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level: Level 1 of Chronic Kidney Disease (L 11)

Questions and Answers List

level questions: Level 1 of Chronic Kidney Disease (L 11)

QuestionAnswer
Anaemia complicationsImbalance of homeostatis Since no
Function of KidneysAcid base balance Electrolyte & balance Remove toxins and waste products Control BP Produce Erythropoietin/renin/calcitriol
Definition of CKDAbnormalities of kidney structure or function, present for ≥3 months, with implications for health such as: A glomerular filtration rate less than 60 mL/minute/1.73 m², or the presence of one or more of the following markers of kidney damage: albuminuria/proteinuria, Urine sediment abnormalities (e.g., haematuria) Abnormalities (Electrolyte, histology, imaging) History of kidney transplantation.
Range of CKD classification (GFR & Albumin)G1 90+ ml/min/1.73m^2 G2 60-89 G3a 45-59 G3b 30-44 G4 15-29 G5 less than 15 Albumin A1 lower than 30 mg/g A2 30-300 A3 300 +
Renal Causes of CKDGlomerulonephritis Inherited diseases, such as polycystic kidney disease Chronic pyelonephritis Interstitial nephritis Outflow obstruction Myeloma
Systemic causes of CKDHeart failure Reno vascular disease SLE (Lupus) Vasculitis
Drug causes of CKDNSAIDs Lithium Antibiotics Diuretics LMW Heparin
Complications of CKDCardiovascular disease Peripheral neuropathy Renal mineral and bone disorder ( bone pain/disturbed Vitamin D, Calcium, PTH and phosphate metabolism) Renal anaemia
Cardiovascular complicationsHypertension and dyslidaemia, which in turn can contribute to the progression of renal failure, activation of inflammatory mediators and RAAS system, leading to accelerated atherosclerosis.
Cardiovascular managementAspirin, statins, ACE inhibitors or angiotensin receptors blockers and beta blockers. For Optimal control of glycaemia and blood pressure.
Neuropathy complicationsStroke, cognitive dysfunction, encephalopathy, through to autonomic and peripheral neuropathies. (affects the level of electrolytes) Peripheral neuropathy as a result of kidney disease is referred to as uremic neuropathy.
neuropathy managementRenal replacement therapy Risk factors Complications
Renal mineral and bone disorder complicationsMineral bone disorder Decreased Calcitriol (Vit D-absorb Ca) Low calcium, high phosphate Hight PTH- increase calcium from bones (pain, shape)
Renal mineral and bone disorder managementGut phosphate binders/diet/dialysis Calcitriol (1,25 (OH) Vitamin D) analogues- increase calcium absorption and suppress PTH Calcimimetic agents- reduce calcium by acting on calcium sensing receptors in parathyroid to reduce PTH.
Anaemia complicationsImbalance of homeostatis Since decreased eythropoietin, so lower red bone marrow, decreased RBC count
anaemia managementHb 100- 120g/L Check B12, Folate, Iron Supplement Iron poorly absorbed in CKD ESAs improves QOL Avoids blood transfusion
Stages of CKD management1/2- ACE inhibitor, Statin, Bp control, Glycaemic control 3/4- Education-Renal replacement Therapy, Anaemia- epo stimulating agent/Iron 2' Hyperparathyroidism- Diet/phosphate and calcium control Metabolic acidosis- Sodium bicarbonate 5- Renal replacement therapy, Haemodialysis, Peritoneal dialysis, Renal transplant
Haemodialysis vs Peritoneal DialysisHD Staff required Has to happen in HD unit Cardiac Risk 6 weeks Difficult to access with veins PD No staff required Can happen anywhere Safer for Cardiac risk 2 weeks Difficult to access with adhesions
What does Dialysis help maintainMaintain Euvolaemia (sodium & water) maintains electrolytes Dialysate bicarbonate diffuses blood into correct acidosis
Renal transplant benefitsImproved patient survival Correct symptoms and metabolism improved QOL and Family QOL