CKD Flashcards
(27 cards)
what would you expect to happen to creatinine and eGFR in CKD?
decreased eGFR <60
increased creatinine- need to measure Cr twice 90 days apart to assess baseline
is CKD reversible?
no it is irreversible
Kidney function declines with age naturally, how is CKD different?
the decline in kidney function is accelerated by an active problem
what would you expect the kidneys in CKD to look like on an US scan?
small shiny kidneys
what are the 5 commonest causes of CKD?
- Diabetes
- HTN
- chronic glomerulonephritis,
- reflux nephropathy
- PCKD
what are the functions of the kidney?
A WET BED A- acid base balance W- water homeostasis E- erythropoiesis (EPO from juxtaglomerular apparatus) T- toxin removal B- BP control (through Renin release) E- Electrolyte balance D- Vit D activation (PTH acts on the kidney to activate VitD)
when the kidney fails the above functions become impaired
When the kidneys fail what happens to kidney function ?
kidney function declines.
patients have an increased risk of CVD
outline how you would manage CKD patients? (mild mod and severe)
Mild- manage CV risk, treating risk factors such as BP, fluid and environment
Mod- renal specific effects need to me managed e.g. EPO, bone and CV risk
Severe- this is when there is low clearance and eGFR is very low- discussions need to be had about treatment and outcomes- prognosis poor) they may be in ESRD requiring dialysis and or transplant
what are the 2 types of transplant donors?
live or deceased
what are the 2 types of dialysis?
Haemodialysis and peritoneal dialysis
True or false: with CKD there is an increased risk of CVD equivalent to the risk of having had a previous MI
True
what happens to acid base balance in CKD?
decreased renal H+ excretion results in a metabolic acidosis (reduced pH, low HCO3, base deficit, possibly some respiratory compensation)
what happens to the water homeostasis in CKD?
urine output is usually preserved until late
Nocturia- due to loss of phyisiological nocturnal anti-diuresis
Polyuria and thirst- occurs mainly due to loss of urine concentrating ability
HTN mainly due to volume expansion
patients cam become oliguric (<0.5ml/kg/hr)in acute on chronic disease
what happens when the kidneys fail to regulate fluid and electrolyte balance?
hyperkalaemia and hyperphosphataemia
what happens when the kidneys fail to excrete metabolic waste products?
results in uraemia syndrome
usually occurs late when eGFR <15ml/min
clinical features: N, anorexia, lethargy, itch, restless legs
very late features: pericarditis, neuropathy
why does HTN occur in CKD?
due to volume expansion
what happens when the kidney fails to produce EPO?
results in a normochromic anaemia of renal failure
what happens when the kidney fails to hydroxylate (activate) vit D?
deficiency in activated Vit D results in hypocalcaemia, osteomalacia, secondary hyperparathyroidism
combined picture of renal osteodystrophy when calcium is resorbed from bone.
In the management of CKD how would you manage the failure to excrete waste products and among acid base balance?
RRT
dialysis (haemodyalysis or peritoneal dialysis)
renal transplantation
In the management of CKD how would you manage the failure to regulate fluid and electrolyte balance?
fluid restrict
restrict dietary potassium, phosphate
give phosphate binders such as calcichew
treat hyperkalaemia
In the management of CKD how would you manage the failure to synthesis erythropoeitin?
give recombinant EPO ingestion 1-3x/week
In the management of CKD how would you manage the failure to activate vitamin D?
give activated Vit D e.g. calcitriol
aim to normalise serum calcium and suppress parathyroid hormone levels tp 2-3x normal
how would you manage the CV risk in CKD patients?
manage HTN aiming for BP<140/90 (or <130/80 if DM) use ACEi
statins (irrespective of lipids)
low dose aspirin
what is sevelamer?
Sevelamer is a non-calcium based phosphate binder that treats hyperphosphataemia in patients with CKD mineral bone disease
It is licensed for the treatment of hyperphosphataemia in patients on haemodialysis or peritoneal dialysis.
