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Renal Week 2 2017/18 > 3: Chronic kidney disease > Flashcards

3: Chronic kidney disease Flashcards

1
Q

What is chronic kidney disease?

A

Abnormal kidney function AND/OR structure

U&Es may be normal

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2
Q

CKD significantly increases your chances of ___ to other diseases.

A

mortality

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3
Q

CKD is closely linked to which two other diseases?

A

Cardiovascular disease

Diabetes

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4
Q

Your risk of developing CKD (increases / decreases) with age.

A

increases with age

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5
Q

What is the difference between acute kidney injury and chronic kidney disease?

A

AKI has an onset of less than 48h

Prolonged - two samples indicating abnormal kidney function, 90 days apart

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6
Q

How long does kidney function need to be abnormal for a patient to be given a diagnosis of chronic kidney disease?

A

90 days

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7
Q

What is the difference between GFR and eGFR?

A

eGFR is modified based on creatinine, age, sex and race

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8
Q

How is CKD staged?

A

Stages G1 to G5 (including G3a and G3b)

Learn the egfr thresholds and descriptions

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9
Q

An eGFR of > ___ is normal.

A

> 90

average is 125

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10
Q

An eGFR of < ___ is abnormal.

A

< 90

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11
Q

How is proteinuria actually measured?

A

Albumin/creatinine ratio

ACR measured alongside eGFR to quantify degree of kidney disease

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12
Q

How is ACR classified?

A

A1 to A3

>300 is nephrotic

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13
Q

What two values are used to classify CKD?

A

eGFR

ACR

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14
Q

Is eGFR used for AKI?

A

Only used for CKD

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15
Q

What is measured to quantify the degree of an AKI?

A

Creatinine only

eGFR not useful

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16
Q

People who have had an AKI need to be monitored for several years afterwards.

How?

Why?

A

eGFR

AKI massively increases CKD risk (loss of nephrons, remaining nephrons have to work really hard and burn out quicker)

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17
Q

Why is eGFRcystatinC more accurate than eGFR?

A

eGFR value is modified by creatinine levels

Creatinine is cleared by kidneys AND bowels

So technically eGFR can OVERESTIMATE kidney function

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18
Q

People with which particular diseases should have their CKD and ACR checked?

A

AKI

CKD

Cardiovascular disease

Diabetes

loads but existing renal disease, cvd and diabetes are the main ones

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19
Q

How can you tell if haematuria has come from the kidneys or bladder?

A

Microscopy

Kidneys - red cells will be dysmorphic from being squeezed through tract

Bladder - red cells will be intact

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20
Q

What is the definition of accelerated CKD progression?

A

eGFR decrease in 25% within a year

OR

Consistent decrease by 15 units per year

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21
Q

What is the difference between ACR and PCR?

A

ACR picks up kidney damage due to extra-renal stuff e.g hypertension diabetes

PCR also factors in tubular damage and stuff

?!?!?!?!

22
Q

Which common drugs are nephrotoxic?

A

NSAIDs

23
Q

Elderly patients with advanced CKD and extensive co-morbidities (will / won’t) benefit from treatment.

A

probably won’t

24
Q

criteria for CKD referral for treatment

gfr < 30

ACR > 70 (>30 with haematuria)

resistant hypertension

genetic stuff

renal artery stenosis

A
25
Q

What are the blood pressure targets in CKD?

A

140 / 90 if no proteinuria

130 / 80 if protein/haematuria

26
Q

Anti-hypertensives like ACE inhibitors are nephrotoxic, but also reduce glomerular BP.

When should they be withdrawn?

A

Significant enough decrease in eGFR / ACR

check slides

27
Q

What prevention drug should be offered to all patients with CKD?

A

Statin

look up side effects of these

28
Q

2/3rds of CKD are caused by which diseases?

A

Diabetes

Hypertension (i.e CVD)

29
Q

What are some vascular causes of CKD?

A

Renal artery stenosis (for a variety of reasons, fools kidney into thinking systemic BP is low, so produces renin, but no effect, vicious cycle, systemic hypertension damages OTHER kidney)

Small-vessel ​vasculitis

(like GWP, EGWP and microscopic polyangiitis)

30
Q

What are some glomerular / tubular causes of CKD?

A

Glomerulonephritis

Tubulonephritis

v complicated so come back to this

31
Q

What are some urological signs of CKD?

A

Renal calculi

32
Q

clinical signs of ckd

produced by anaemia (haematuria plus kidneys can’t produce erythropoietin)

weight loss (nutrients filtered)

and uraemia (build up of urea in the blood) - loads of these

kussmaul breathing (caused by metabolic acidosis)

A
33
Q

Symptoms of CKD are produced by what blood abnormalities?

A

Uraemia

Anaemia

Metabolic acidosis

34
Q

People with CKD tend to be in ___ for a lot of different reasons.

A

pain

35
Q

How is end-stage CKD treated?

A

Haemodialysis

Peritoneal dialysis (try and figure out how these work)

Kidney transplant (put BACK in the iliac fossa, not retroperitoneal) - either deceased* donors or live donors

Conservatively - 20% of patients treated symptomatically, palliatively

36
Q

People with CKD are at greatly increased risk of ___ disease.

A

cardiovascular

37
Q

What eGFR level and urinary sign predicts greatly increased CVD risk in people with CKD?

A

< 50

Microalbuminuria

38
Q

What process drives the cardiovascular complications of CKD?

A

Atherosclerosis

39
Q

People on dialysis are at hugely increased risk of CVD - why?

A

Because they have end-stage CKD

40
Q

What are modifiable risk factors for cardiovascular disease?

A

Smoking

Alcohol

Weight

Exercise

Diet (particularly salt)

41
Q

What should be prescribed to reduce CVD risk in people with CKD?

A

Antihypertensives if needed

Statin

42
Q

Why are people with CKD at risk of pathological fracture?

A

Affects bone composition, causing

pain

fracture

CVD……

43
Q

What endocrine disease can be caused by disordered calcium metabolism in CKD?

A

Hyperparathyroidism

either secondary - physiological due to hypocalaemia (it’s all being filtered)

or tertiary - prolonged secondary, glands don’t respond anymore

44
Q

What nutrient should be restricted to prevent bone disease in people with CKD?

A

Phosphate

hyperphosphataemia common in people with CKD

45
Q

What dietary supplement should be given to people with CKD?

A

Vitamin D supplements

46
Q

What distinct spinal appearance can be seen on X-ray in people with CKD?

What causes it?

A

Rugger-jersey spine - sclerosis and lucency of consecutive vertebrae

Caused by hyperparathyroidism - minerals stripped from bone

47
Q

What blood disorder can CKD cause?

A

Anaemia

48
Q

How is anaemia secondary to CKD treated?

A

Check VitB12 and folic acid

Iron supplements

49
Q

amputations due to peripheral vascular disease

calcium/po3/pth –> calciphylaxis, skin death, can’t be grafted because dermis wiped out

sclerosis of peritoneum

A
50
Q

when i say cvd i mean cardiovascular disease

not cerebrovascular disease

A

Renal Week 2 2017/18 (11 decks)

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