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â–º Med Misc 43 > NEPH - Chronic kidney disease > Flashcards

Flashcards in NEPH - Chronic kidney disease Deck (18):
1

(4) normal kidney functions

- Excretion of solutes and waste products
- Acid/base homeostasis
- Na/Water balance
- Endocrine functions (EPO, Vit D-OH)

2

(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)

3

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)

4

(6) Risk factors for chronic kidney disease

•Older age (age >55)
•Hypertension
•Diabetes
•Smoker
•Obese
•First degree family relative with CKD

5

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

6

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

7

Causes of haematuria

- Glomerular pathology
- malignancy
- ureteric stones
- other more ‘Benign’ causes: menstrual periods or UTI

Can be Macroscopic vs. microscopic

8

What can help identify if haematuria is glomerular in origin?

Urine microscopy -> red cell cast (implies a glomerular lesion)

9

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

10

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%

11

What are the 2 most important modifiable risk factors for reducing progression of CKD?

Hypertension, Proteinuria

12

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

13

What are (5) metabolic Cx of CKD?

–Anaemia
–Metabolic acidosis
–Calcium/phosphate/PTH management
–Dyslipidemia
–Nutrition

14

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

15

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)

16

Signs & symptoms of CKD 4-5
- general
- CV
- GI
- Skin
- Neuro
- Ophthal

- general: lethargy, malaise, fluid overload, nocturia
- CV: HTN, HF, pericarditis, IHD
- GI: anorexia, N&V, dysgeusia, metallic taste in mouth
- Skin: pruritus
- Neuro: peripheral neruopathy, seizures, restless legs
- Ophthal: changes of HT may be present

17

Discuss control of diabetes in CKD
- target
- risk reduction
- Mx

Targets:
•Pre-prandial BSL 4.4-6.7 mmol/L
•HbA1c less than 7.0%

Intensive blood glucose control significantly reduces the risk of developing microalbuminuria, macroalbuminuria and/or overt nephropathy in people with Type 1 and Type 2 diabetes

Management
– Lifestyle modification
– Oral hypoglycaemic agents
– Insulin

18

(3) indications for dialysis

- Hyperkalaemia on ECG changes
- Signs of fluid overload
- Signs of uraemia

Acidosis can be fixed with bicarbonate (not that urgent)

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