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Medicine > Renal - CKD > Flashcards

Renal - CKD Flashcards

1
Q

What is CKD?

A

Chronic reduction in kidney function over 3 months

Permanent and progressive

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2
Q

What factors can cause CKD?

A

Diabetes
Hypertension
Medications (NSAIDs or lithium)
Glomerulonephritis
Polycystic kidney disease

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3
Q

How do patients with CKD present?

A

Most are asymptomatic

  • Fatigue
  • Pallor (anaemia)
  • Foamy urine (proteinuria)
  • Pruritis
  • Oedema
  • Peripheral neuropathy
  • Nausea
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4
Q

What investigations are used for CKD?

A

eGFR
Estimated glomerular filtration rate

Based on serum creatinine, age and gender

Proteinuria
Urine albumin: creatinine ratio (ACR)

Haematuria
Urine dipstick or microscopy
Infection, malignancy, glomerulonephritis or kidney stones

Renal ultrasound
Obstructions
Polycystic kidney disease

BP
HbA1c
Lipid profile (hypercholesterolaemia)

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5
Q

What are the different stages of CKD?

A

G Stage
eGFR
1- Over 90
2- 60-89
3a- 45-59
3b- 30-44
4- 15-29
5- Under 15

A Stage
Albumin:creatinine ratio
1- Under 3mg/mmol
2- 3-30mg/mmol
3- Above 30mg/mmol

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6
Q

What is accelerated progression?

A

Sustained decline in eGFR within 1 year

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6
Q

What are the complications of CKD?

A

Anaemia
Renal bone disease
CVD
Peripheral neuropathy
End-stage kidney disease
Type 2 hyperparathyroidism
Dialysis-related complications

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7
Q

What is the kidney failure risk equation used for?

A

5-year risk of kidney failure requiring dialysis

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8
Q

What does NICE recommend for renal referral?

A
  • eGFR less than 30
  • Urine ACR more than 70mg/mmol
  • Accelerated progression
  • 5-year risk over 5%
  • Uncontrolled hypertension despite 4 or more anti-hypertensives
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9
Q

How are underlying causes managed in CKD?

A
  • Optimise diabetic control
  • Optimise hypertension control
  • Reduce or avoid nephrotoxic drugs
  • Treating glomerulonephritis
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10
Q

What is the blood pressure target in patients under 80 with CKD?

A

130/80

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11
Q

What medications help slow CKD progression?

A

ACEi or ARBs
SGLT-2 inhibitors (dapagliflozin)

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12
Q

How can complications of CKD risk be reduced?

A

Exercise
Avoid smoking
Atorvastatin 20mg for primary prevention of CVD - all patients with CKD

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13
Q

How are the following complications managed?
Metabolic acidosis
Anaemia
Renal bone disease

A

Metabolic acidosis
IV NaCl 0.9% first-line
IV Sodium bicarbonate second-line

Anaemia
Iron and EPO

Renal bone disease
Vitamin D
Low phosphate diet
Phosphate binders

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14
Q

How is end-stage renal disease managed?

A

Special dietary advice
Dialysis
Renal transplant

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15
Q

When are ACEi offered?

A

Diabetes + ACR above 3mg/mmol

Hypertension + ACR over 30mg/mmol

All patients with ACR over 70mg/mmol

16
Q

Why does serum potassium need close monitoring in CKD?

A

CKD and ACEi can cause hyperkalaemia

17
Q

When are SGLT-2 inhibitors (Dapagliflozin) offered?

A

Diabetes + urine ACR above 30mg/mmol

Considered for
Diabetes + urine ACR 3-30mg/mmol
Non diabetics with ACR of 22.6mg/mmol

18
Q

Why do patients with CKD get anaemia?

A

Kidneys produce EPO

CKD causes reduced EPO and a drop in RBCs causing normocytic anaemia and normochromic

Treat with EPO agents recombinant human EPO

Iron deficiency is treated first, IV iron given particularly in dialysis patients

19
Q

Why do blood transfusions increase the risk of future transplant rejection?

A

Allosensitisation
Sensitises immune system when blood transfusions are given

20
Q

What is renal bone disease also known as?

A

Chronic kidney disease-mineral and bone disorder
CKD-MBD

21
Q

What does renal bone disease involve?

A

High serum phosphate
Low vitamin D activity
Low serum calcium

Osteoporosis can also exist alongside (treat with bisphosphonates)

22
Q

Why do you get high serum phosphate in renal bone disease?

A

Reduced phosphate excretion by diseased kidneys

23
Q

Why is there low vitamin D activity in renal bone disease?

A

Kidneys metabolise vitamin D into its active form

Diseased kidneys do not produce as much active vitamin D thus reducing vitamin D activity

Vitamin D also has a large role in promoting calcium absorption in the intestines, therefore low serum calcium too

24
Q

Why does CKD cause secondary hyperparathyroidism?

A

Parathyroid glands release more PTH in response to low serum calcium and high serum phosphate

25
Q

Why can renal bone disease lead to osteomalacia?

A

Increased turnover of bones due inadequate calcium supply

26
Q

Why does osteosclerosis occur in renal bone disease?

A

Osteoblasts increase their activity due to decreased mineral density

This creates new tissue in the bone, this new bone is not properly mineralised due to low calcium levels

27
Q

What is a Rugger jersey spine?

A

Characteristic renal bone disease X-ray finding

Sclerosis of both ends of each vertebral body and osteomalacia in the centre

28
Q

How is renal bone disease managed?

A

Low phosphate diet
Phosphate binders
Active vitamin D (calcitriol and alfacalcidol)
Ensuring adequate calcium intake

Medicine (111 decks)

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