NEPH - Chronic kidney disease Flashcards
(4) normal kidney functions
- Excretion of solutes and waste products
- Acid/base homeostasis
- Na/Water balance
- Endocrine functions (EPO, Vit D-OH)
(4) aspects with kidney disease (think about normal functions not working)
- Accumulation of solutes and waste products
- Accumulation of acids
- Na/water imbalance
- Anaemia AND Ca/PO4/PTH imbalance (called CKD/MBD)
How do you define CKD?
GFR 3 months with or without evidence of kidney damage
OR
Evidence of kidney damage (with or without decreased GFR) for >3 months:
•microalbuminuria
•proteinuria
•glomerular haematuria
•pathological abnormalities (eg. on renal biopsy)
•anatomical abnormalities (eg. cysts on ultrasound)
(6) Risk factors for chronic kidney disease
- Older age (age >55)
- Hypertension
- Diabetes
- Smoker
- Obese
- First degree family relative with CKD
Ix of CKD
Blood:
- FBE
- CMP, PTH, HbA1C
- LFT
- Uric acid
- Fe, B12, folate
Urine
- urinalysis + microscopy
- spot urine for ACR/PCR
- 24h urine collection for protein/creatinine clearance
Imaging: renal tract US
What are the basic underlying principles of management for ALL patients with CKD
- Identify and treat the underlying cause of the kidney disease
- reduce further progression of kidney disease (BP, Lipids, Glucose control)
- reduce cardiovascular risk (BP, lipids, Glucose control)
- early detection and management of metabolic complications (anaemia, Ca/PO4/PTH, acidosis)
- medication adjustment/avoidance of renally excreted and nephrotoxic medications
Causes of haematuria
- Glomerular pathology
- malignancy
- ureteric stones
- other more ‘Benign’ causes: menstrual periods or UTI
Can be Macroscopic vs. microscopic
What can help identify if haematuria is glomerular in origin?
Urine microscopy -> red cell cast (implies a glomerular lesion)
What do you expect to see in IgA nephropathy
- renal biopsy
- immunofluorescence
- renal biopsy: glomeruli with mesangial expansion and mesangial cell proliferation
- immunofluorescence: positive for IgA deposits in the mesangium
Discuss lifestyle modification in CKD
SNAP factors
(Smoking, Nutrition, Alcohol and Physical activity)
- Biggest SBP reduction in weight reduction (>5% weight), healthy diet.
–At least 50% reduction in risk of diabetes
–Cessation of smoking would be expected to reduce the risk of progressive CKD by at least 50%
What are the 2 most important modifiable risk factors for reducing progression of CKD?
Hypertension, Proteinuria
What is the leading cause of death in CKD patients?
Cardiovascular disease
Patients with CKD are 20 times more likely to die from cardiovascular events than survive to reach dialysis
Multifactorial in nature
•LVH can be a risk factor
•Atherosclerosis vs arteriosclerosis
•Patients with CKD have poor prognosis after myocardial infarction
What are (5) metabolic Cx of CKD?
–Anaemia –Metabolic acidosis –Calcium/phosphate/PTH management –Dyslipidemia –Nutrition
How do you Mx metabolic acidosis in CKD?
Sodium bicarbonate
–Maintain serum bicarbonate > 20 mmol/L
–Watch for sodium loading:
Volume expansion, hypertension
Treatment with bicarbonate may also slow down renal progression
How is CKD-MBD (mineral and bone disease) defined? Rx?
Dx by:
• Laboratory investigations
• Bone abnormalities
• Calcification of soft tissues
Rx:
Treat with phosphate binders, control of hyperparathyroidism (1,25 OH Vit D, cinacalcet)
