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Flashcards

Chronic Kidney Disease

Ellie Britt Nephrology English 26 cards

membranous glomerulonephritis

Cards in this deck (26)

  1. 1Definition of CKDkidney damage or GFR<60ml/min per 1.73m2 for 3 months or more
  2. 2Creatinine & Creatinine ClearanceSerum creatinine product of muscle metabolism.
    Fairly constant production and constant serum levels
    24h urine creatinine clearance – often inaccurate
    Freely filtered but tubular secretion (collecting duct)
  3. 3relationship between serum creatinine and GFRinversely proportional
  4. 4problems with serum creatinine - exponential relationship - muscle massExponential relationship
    leads to:
    1. Slow recognition of loss of the
    first 70% of renal function ie LAG TIME
    2. Surprise at the sudden rise in creatinine with late renal referral
    Effect of muscle mass leads to:
    - Overestimation of function in women
    - Overestimation of function in the elderly
    - Overestimation in other low muscle mass groups e.g. amputees, para/quadriplegics, rheumatoid arthritis
  5. 5components of MDRD formulaserum creatinine, age, black ethnicity, gender
  6. 6problems with eGFR (6)- Only validated in whites and African-Americans
    - Mean age 50 ie not validated in elderly!
    - Values above 60ml/min not distinguishable so reported as eGFR >59ml/min
    - Drug dosing – doesn’t take weight into account
    - AKI – not valid
    - Pregnancy
  7. 7Stages of kidney damageStage 1: eGFR >90 (normal)
    Stage 2: 60-89
    Stage 3a: 45-59
    Stage 3b: 30-44
    Stage 4: 15-29
    Stage 5: <15 (renal failure)
  8. 8What is used by NICE to judge severity of CKD?eGRF and albuminuria
  9. 9Proteinuria - normal - how measuredSome protein in urine normal : <150mg/day . About 2/3 is albumin
    - Dipstick for albumin. Not very accurate
    - 1+ : can see in fever, exercise, normals
    - 24h collection gold standard but not used now in routine practice
    - PCR and ACR useful and correlate with 24h
  10. 10quantifying proteinuriaprotein:creatinine ratio
  11. 11ACR and PCR(mg/mmol)
    Normal ACR <2.5
    Normal PCR <20
    Albuminuria : ACR >30
    ACR is about 2/3 of equivalent PCR result
    eg ACR 70 = PCR 100 = 24h urine protein 1g
  12. 12How to follow progress in albuminuria?PCR
  13. 13nephrotic range proteinuriaPCR >300 (3g/24hr)
  14. 14causes of CKD (6)1. diabetic nephropathy
    2. renovascular disease/ischaemic nephropathy
    3. chronic glomerulonephritis
    4. reflux nephropathy/chronic pyelonephritis
    5. ADPKD
    6. obstructive uropathy
  15. 15—membranous glomerulonephritismembranous glomerulonephritis
  16. 16symptoms of advanced CKD- pruritus
    - nausea/anorexia/weight loss
    - fatigue
    - leg swelling
    - breathlessness
    - nocturia
    - joint/bone pain
    - confusion
  17. 17signs of advanced CKD- peripheral and pulmonary oedema
    - pericardial rub
    - rash/excoriation
    - hypertension
    - tachypnoea
    - cachexia
    - pallor &/or lemon tinge
  18. 18general principles of CKD management- Targeted screening for CKD
    - Interventions to slow the rate of progression of CKD and reduce cardiovascular risk
    - Medicines to replace impaired individual functions of the kidney
    - Advanced planning for future renal replacement therapy (RRT)
    - Renal replacement therapy
  19. 19slowing progression of CKD (6)- aggressive BP control
    - good diabetic control
    - diet
    - smoking cessation
    - lowering cholesterol
    - treat acidosis
  20. 20BP control for hypertension in CKDACE-I/ARB Drugs of Choice for Hypertension in CKD if All BP lowering will reduce rate of progression
    Reduction in eGFR of up to 25% in first few weeks is a good thing
    Will get more of a reduction if critical reduced renal perfusion (volume depletion, sepsis, RAS)-
    sick day rules
  21. 21NSAIDs effect of kidneyvasoconstriction
  22. 22anaemia in CKD - when - management - target HbCommon, particularly when eGFR <30
    Iron absorption & utilisation suboptimal
    Replace iron, B12, folate first if low
    ESA eg Darbepoietin alfa 30microg every 2 weeks
    Trigger usually Hb <100g/l
    Target Hb 100-120g/l.
    Higher associated with adverse CV events
  23. 23pathophysiology of secondary hyperparathyroidismpathophysiology of secondary hyperparathyroidism
  24. 24CKD-MBD treatmentactivated vitamin F: Alfacalcidol
    occasionally Mg supplements
    Phosphate binders: target phosphate 0.9-1.5
    - calcium carbonate/acetate
    - non-calcium: sevelamer, lanthanum, aluminium
    Calcimimetic: cinacalcet
    Parathyroidectomy
  25. 25RRT options (4)- transplant
    - conservative care
    - home based therapies: home haemodialysis, PD
    - hospital based therapies: hospital haemodialysis, self care unit
  26. 26When to start dialysis?Individual approach based on symptoms
    Most start with eGFR 6-8ml/min
    no benefit to early start
    - weight loss and persistent nausea
    - persistent hyperkalaemia, acidosis, severe hyper-phosphataemia or pruritis
    - problematic fluid overload
    best to have permanent access

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Nephrology Flashcards on Chronic Kidney Disease, created by Ellie Britt on 16/01/2018.
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Ellie Britt
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