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Flashcards in CKD Deck (10):
1

what is CKD

long standing progressive impairment in renal function
defined on the basis of persistent (>3mo) evidence of kidney damage (proteinuria, haematuria) and or impaired GFR

2

what pts are at inc risk of CKD

diabetes mellitus
hypertension
atherosclerotic renal vascular disease
schistosomiasis in middle east
they should be regularly screened

3

clinical features CKD

early = asymptomatic
A declining GFR, rise in serum urea and creatinine conc
Anaemia
Bone disease
Neurological
Cardiovascular

4

Investigations

Same as AKI

5

Why is anaemia a feature of CKD

due to decrease in erythropoietin production by the diseased kidney

erythropoietin = a hormone secreted by the kidneys that increases the rate of production of red blood cells in response to falling levels of oxygen in the tissues.

6

Why is bone disease a feature of CKD

renal phosphate retention and impaired production of 1,25-dihydroxyvitamin D lead to falls in calcium concentration and inc in PTH. Sustained inc in PTH = skeletal decalcification = osteomalacia and osteoporosis

7

What are the neurological features in CKD

polyneuropathy manifests as paraesthesiae & weakness
autonomic dysfunction presents as postural hypertension and disturbed GI motility
advanced uraemia = depressed cerebral func
median N compression in carpal tunnel common

8

why CVD in CKD

MI, cardiac failure, sudden cardiac death and stroke due to HTN, dyslipidaemia & vascular calcification

9

differentiate CKD from AKI

hx, duration of symptoms and previous urinalysis of serum creatinine
normocytic anaemia, small kidneys on USS and presence of renal osteodystrophy = chronic

10

management CKD

- treat underlying cause eg immunosuppressants for vasculitis
- slow deterioration of renal function (renoprotection) = maintain norm BP and urinary protein w ACEi, diuretic and CCB
- reduce CV risk - BP control, reduce proteinuria, statins, stop smoking
- treat complications eg anaemia
- appropriate dose adjustment of drugs