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Renal Medicine, Urology, Haematology > Clinical Topic 2: Chronic Kidney Disease > Flashcards

Clinical Topic 2: Chronic Kidney Disease Flashcards

(45 cards)

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1
Q

What is the most likely cause of death of CKD patients on Haemodialysis?

A

Ischaemic Heart Disease

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2
Q

Define chronic kidney disease

A
  1. Sustained reduction in GFR and/or urinary abnormalities
    OR
  2. eGFR consistently below 60ml/min/1.73m2 OR ACR above 3mg/mmol for 3 MONTHS
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3
Q

What is the appearance of kidneys in Chronic Kidney Disease?

A

Bilateral shrunken kidneys

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4
Q

What is the appreance of kidneys in diabetic nephropathy on USS?

A

Bilateral enlarged / normal kidneys

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5
Q

What is Stage 1, 2, 3a, 3b, 4, 5 Chronic Kidney Disease?

A 
Stage 1: >90
Stage 2: 60 - 89
Stage 3a: 45 - 59
Stage 3b: 30 - 44
Stage 4: 15 - 29
Stage 5: < 15
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6
Q

What factors may inappropriately skew eGFR estimation?

A
  • Pregnancy
  • Increased muscle mass
  • Red meat consumption 12 hours before sample
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7
Q

What are the four histological features of Diabetic-related Chronic Kidney Disease?

A
  • Mesangial expansion
  • Basement membrane thickening
  • Glomerular schlerosis
  • Podocyte damage
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8
Q

How does Chronic Kidney Disease affect Na+ / H2O balance?

A

↓ in GFR leads to an increase in Na+ / H2O retention, causing ↑ in BP, and ↑ Peripheral Oedema

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9
Q

How does Chronic Kidney Disease affect K+ balance?

A

↓ in GFR leads to an increase in K+ retention, causing hyperkalaemia. Hyperkalaemia can cause muscle weakness → ECG changes, i.e. Tall tented T-waves

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10
Q

How does Chronic Kidney Disease affect acid-base balance?

A

Diminished capacity to excrete H+ to generate bicarbonate, hence metabolic acidosis

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11
Q

How does Chronic Kidney Disease affect Calcium levels and bone health?

A

Hypocalcaemia and osteoporosis

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12
Q

How does Chronic Kidney Disease cause anaemia? What kind of anaemia is it?

A

Normocytic, normochromic anaemia

Decreased EPO production (main cause)

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13
Q

How can you manage hypocalaemia and deteriorating bone health in patients with Chronic Kidney Disease?

A

Activated Vitamin D
Phosphate binders - calcium carbonate
Calcimimetic - cincalcalet
Monitor PTH/calcium 3 monthly and titrate dose accordingly
Consider parathyroidectomy

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14
Q

How can you manage anaemia in patients with Chronic Kidney Disease?

A

Oral/IV iron
EPO stimulating agents - Roxadustat/Evrenzo

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15
Q

What is the most common electrolyte abnormality in patients with Chronic Kidney Disease?

A

Hypocalcaemia

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16
Q

What are the effects of advanced uraemia in patients with CKD?

A
  • Uraemia induced platelet dysfunction (bruising, bleeding)
  • Uraemic pericarditis (chest pain, friction rub)
  • Uraemic neuropathy (distal sensorimotor polyneuropathy)
  • Uraemic encephalopathy (headache, confusion, coma, seizures)
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17
Q

What are the four indications for renal replacement therapy?

A
  • Symptoms of uraemia
  • Fluid overload
  • Resistant hyperkalaemia
  • eGFR < 10
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18
Q

Due to the theoretical risk of BBV within haemodialysis units, what serology testing is performed and when? What must they also be vaccinated against?

A

Hepatitis B, C and HIV serology every 6-12 months

Must be vaccinated against Hepatitis B

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19
Q

What are the three main forms of Renal replacement therapy for CKD patients?

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A

Haemodialysis
Peritoneal dialysis
Renal transplantation

20
Q

What are some of the complications of Haemodialysis?

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A

Loss of venous access

Bacteraemia from line contamination

21
Q

How is access obtained in Haemodialysis?

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A

Arteriovenous fistula
Arteriovenous graft
Central catheter

22
Q

What are some of the complications of Peritoneal Dialysis?

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A

Bacterial peritonitis
Peritoneal sclerosis
Weight gain

Hyperglycaemia (dialysis fluid has high glucose intake)

23
Q

What are some organisms which commonly cause bacterial peritonitis in Peritoneal Dialysis?

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A 
Staphylococcus epidermis (most common)
Staph aureus
24
Q

What is the normal range for anion gap?

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A

10 - 18 mmol/L

25
What speeds up the progression of chronic kidney disease?
Diabetes Hypertension Polycystic kidney disease Drugs - NSAIDs, lithium Glomerulonephritis
26
What is eGFR calculated based off of?
Serum creatinine Age Gender
27
How does Chronic Kidney Disease cause bone disease?
Less calcitrol production -> increased bone resorption to increase serum calcium
28
When to refer patients with CKD to a renal specialist?
When eGFR consistently below 30
29
Two most common causes of CKD in adults
Hypertension (26%) Diabetes (44%)
30
Patients with diabetic nephropathy will usually have...?
Other diabetic complications
31
Management of CKD?
Slow progression by... 1) treat underlying cause of CKD 2) Optimise BP 3) Reduce proteinuria with Acei/ARB and SGLT2 inhibitors 4) Address risk factors for CVD 5) Treat CKD complications 6) Dietary advice
32
What is classed as significant proteinuria that should be treated urgently?
> 70 mg/mmol
33
What is the Kidney Failure Risk Equation Tool (KFRE) used for?
Calculate risk of renal replacement therapy in next 2-5 years with CKD stage 3a-5
34
How to acutely control hypertension in hospital?
5mg amlodopine
35
When should iron deficiency be treated even if the ferritin is normal?
When transferrin saturation < 20
36
Clinical findings of renal bone disease?
Hyperphosphataemia Low vitamin D Hypocalcaemia Osteomalacia Rugger jersey spine on x ray
37
Indications for short term dialysis?
Hyperkalaemia refractory to medical treatment Fluid overload refractory to diuretics +/- oligo/anuria Symptomatic uraemia Severe acidosis Toxins
38
Indication for long term dialysis?
Stage 5 CKD
39
Patients with any indication for dialysis should be...?
Referred to renal team urgently
40
What is STEAL syndrome?
Complication of AV fistula AV fistula steals blood from limb distal to it and goes to AV fistula instead Leads to ischaemia
41
What is high output heart failure in the context of AV fistula?
Complication of AV fistula When high pressure arterial blood flows into venous system causing increased pre-load onto heart Leading to cardiac hypertrophy
42
How is access to peritoneal dialysis obtained?
Tenchkoff catheter - tube inserted into peritoneal cavity
43
Advantages of peritoneal dialysis over haemodialysis? Disadvantages?
- Better tolerated by patient - Less expensive - More flexible (can run at night) Disadvantages are it has higher risk of abdominal infection
44
Complications of haemodialysis?
STEAL syndrome High output heart failure Infection Aneurysm Thrombosis Stenosis Internal bleeding (due to anticoagulated blood)
45
Define the A stages of CKD
A1= under 3mg/mmol A2= 3-30 A3= above 30

Renal Medicine, Urology, Haematology (10 decks)

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