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CKD Flashcards

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1
Q

What is the definition of CKD?

A

Abnormal kidney structure or function, present for > 3 months, with implications for health

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2
Q

What is stage 1 CKD classed as in terms of GFR?

A

>/= 90 ml/min/1.73m2​

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3
Q

What is stage 2 CKD classed as in terms of GFR?

A

80-89 ml/min/1.73m2

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4
Q

What is stage 3 CKD classed as in terms of GFR?

A

30-59 ml/min/1.73m2​

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5
Q

What is stage 4 CKD classed as in terms of GFR?

A

15-29 ml/min/1.73m2

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6
Q

What is stage 5 CKD classed as in terms of GFR?

A

<15 ml/min/1.73m2

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7
Q

What does A1 mean in terms of persistent albuminuria?

A

<30 mg/g

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8
Q

What does A2 mean in terms of persistent albuminuria?

A

30-300 mg/g

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9
Q

What does A3 mean in terms of persistent albuminuria?

A

>300 mg/g

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10
Q

What is Stage 3a CKD defined as in erms of GFR?

A

45-59 ml/min/1.73m2

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11
Q

What is Stage 3b CKD defined as in erms of GFR?

A

30-44 ml/min/1.73m2

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12
Q

What are congenital causes of CKD?

A
  • Polycystic kidney disease
  • Tuberous sclerosis
  • Medullary cystic disease
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13
Q

What vascular problems can cause CKD?

A
  • Hyperensive nephrosclerosis
  • Renovascular disease
  • Small/medium vessel vasculitis
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14
Q

What secondary glomerular diseases can cause CKD?

A
  • SLE
  • Polyangiitis
  • Wegener’s
  • Amyloidosis
  • Diabetic nephropathy
  • HUS
  • TTP
  • Systemic sclerosis
  • Sickle cell disease
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15
Q

What tubulointerstitial diseases can cause CKD?

A
  • Tubulointerstitial nephritis
  • Reflux nephropathy
  • TB
  • Schistosomiasis
  • Nephrocalcinosis
  • Multiple myeloma
  • Renal papillary necrosis
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16
Q

What causes of urinary tract obstruction can lead to CKD?

A
  • Calculi
  • Prostatic disease
  • Pelvic Tumours
  • Retroperitoneal fibrosis
  • Schistosomiasis
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17
Q

What are symptoms which can occur in CKD?

A

Most are asymptomatic, but in more severe disease - symptoms of uraemia and kidney dysfunction:

  • Malaise
  • Loss of appetite/anorexia
  • Insomnia
  • Itching
  • Nausea/vomiting/diarrhoea
  • Paraesthesiae/Tetany
  • Bone pain
  • Symptoms of anaemia
  • Oedema
  • Amenorrhoea
  • Erectile dysfunction
  • Severe dysfunction - Mental slowing, seizures, Myoclonic twitching
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18
Q

What are peripheral signs of CKD?

A
  • Peripheral oedema
  • Signs of PVD
  • Vasculitic rash
  • Gouty tophi
  • Signs of immunosuppression - bruising easily, skin malignancy
  • Asterixis
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19
Q

What signs might you see in the face in someone with CKD?

A
  • Anaemia
  • Xanthelasma
  • Uraemic (yellow) tinge
  • Jaundice - HRS
  • Gum hypertrophy
  • Cushingoid appearence
  • Periorbital oedema - nephrotic syndrome
  • Telangiectasia - scleroderma
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20
Q

What signs might you see in the neck in someone with CKD?

A
  • Increased JVP
  • Lymphadenopathy
  • Scar from parathyroidectomy
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21
Q

What cardiovascular signs might you see in someone with CKD?

A
  • HTN
  • Sternotomy scar
  • Cardiomegaly
  • Stigmata of endocarditis
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22
Q

What respiratory signs might you see someone with CKD?

A

Pulmonary oedema/effusion

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23
Q

What signs might you see on the abdomen in someone with CKD?

Study These Flashcards
A
  • PD catheter
  • Signs of previous transplant
  • Ballotable polycystic kidney +/- palpable liver
24
Q

What investigations might you do in someone who you suspected had CKD in an attempt to identify a cause?

Study These Flashcards
A
  • Bedside - BP, Urine dipstick
  • Bloods - U+E’s, FBC, Ca2+, PO43-, PTH, LFT, ESR, Glucose, CK
  • Imaging - Renal USS
  • Other - Renal biopsy, Urine MC+S, Urine PCR, blood film
25
Why might you do a blood glucose in someone who is suspected to have CKD?
Look for diabetes as a cause of renal failure
26
What blood tests might show that someone with CKD is developing renal osteodystrophy?
* **Decreased Ca2+** * **Increased PO43-** * **Increased PTH**
27
What bloods test would you consider doing to look for signs of intrinsic renal disease?
* **ANA** * **ANCA** * **Antiphospholipid antibodies** * **Paraprotein** * **Complement** * **Anti-GBM** * **Hepatitis serology** * **Cryoglobin**
28
What might you see on urine dipstick in someone with CKD?
* **Haematuria** - GN * **Proteinura** * **Glycosuria** * **White cells**
29
What might you see on Urine electrophoresis in someone with CKD?
Bence-Jones Proteins
30
What might you see when measuring urine osmolality in someone with CKD?
Low urine osmolality - inability of kidneys to concentrate urine
31
What is renal osteodystrophy?
Bone mineral disorder Embraces the various forms of bone disease that may develop alone or in combination in CKD – hyperparathyroid bone disease, osteomalacia, osteoporosis, osteosclerosis and adynamic bone disease
32
How would you monitor renal function in CKD?
Annual measurements of: * **GFR** * **Albuminuria**
33
What are risk factors for decline in renal function?
* **Hypertension** * **DM** * **Metabolic disturbance** * **Volume depletion** * **Infection** * **NSAIDs** * **SMoking**
34
What might a markedly raised ESR indicate as the cause of CKD?
Myeloma or vasculitis as a cuase of CKD
35
What might fragmented RBCs +/- thrombocytopenia on blood film in someone with CKD indicate as the potential cause of CKD?
Haemolytic causes * **HUS** * **TTP** * **Accelerated hypertension**
36
What might an elevated CK indicate as the cause of CKD?
Rhabdomyolysis
37
What are the main aspects of CKD management?
* **Slow disease progression** * **Treat complications** - renal and other * **Consider preparation for RRT**
38
How would you treat someone with CKD to slow disease progression?
* **BP management** * **Tight glycaemic control** * **Exercise** * **Weight loss** * **Smoking cessation** * **Reduce salt intake**
39
What is the general target BP aimed for when trying to control BP in someone with CKD?
\<140/90 mmHg
40
If someone had DM with CKD, what BP would you aim for when trying to control BP as management of CKD?
\<130/80
41
When would you consider using ACEi/ARBs in managing CKD?
* **DM and A:CR ratio \> 3mg/mmol** * **Hypertension and A:CR ratio \> 30mg/mmol** * **Any CKD with A:CR ratio \>70 mg/mmol**
42
What is the risk of use ACEi/ARBs in someone with CKD?
Hyperkalaemia
43
In those with DM and CKD, what is the target HbA1c aimed for?
\<53 mmol/mol
44
What factors contribute to anaemia in CKD?
* **Erythropoeitin deficiency** * **Bone marrow toxins** * **Bone marrow fibrosis 2o to HPTH** * **Haematinic deficiency** * **Increased haemolysis** * **Increased blood loss** - GI, blood sampling, HD * **ACEi use**
45
How would you manage anaemia in someone with CKD?
* **Treat deficiencies** - Iron, B12, folate * **Look for signs of blood loss** * **EPO** - if Hb \< 110 g/l
46
What are complications of CKD?
* **Hyperkalaemia** * **Anaemia** * **Metabolic Acidosis** * **Renal bone mineral disease** * **Pruritis** * **Gout** * **Nephrogenic systemic fibrosis** * **Endocrine abnormalities** * **Severe uraemia** * **Restless legs/cramps** * **Calciphylaxis** * **Pericarditis** * **CVS disease**
47
How would you manage acidosis in someone with CKD?
Consider sodium bicarbonate supplements with eGFR \< 30 and bicarb \< 20 mmol/L
48
How would you manage oedema in someone with CKD?
* **Restrict fluid intake** * **Restrict sodium intake** * **Consider High doses loop + thiazide diuretics**
49
Why does vitamin D synthesis reduce with increasing kidney dysfunction?
Kidney loses its ability to hydroxylate Vit D in the kidney
50
How would you manage CKD related bone-mineral disorders?
* **Dietary phosphate restriction and phosphate binders** * **VIt D supplements**
51
Why do those with CKD develop secondary hyperparathyroidism?
* Decreased renal production of the 1α-hydroxylase enzyme -\> reduced conversion of 25-(OH)2D3 to 1,25-(OH)2D3. * Reduced activation of vitamin D receptors (VDR) in the parathyroid glands -\> increased release of PTH * Calcium sensing receptors (CaR), expressed in the parathyroid glands, react rapidly to acute changes in extracellular calcium -\> a low calcium leads to increased release of PTH.
52
What dietary advice would you want to give someone with CKD?
* Potassium restriction if hyperkalaemic * Phosphate restriction if hyperphosphataemic
53
How would you manage cardiovascular risk in someone with CKD?
* **Antiplatelets** * **Atorvastatin** * **Consider ACEi in hypertension** * **Lifestyle advice** - smoking, diet, alcohol, exercise
54
What drugs are particularly important to check before prescribing in CKD?
* **Aminoglycosides** * **Penicillins** * **Cephalosporins** * **Heparin** * **Lithium** * **Opiates** * **Digoxin**
55
What mnemonic could you use to remember the features of CKD?
RESIN + 8 P's * **R**etinopathy * **E**xcoriations (scratch marks) * **S**kin is yellow * **I**ncreased blood pressure * **N**ails are brown * **P**allor * **P**urpura and bruises * **P**ericarditis and cardiomegaly * **P**leural effusions * **P**ulmonary oedema * **P**eripheral oedema * **P**roximal myopathy * **P**eripheral neuropathy

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