ- Normal or increases GFR but other evidence of kidney damage
Describe Stage 2 CKD
π 60-89ml/min/1.73m2β- Mild reduction in GFR, with other evidence of kidney damage
Describe Stage 3 CKD
π 3Aβ- 45-59ml/min/1.73m2
3Bβ- 30-44ml/min/1.73m2
Moderately reduced GFR with/without other evidence of kidney damage
Describe Stage 4 CKD
π 15-29ml/min/1.73m2
Severely reduced GFR
Describe Stage 5 CKD
π <15 ml/min/1.73m2
End-stage or approaching end-stage kidney failure
Describe Stage 5D CKD
π <15 ml/min/1.73m2
On Dialysis
What are the causes of CKD?
πGlomerulonephritis
πReflux Nephropathy & other CongenitalRenal Diseases
πInfective & obstructive causes
πPolycystic Kidney Disease
πHypertension
πDM
Mnemonic: GRIP HD
What are the final results in the pathogenesis of CKD?
π Glomerulosclerosis
π Proteinuria
π Tubulo-interstitial fibrosis
What are the clinical features of CKD?
π No symptoms im the early stages
π Elevation of blood biochemical markers- urea, creatinine
πLoin pain
πPassage of βsandyβ urine
πHematuria
πUremic symptoms- Nausea, Vomiting, hiccups, convulsions, drowsiness, coma
πPresence of urinary markers e.g. Albumin, TBC
What are the risk factors of CKD?
π Susceptibility factors β older age, family history of CKD, low birth weight
π Initiation Factors β Diabetes, high blood pressure, systemic infections, autoimmune disease, urinary tract infections
π Progression factors β heavy proteinuria, uncontrolled blood pressure, uncontrolled diabetes, smoking.
π End-stage factors β lower dialysis dose, temporary vascular access, anemia, hypoalbuminemia, late referral to Nephrologist.
What are the goals of management in CKD?
π Treat underlying causes of CKD e.g. DM, HTN, obstructive diseases of the urinary tract.
πTreat progression factor e.g. Poor glycemic control, uncontrolled hypertension, increasing proteinuria.
πStop smoking, herbal concoction.
πTreat uremic complications.
πPrepare for kidney replacement therapy if necessary/counselling.
πTreat cardiovascular diseases (CVD) and its risk factors.
πAvoid use of Nephrotoxic drugs.
How would you manage stage 1-2 CKD
- Annual follow UP
- urinalysis, uACR/uPCR and GFR.
- Control BP with ACEI or ARB.
- KDIGO recommends BP target of <140/90 for non-diabetic, non proteinuric CKD patients.
- Target <130/80 if proteinuria (> 30mg/24hrs) Β± DM
How would you manage stage 3 CKD?
- 6 monthly follow-up.
- As in stage 1 AND
- USS of urinary tract if lower urinary tract symptoms.
- Manage anemia- ( Hb < 11g/dl)
- Iron studies.
- intravenous iron and erythropoietin.
- Check serum calcium and potassium every 6 months.
- Baseline parathyroid hormone (PTH); 6-12 monthly if abnormal
How would you manage stage 4-5 CKD?
- Refer Nephrologist
- Dietary counsel.
- Restrict protein to 0.8g/kg/day.
- Reduce salt intake to < 5g/ day.
- Low potassium diet( in hyperkalemia)
- Low phosphate diet.
- Management of anemia
- Correct acidosis and electrolyte imbalance.
Management of mineral bone disease.
- Discuss renal replacement, or conservative management.ββββββββββββββββ
