RENAL 2/3 Flashcards
(49 cards)
Is chronic kidney disease progressive or long- term?
slowly, progressive irreversible loss of renal function over a period of years
what are the initial manifestations of chronic renal disease?
biochemical abnormalities>Loss of excretory , metabolic and endocrine functions of the kidney
what is another word for renal failure?
(Uremia)/ CKD
what are the two ways in which chronic kidney disease can be characterised?
Kidney damage: indicated by persistentproteinuria, haematuria or anatomical abnormality
•Decreased kidney function: indicated by a glomerular filtration rate (GFR) of less than60ml/min/ 1.73m2which persists for more than3 months
how many stages of chronic kidney disease are there?
5 stages 1-5, 5 being the worst
how often should you measure your GFR?
1&2- 12 monthly
3a&3b - 6 monthly
4-3 monthly
5- 6 weekly
what is more sensitive ACR or PCR?
ACR- ACR is more sensitive than PCR and is recommended choice forpatients with diabetes.
what are the units of ACR and PCR?
Units of ACR & PCR – mg (of protein) per mmol (of creatinine).
when does a sample of ACR need to be rechecked?
Early morning sample is taken and ACR value of between 3 and70mg/mmol warrants a subsequent morning sample for confirmed diagnosis.
which figure will be greater -ACR or PCR?
PCR value will always be greater than ACR as there are proteins other than albumin in urine.
what is one of the main causes of chronic renal failure?
Diabetes mellitus
what can early treatment of CKD help?
Early treatment of CKD and its complications can delay or prevent progression to ESRD
•Annual SrCr checks recommended forestimation of GFR, urine dipstick for patients known to have a high risk of developing CKD.
what treatment do you give for CKD?
- Inulin – excreted unchanged in the urine,•provides accurate GFR assessment.•Expensive, time consuming
- Serum creatinine (SrCr)•Simple to measure, Inexpensive•Routinely used to assess renal function•Not always accurate and can beinfluenced by many factors.
What method do you use for the estimation of creatine clearance?
Cockcroft and Gault formula
Estimating renal function or calculating drug doses inpatients with renal impairment who are elderly or at extremes of muscle mass
what is the constant ceratine for males and females?
Constant = 1.23 for men; 1.04 for women
what do you need to make dose adjustments for in creatine clearance?
- Direct-acting oral anticoagulants (DOACs)•Patients taking nephrotoxic drugs (examples include vancomycin andamphotericin B)
- Elderly patients (aged 75 years and older)•Patients at extremes of muscle mass (BMI <18 kg/m2 or >40 kg/m2)
- Patients taking medicines that are largely renally excreted and have anarrow therapeutic index, such as digoxin and sotalol
how would you investigate CKD?
•Identify the underlying disease
–History
–Examination–Test of:
•Biochemistry•Immunology•Radiology•Biopsy
what are the reversible factors you look for in the nvestigation and management of CKD?
- Hypertension
- Reduced renal perfusion–
- Urinary tract obstruction
- Urinary tract infection
- Other infections : Increased catabolism or ureaproduction
- Nephrotoxic medications
what is the aim of management of CKD?
Attempt to prevent further renal damage
•Attempt to limit adverse effects of loss ofrenal function
•Institute renal replacement
what are the early stages of CKD like?
asymptomatic-As kidney function worsens patients will accumulate uraemic toxins and develop symptoms such as- nausea/vom
what happens in CKD stages 4/5?
Hyperkalaemia
–Uraemia
–Anaemia
–Impaired Vitamin D metabolism leading tohyperparathyroidism which in turn affects boneturnover
what are the 3 key interventions?
- Glycaemic control (for diabetics)
- Blood pressure control
- Reducing proteinuria
what will progression of CKD depends on?
depends on the cause
is Hyperglycaemia an independent risk factor for nephropathy?
yes
