Karteikarten
Renal
Karten in diesem Stapel (43)
- 1define chronic kidney disease- CKD- abnormal kidney structure or function
present for >3 months - 2name a marker of kidney damage- albuminuria
- 3name three ways to classify CKD- based on:
1. GFR
2. albuminuria
3. underlying disease - 4table of CKD classification based on GFFR
- 5table of CKD classification based on albuminuria
- 6what are the most common causes of CKD?- diabetes (24%)
- glomerulonephritis (13%)
HTN - 7how might albuminuria and GFR classification be used to predict adverse outcomes in CKD?- composite score made from both
the higher the category of albuminuria CKD and higher category the GFR CKD the higher the risk of adverse outcomes - 8table of above
- 9low GFR and high albuminuria are associated with?- all-cause mortality
- cardiovascular mortality
- progressive KD/K failure
- AKI - 10patients are more likely to die of what in the case of CKD?- cardiovascular disease
more so than the need to renal replacement therapy - 11what features of a history for CKD should you investigate to find out if the patient really has CKD?- if the eGFR reflects the true GFR
- is the eGFR corrected for ethnicity or drugs (trimethoprim can alter the creatinine concentration- not GFR- therefore eGFR will be altered)
- is it chronic - more than 3 months - 12what parts of the history are necessary to ask about in the case of suspected CKD?- presence of UTI in past/present
- lower urinary tract symptoms
- PMH of increased blood pressure etc/diabetes
- FHx of renal disease
- ask about Fhx of systemic disorders/ symptoms associated with this- eyes, skin, joints etc - 13what symptoms might a patient with CKD complain of?- symptomatic if GFR <30
- breathlessness
- peripheral oedema
- anorexia
- nausea and vomitting
- pruritus
-impotence - 14what peripheral signs might you pick up in a patient with CKD on examination?- peripheral oedema
- gouty tophii/ joint disease (CTD)
- arteriovenous fistula (thrill, bruit)
- bruising from steroids
- skin malignancy - 15what facial signs might you pick up in a patient with CKD on examination?- anaemia - remember our pt
- xanthelesma
- uraemia (yellow tinge)
- cushingoids - (steroids) - 16what might you find on examination of a. patient with CKD's neck- raised JVP
- 17name other signs on examination in CKD- raised BP, cardiomegaly
- pulmonary oedema\ - 18list blood test results that you might find in CKD- U+E = eGFR low, creatinine high
- Hb - normocytic, nor chromic anaemia
- decreased calcium - reduced vit D (1 alpha hydroxylase)
- increased PTH as a result of low calcium
- might have autoantibodies - 19when should yo consider renal biopsy- in progressive disease
- 20how often should kidney function be monitored in CKD?- at least annually
- if high risk- 6 months
if very high risk at least every 3 months - 21a list of principles for the management of CKD1 Appropriate referral to nephrology.
2 Treatment to slow renal disease progression.
3 Treatment of renal complications of CKD.
4 Treatment of other complications of CKD.
5 Preparation for renal replacement therapy (dialysis/transplantation) (p306). - 22give two indications for renal referral for CKD- stage G4/5 CKD
- declining eGFR - 23what is the target BP in patients with CKD how about in CKD in patients with DM?1. SYSTOLIC <140mmhg
diastolic <90mmHg
2. systolic <130mmHg
diastolic <80mmHg - 24when should you consider giving RAAS antagonists such as ARB's/AE-i?-DM AND A:CR >3
- hypertension and ACR>30
- any CKD with ACR >70 mmhg - 25why should you not give RAAS antagonists together?- risk of hyperkalamia and hypotension
- 26what HbA1c should be aimed for in CKD?- 53
- 27what lifestyle advice should be given to patients with CKD?exercise
- healthy weight
- smoking cessation
SALT INTAKE MINIMISED - 28how do you manage anaemia caused by CKD?- iron therapy- either oral or IV
- watch others such as B12/folate
- consider EPO/ESA- can cause red cell aplasia rarely - 29how do we manage acidosis in patients with CKD?- consider sodium bicarbonate supplements
- sodium component may be a problem for HTN so monitor - 30how do we manage oedema that results from CKD?- restrict fluid and sodium intake
- high doses of loop diuretic - furosemide
can also give a thiazide - 31which parameters need monitoring in CKD with regards to bone mineral density?-calcium- will be hypo
- vit d
- phosphate- will be higher
- PTH- high - 32what treatments are indicated in bone mineral disorders secondary to CKD?- phosphate binders if phosphate high
- vitamin D (cholecalciferol) if deficient
- persistence of high PTH- use Vit D analogue
- 1 alpha calcidol for example - 33leg pain in CKD is common- how might you manage this?- gabapentin/pregabalin
- 34name ways of minimising the cardiovascular risk associated with CKD- antiplatelets- low dose aspirin
-atorvastatin
- HF- treat as usual
- REMEMBER THAT A GFR <60 MIGHT INCREASE BNP/TROPONIN LEVELS - 35when should you start preparing a patient with CKD for RRT?progressive CKD when the risk of renal failure is 10-20% within a year
remember that all patients listed for RRT should be put on the deceased donor transplantation list 6 months before RRT - 36reminder to be careful of prescribing medicationsrenal metabolism
- 37at what GFR is most RRT given?- approx 5-10
- when transplant is awaited or not possible - 38what is the preferential access for harm-dialysis ?- AVF
- made before need for RRT
- problems include access fistula, infection, stenosis, thrombosis (think about audit) - 39description of peritoneal dialysisUses the peritoneum as a semi-permeable membrane. A catheter is inserted into the peritoneal cavity and fluid infused. Solutes di use slowly across. Ultrafiltration is achieved by adding osmotic agents (glucose, glu- cose polymers) to the fluid. It is a continuous process with intermittent drainage and refilling of the peritoneal cavity, performed at home. Problems: Catheter site infection, PD peritonitis, hernia, loss of membrane function over time.
- 40dialysis ye
- 41haemofiltration Haemofiltration (fig 7.7) Water cleared by positive pressure, dragging solutes into the waste by convection. The ultrafiltrate (waste) is replaced with an appropriate volume of (‘clean’) fluid either before (pre- dilution) or after (post-dilution) the mem- brane. Haemodynamic instability so used in critical care when HD not possible due to BP. Not used for chronic RRT unless in combination with HD (haemodiafiltration) for haemodynamic stability and middle molecule clearance, eg 2-microglobulin.
- 42list complications of RRTAnnual mortality is significant, mostly due to cardiovascu- lar disease: BP, calcium/phosphate dysregulation, vascular sti ness, inflammation, oxidative stress, abnormal endothelial function. Protein-calorie malnutrition: In- creases morbidity and mortality. Renal bone disease: High bone turnover, renal osteodystrophy, osteitis fibrosa. Infection: Uraemia causes granulocyte and T-cell dysfunction with sepsis-related mortality. Amyloid: 2-microglobulin accumulates in long–term dialysis causing carpal tunnel syndrome, arthralgia, visceral e ects.
- 43—
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- Karteikarten am Renal , erstellt von Alexander Wolff am 22/04/2018.
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