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Flashcards in CKD Deck (6):
1

What is the Definition of CKD?

  1. >3months (measured on 2 separate occasions): - eGFR <60L/min/1.73m2 (would recheck in 7 days to rule out AKI) 
  2. evidence of renal damage (haematuria, microalbuminuria, pathological abnormalities).

2

Screening for CKD?

  • only screen at risk populations between 18-30 above 30 screen every 2 years for Aboriginal and every 12months in HTN/diabetes 
    • ACR (microalbuminuria >2.5M and >3.5F (first thing in the morning))
    • eGFR Can increase due to:
      • UTI, f
      • ebrile illness,
      • dietary protein,
      • drugs (NSAIDs),
      • correct eGFR for age using CKD-EPI
    • important to rule out treatable kidney disease:
      • UTI
      • Stone
      • Autoimmune
      • Nephrotoxic drugs
      • Kidney cancer

3

What should you do for a CKD management plan?

Management plan:

ST: 

  • All CKD is treated with ACE I or ARB plus diuretic (avoid NSAIDs and nephrotoxins) 
    • aim for >50% reduction in ACR 
  • start a statin 
  • CKD 1-3 stages reduce daily protein intake 0.75g/kg/day and restrict fluid intake 2-2.5L 
  • diabetes control <7%HbA1c 

MT:

  • CVD risk (BP, cholestrol, smoking cessation, glycemic control, decrease weight)
  • avoid nephrotoxins
  • lifestyle (salt restrict, decrease alcohol, physical activity)

LT: 

  • review every 12 months with investigations (6mths if microalbumin, 3 months if CKD stage 4 or worse)
  • monitor for complications (dose adjust) 
  • add to recall practice software 

If CKD 1-2 then start thinking about RRT: 

  1.  fluid overload (diuretics/dialysis)
  2. electrolyte changes (calcium supplements, phosphate binders, resonium/frusemide),
  3. dialysis
  4. OP/osteomalacia
  5. hyperPTH
  6. HTN (ACE/ARB)
  7. anamia (darbepoetin or iron infusions) 

4

What are some RF modifications to stop people getting CKD? 

  • Obesity (lose weight) 
  • Diabetes control 
  • HTN control 
  • Smoking cessation 
  • healthy diet 
  • limit salt intake to <6g per day 

Tx BP with ACE I or ARB, use a statin 

Prevent children from getting rheumatic fever and prevent pregnancy complications 

5

What can cause an elevated urine protein but not an elevated urine albumin? 

  1. tubulointerstitial disease 
  2. multiple myeloma 

6

Why do you have to repeat CKD test screening? What tool should you use? 

  • CKD-EPI - measures cerum creatinine and accounts for age/gender 
  • illness, diet, weight can bias eGFR estimate 
  • repeat eGFR in 7 days to exclude AKI but also to check the legitimacy of the result. 
  • should do albumin in the morning, first pass. Repeat 2x in 3 months