CKD, Hypertension And Hyperlipidaemia + HF Flashcards
(74 cards)
What is CKD ?
The progressive loss of nephrons resulting in permanent compromise of renal function.
What are the classifications of CKD ?
Stage 1 - normal GFR with other evidence of kidney damage
Stage 2 - mild impairment 60-89 GFR
Stage 3 - moderate impairment 30-59 GFR
Stage 4 - severe impairment 15 - 29 GFR
Stage 5 - east allied renal failure less than 15 GFR
Other than GFR what are some other ways in which kidney damage can be shown ?
Persistent microalbuminuria
Persistent Proteinuria
Persistent haematuria
Abnormalities seen on USS
Biopsy showing glomerulonephritis
What are some causes of CKD ?
Glomerulonephritis
Multisystem - DM or Alport’s
Pyelonephritis
HTN
Polycystic kidney disease
Idiopathic
What is common in the PMH if someone has CKD ?
Recurrent UTI’s
HTN
( May have had pre-eclampsia )
What medications should be asked about if someone is suspected to have CKD ?
Analgesics
Anti-rheumatic meds
Antibiotics - gentamycin, aminoglycosides and cephalosporins
What conditions are important to ask about in the family history when someone is suspected of having CKD ?
Adult polycystic kidney disease
Alports disease
What are some clinical features of CKD ?
Nausea and vomiting
Diarrhoea
Uraemic pericarditis
HTN
HF
Confusion
Seizures
Anaemia
Itchy skin
What conditions should be screened for CKD ?
DM
HTN
CVD
Renal tract disease or calculi
What investigations should be performed when suspecting CKD ?
FBC
ESR
U&E
EGFR
Bone profile
MSU
Creatinine clearance
USS
Renal biopsy
Albumin : creatinine ratio
What is the management of CKD in primary care ?
Regular measurements of kidney function using serum creatinine
Advice on smoking cessation
Weight loss advice
Encourage regular aerobic activity
Limit alcohol
Oral anti platelets and anticoagulants
What are some complications of CKD ?
HTN
Anaemia
Renal osteodystrophy
Atherosclerosis
Renal cysts
What is heart failure ?
A clinical syndrome with typical symptoms and signs caused by a structural and/or functional abnormality that produces raised intracardiac pressure and inadequate Canadian output at rest and/or exercising.
What is the NYHA score for HF ?
A functional classification of HF based on severity of symptoms and limitation of physical activity.
What are some causes of HF ?
Coronary artery disease
Hypertension
Valvular disease
Congenital heart disease
Arrhythmias
Volume overload
What are some complications of HF ?
AF
Ventricular arrhythmias
Cachexia
Anaemia
Depression
CKD
AKI
Sudden cardiac death
What signs can be examined for in patients with suspected HF ?
Tachycardia
Displaced heart beat or murmurs
Raised JVP
Obesity
Peripheral oedema
What investigations should be performed when suspecting HF ?
Measure NT-pro-BNP ( if less than 400 HF less likely )
Arrange a 12 lead ECG
CXR
Blood tests - U&E, eGFR, FBC, iron levels, TFT and LFT
Urine dipstick
What increases levels of BNP ?
Age over 70
Left ventricular hypertrophy
MI
Right ventricular overload
Hypoxia
CKD
Sepsis
COPD
DM
Liver cirrhosis
What conditions cause breathlessness over than HF ?
COPD
Asthma
PE
Lung cancer
Anxiety
What conditions cause peripheral oedema over than HF ?
Nephrotic syndrome
Drugs such as amlodipine
Hypoalbuminaemia
What is the management for HF ?
Loop diuretic if volume overload is present - titrate dose to relieve symptoms
Prescribe an ACEi and beta blocker
Aldosterone antagonist and SGLT2i
Consider Antiplatelet drug and statin therapy
Reduce risk factors
What information and advice should be given to someone with HF ?
Reduce salt consumption
Restrict fluid intake
Smoking cessation
Reduce alcohol consumption
Regular low intensity physical activity
When should a HF patient be referred ?
Severe HF
HF that doesn’t respond to treatment
Ejection fraction lower than 35%
Pro- BNP higher than 2000
Other co-morbidities - CKD or COPD
