CKD

CKD

1. Causes

   • HTN
   • Diabetes
   • Age related decline
   • Glomerulonephritis
   • PKD
   • Medications - NSAIDS, PPIs, lithium

2. RFs

   • Older age
   • Diabetes
   • HTN
   • Smoking
   • Nephrotoxic meds

3. Presentation

   • Usually asymptomatic
   • Pruritus
   • Loss of appetite
   • Nausea
   • Oedema
   • Muscle cramps
   • Peripheral neuropathy
   • Pallor
   • HTN

4. Ivx

   • eGFR - 2 tests required 3 months apart
   • Proteinuria - ACR >3mg/mmol
   • Haematuria - should prompt investigation for malignancy
   • Renal USS - Accelerated CKD, haematuria, FH of PKD or evidence of obstruction

5. Stages

   • G1 = >90 G2 = 60-89 G3a= 45-59 G3b= 30-44 G4 = 15-29 G5 = <15
     • A1 = < 3mg/mmol A2 =3 – 30mg/mmol A3= > 30mg/mmol

6. Complications

   • Anaemia
   • Renal bone disease
   • CVD
   • Peripheral neuropathy
   • Dialysis related problems

7. Referral to a Specialist

   • eGFR < 30
   • ACR ≥ 70 mg/mmol
   • Accelerated progression (↓in eGFR of 15 or 25% or 15 ml/min in 1 year)
   • Uncontrolled HTN despite ≥ 4 antihypertensives

8. Management

   • Slowing progression
     • Optimise diabetic control
     • Optimise hypertensive control
     • Treat glomerulonephritis
   • Reducing risk of complications
     • Exercise, maintain healthy weight, stop smoking
     • Special dietary advice about phosphate, sodium, potassium, water intake
     • Offer atorvastatin 20mg
   • Treating complications
     • Oral sodium bicarbonate - metabolic acidosis
     • Iron supplementation, erythropoietin - anaemia
     • Vitamin D - renal bone disease
     • Dialysis - end stage renal failure
     • Renal transplant

9. Anaemia of Chronic Kidney Disease

   • Oral iron > IV iron > erythropoetin

10. Renal Bone Disease

    • Features
      • Osteomalacia Osteoporosis Osteosclerosis
    • x-ray
      • "Rugger jersey” spine
    • Management
      • Active forms of vitamin D (alfacalcidol & calcitriol)
      • Low phosphate diet
      • Bisphosphonates