Renal Flashcards
(37 cards)
CKD evaluation investigations
- US KUB
- urine ACR
- Fasting lipids
- Fasting glucose
- Urine MCS
- FBC, CRP, ESR
- Repeat EUCs 1 week
Other than CKD, Causes for proteinuria (Other than CKD)
- UTI
- Heavy exercise (transient)
- CCF
- acute febrile illness (transient)
- NSIADS
- menstruation
Causes of proteinuria
- Diabetic nephropathy
- Hypertensive nephropathy /nephrosclerosis
- PKD
- Minimal change disease
- Multiple myeloma
- Nephrotic syndrome (Focal segmental glomerulosclerosis (FSGS) , minimal change disease)
- Amyloidosis
- CCF
- Rhabdo
- UTI
- Exercise
- Menstruation
How to detect proteinuria (albuminuria)
- Urine ACR (First void ACR !!! is best)
- Repeat ACR (always do one) first void to confirm
(dipstick not sensitive enough)
Confirmed if 2/3 positive
CKD if present for 3 months
Special case CKD investigations
When suspecting autoimmune cause: SLE (joint pain,
- ANA
- ENA
- Complement
- Anti- glomerular basement membrane antibody
- Anti- neutrophil cytoplasmic antibody
Risk factors for hepatitis
- HIV, HBC, HCV
> 40 % MM suspected
- Serum protein electrophoresis
Diabetic medication cautions in CKD
SGLT2s
- Dapglifozin: Contraindicated eGFR< 25
Metformin:
- Reduce dose eGFR 30-60
- Contraindicated <30
- Temporarily stop in periods of illness
DPP4s
- No dose adjustment needed for linagliptin (GOOD)
Sulphonylureas
- Dose reduce <30
- increased hypo risk
GLP1s
- Contraindicated <30
Antihyperglycaemic choice 2nd line (following metformin) for CKD
SGLT2 PREFERRED
(dapaglifozin,)
Note: dose reduce if eGFR < 45
Empagliflozin can be used until >25
OR
GLP1
(Liraglutide, dulaglutide, semaglutide)
Microalbuminuria levels
(ACR mg/mmol)
(mg/day)
Male:
2.5 - 25
Female:
3.5 - 35
mg/day= 30-300
Macroalbuminuria
Male: >25
Female: >35
> 300 mg/day
What is a kidney health check & how often
eGFR
ACR
BP
1-2 yrs
(annually for HTN or DM)
Indications for kidney health check
- HTN
- Diabetes
- CVD
- family hx renal failure
- obesity
- smoking
- ASTI >30
Raised ACR what to do?
Repeat ACR
Within 3 months
First void best
Reduced eGFR what to do? (and cut off)
<60 = Repeat within 7 days
NOTE:
Then if stable but reduced: repeat twice in 3 months
If >20% reduction then consider AKI (d/w nephrologist)
Indications for nephrology referral in CKD
- eGFR <30
- ACR >30
- sustained decreased eGFR (25%/yr OR >15 /yr
- HTN on >3 agents
- Albuminuria and haematuria
Haematuria and renal impairment causes
- Glomerularnephritis: IgA or PSGN
- Hypertensive nephropathy
- Analgesic nephropathy (eg paracetemol)
- Malignancy
- MM
- PKD
- Angiomyelolipoma
CKD treatment goals (for KFP)
- BP <130/80
- Annual influenza/pneumococcal (for DM or ESKD)
- etOH <2/d
- salt <6g/day
- HBa1c <7
- PA: 150-300 moderate intensity
- LIPIDS:
statin if >50
or <50 with DM, CVD, Ischaemic stroke, high risk CVD - Ferritin >100
eGFR reduction with ACEi/ARB
<25% within 2 months
If >25% then cease & refer to nephrologist
Special investigations for CKD evaluation (for cause)
Signs of systemic disease (rash, pulmonary symptoms, arthritis)
- ANA, ENA, complement
- Anti- neutrophil cytoplasmic antibody
- Anti- GBM antibody
HIV/HCV/HBV serology
> 40 and concerns for MM: serum and urine protein electrophoresis
SICK DAY medications to avoid
(SADMANS)
S: Sulfonylureas
A: ACEi
D: Diuretics
M: Metformin
A: ARB
N: NSAIDs
S: SGLT2
Cyst number for cut off for PKD
<39 yrs: 3 in total
40-59: 2 in each kidney
> 60: 4 in each kidney
Renal stone prevention advice
- Maintain hydration aiming for clear urine
- Low sodium
- Low oxalate intake
- Low protein
- Limits sugary beverages
- Healthy BMI (weight loss)
Nephritic syndrome features
Haematuria
Protein +
HTN
Low urine volume
Nephritic syndrome associated diseases
PSGN
IgA nephropathy
Rapidly progressive glomerularnephritis
HSP
Nephrotic sydnrome features
Protein+++
Frothy urine
oedema
