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Ckd Rrt Pckd Notes

Medicine Notes > Renal and Urology Notes

This is an extract of our Ckd Rrt Pckd document, which we sell as part of our Renal and Urology Notes collection written by the top tier of University Of Leicester students.

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Chronic Kidney Disease Stage 1 damage 2 damage 3 damage 4 5

GFR ml/min
>90 Normal GFR + evidence of renal 60-89Slight decrease in GFR + evidence of renal 30-59 Mod decrease in GFR + evidence of renal 15-29 Severe decrease in GFR + ii
<15 Established renal failure

Symptoms usually don't occur until stage 4 is reached ESRF occurs when dialysis or transplant is require to prolong life Causes
- Diabetes
- Chronic glomerulonephritis
- Hypertension (renovascular damage + glomerular loss)
- Polycystic kidney disease
- Pyelonephritis Clinical features (Think of kidney functions
- Fatigue
- N+V
- Anorexia
- Pruritis
- Weight loss
- Restless legs
- Bone pain
- Dyspnoea
- Ankle swelling
- Altered urine output

and then symptoms of its dysfunction)Pallor Yellow skin pigmentation (uraemia) Brown nails Bruising, purpura Excoriation High BP Cardiomegaly Pericardial rub Pulmonary/peripheral oedema

Investigations
- Bloods o Normocytic, normochromic anaemia, ESR, U+E (raised urea and creatinine) glucose, raised alk phos, phosphate, low calcium, raised PTH
- Urine o MC+S, dipstick, 24hr urinary protein
- Imaging o USS - exclude obstruction, size of kidneys o CXR - cardiomegaly, pleural effusion, pulmonary oedema.
- Biopsy - if normal size kidneys + ? diagnosis Management
- Early referral to nephrologist

-

Treat reversible causes (e.g obstruction, stop nephrotoxins) Treat calcium levels asap (CVS risk) Hypertension - ACEi + ARB EPO for anaemia Hyperlipidaemia - statin Oedema - loop diuretics + fluid restriction Sodium restricted diet (helps control BP and oedema) Moderate protein intake (avoid malnutrition) Restless legs (gabapentin) Prepare for dialysis/transplant. Counselling and consent

Complications
- Increased cardiovascular risk (14/15 patients die of CVS events before ESRF)
- Anaemia o Usually occurs in CKD stage 4 o Due to decreased EPO production and EPO resistance due to uraemia o Treat with EPO injections
- Renal Bone Disease (osteodystrophy) GFR release

phosphate

calcium

PTH

Inactive vit D Osteoporosis +
hyperparathyroidism OsteomalaciaNeed phosphate binders e.g calcichew (restrict dietary phosphate - milk, cheese, eggs) Need vit D analogues e.g alfacalcidol Need calcium supplements to decrease bone disease + HPT

NB in CKD prostaglandins maintain blood flow to kidneys - therefore NSAIDS (inhibitors of prostaglandins) can decrease renal function

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