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CKD Flashcards

1
Q

what is chronic kidney disease

A

abnormal kidney function and/ or structure

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2
Q

what does CKD often co exist with

A

other conditions inc diabetes and CV disease

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3
Q

risk of what is increased in moderate to severe CKD

A

acute kidney injury, falls, fragility and mortality

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4
Q

how does age affect risk of getting CKD

A

increases with age

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5
Q

what is the aim of treatment in CKD

A

prevent or delay progression
reduce/ prevent complications
reduce risk of CV disease

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6
Q

what is eGFR based upon

A

serum creatinine, age, sex, race

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7
Q

what does a spiked creatinine suggest

A

acute kidney injury

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8
Q

how do you diagnose CKS

A

minimum of two samples at least 90 days apart

eGFR, eGFRcreatinine and ACR

can use eGFRcreatinineC

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9
Q

what is G1 stage of CKD

A

e GFR 90 (normal function but urine findings/ structural abnormalities/ genetic trait point to kidney disease

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10
Q

what is G2 stage of CKD

A

eGFR 60-89

midly reduced renal function

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11
Q

what are G3a and b stages of CKD

A

G3a 45-59
G3b 30-44

Moderately reduced kidney function- risk of endocrine and cardiovascular increases problems

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12
Q

what is G4 stage of CKD

A

eGFR 15-29

severely reduced kidney function

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13
Q

what is G5 stage of CKD

A

eGFR <15

established renal failure

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14
Q

what does albumin in urine suggest

A

glomerular damage

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15
Q

what is ACR

A

albumin creatinine ratio
A1 <3
A2 3-30
A3 >30

shows level of albumin in urine, A1 normal

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16
Q

does having and acute kidney injury increase your risk of getting CKD

A

yes have to monitor every 2-3 years

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17
Q

who should you offer CKD testing to

A

people with:diabetes
hypertension
Acute kidney injury
cardiovascular disease (ischaemic heart disease, chronic heart failure, peripheral vascular disease or cerebral vascular disease)
structural renal tract disease, recurrent renal calculi or prostatic hypertrophy
multisystem diseases with potential kidney involvement – for example, systemic lupus erythematosus
family history of end-stage kidney disease (GFR category G5) or hereditary kidney disease
opportunistic detection of haematuria

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18
Q

who DOESNT have CKD

A

an eGFRcreatinine of 45–59 ml/min/1.73m2 and
an eGFRcystatinC of more than 60 ml/min/1.73m2 and
no other marker of kidney disease

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19
Q

what is accelerated progression of CKD

A

a sustained decrease in GFR of 25% or more and a change in GFR category within 12 months

or

a sustained decrease in GFR of 15 ml/min/1.73m2 per year.

20
Q

what are the risk factor with CKD progression

A

Cardiovascular disease
Proteinuria
Acute kidney injury
Hypertension
Diabetes
Smoking- accelerated risk of atherosclerosis
African, African-Caribbean or Asian family origin
Chronic use of NSAIDs
Untreated urinary outflow tract obstruction

21
Q

who with CKD should get referred

A

GFR less than 30 ml/min/1.73m2 (GFR category G4 or G5)
ACR 70 mg/mmol or more, unless known to be caused by diabetes and already appropriately treated
ACR 30 mg/mmol or more (ACR category A3), together with haematuria
accelerated progression
poorly controlled hypertension despite using 4 drugs
genetic causes of CKD
suspected renal artery stenosis

22
Q

what are the BP targets in CKD

A

below 140/90

if also have diabetes/ ACR >70 below 130/80

23
Q

what drugs reduce eGFR

A

ACEi/ ARBs (RAAS inhibition)
reduce glomerular flow
don’t be alarmed and reduce dose when glomerular function decreases

24
Q

what is the treatment for CKD-BMD

A 
dietary advise- phosphat, salt, potassium and fluid restriction 
alfacacidol (vit D)
phosphate binders (calcium based/aluminium/ non calcium based)
calcimimetic
25
why is phosphate an issue in CKD
as kidneys naturally bad at excreting it anyway
26
what causes CKS
``` diabetes hypertension glomerular nephricities vasular- renal artery stenosis, nephosclerosis, micro angiopathic (HUS, pre-eclampsia), GPA, EGPA, MPA post renal obstruction tubuloinstersistal ```
27
what are the types of glomerular nephricities
primary eg Membranous/ IgA/ 1ry FSGS secondary e.g embranous/ DM/ lupus/ FSGS due to HIV/ Heroin/ obesity etc (associated with malignancy) (anything that damages the capillaries of the kidneys)
28
what are the clinical signs of CKD
Anaemia – conjunctival and palmar pallor | weight loss
29
what are the signs of advanced uraemia
``` Lemon yellow skin Uraemic frost (smell on skin) Twitching Encephalopathic flap Confusion Pericardial rub or effusion Kussmaul breathing (metabolic acidosis) ```
30
what are the symptoms of CKD
``` Uraemic: N & V Anorexia Wt loss Fatigue Itch Altered taste Restless legs Muscle twitching Difficulties concentrating Confusion ``` Anaemia: fatigue muscle weakness ``` Pain: bony neuropathic ischaemic visceral ```
31
what are the renal consequences of CKD
Local – pain/stones/ haemorrhage/ infection Urinary – haematuria/ proteinuria/nocturia/oligouria Impaired salt and water handling- odema/ dehydration Hypertension Electrolyte abnormalities- Na/K/Mg/Ca Acid-base disturbance- metabolic acidosis → ESRD
32
what are the extra renal consequences of CKD
Cardiovascular disease (CVD) Mineral & Bone Disease (CKD-MBD) Anaemia Nutrition
33
what are the treatment options for end stage kidney disease
Renal Replacement Therapies (RRT): Haemodialysis (HD) Peritoneal Dialysis (PD) Transplantation or Conservative management
34
what will most patients with CKD die of
a cardiovascular incident
35
what increased CVD risk in CKD
eGFR < 50 mls/min | microalbuminuria
36
what is there greatly increased risk of in CKD
CVD
37
how can you modify CVD risk in CKD
``` Smoking cessation Weight loss Aerobic exercise Limiting salt intake controlling hypertension lipid lowering therapy consider aspirin ```
38
what does mineral and bone disease in CKD affect
increases morbidity and mortality | comprises homeostatic mechanisms
39
what happens in CKD-BMD (bone mineral disease)
``` there are different adaptive changes in; Calcium Phosphate PTH Vit D FGF-23 ```
40
what are the conseqences of CKD-BMD
Secondary/ tertiary HPT (hyperparathryoidism) Vascular calcification Bone pain Fractures CV events Lower quality of life High morbidity and mortality
41
what should be offered to all CKD patients
Atorvastatin 20 mg for the primary or secondary prevention of CVD
42
who is at risk of anaemia with CKD
diabetics
43
what is the target Hb in CKD
100-120 g/L
44
what is the treatment for anaemia in CKD
exclude other causes (B12/folate deficiency, haematological cause) iron therapy- ferbinject, venofer (if oral iron fails refer for IVI iron)
45
what defines renal anaemia
HB < 100-110 g/dl | despite no iron/ haematinic deficiencies
46
how many CKD patients develop ESRD
v small minority

Renal (27 decks)

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